affordable care act – Page 4 – Total Benefit Solutions Inc

What Additional Changes Are Being Made to Part D?

July 3, 2023June 30, 2023Wendy Lopez

As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing. Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty. Also starting in 2024, the calculation of the… Read More

How Is the Medicare Part D Benefit Changing in 2025?

June 30, 2023June 28, 2023Wendy Lopez

Changes in 2025 include a new $2,000 out-of-pocket spending cap, elimination of the coverage gap phase, a higher share of drug costs paid by Part D plans in the catastrophic phase, along with a new manufacturer price discount and reduced liability for Medicare in this phase, and changes to plan costs and the manufacturer price discount in the initial coverage phase. Out-of-pocket drug spending will be capped at $2,000 Beginning in 2025, Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs. (This cap does not apply… Read More

How Is the Medicare Part D Benefit Changing in 2024?

June 29, 2023Wendy Lopez

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

What Does the Medicare Part D Benefit Look Like in 2023?

June 28, 2023June 29, 2023Wendy Lopez

The standard design of the Medicare Part D benefit currently has four distinct phases, where the share of drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies (Figure 1). (The Part D enrollee shares reflect costs paid by enrollees who are not receiving low-income subsidies.) If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

Aetna members can soon use their OTC benefit at CVS

June 27, 2023June 27, 2023Wendy Lopez

Starting July 1, members who have an over-the-counter (OTC) benefit administered by OTC Health Solutions, can purchase eligible OTC items in person at all CVS stores (except for CVS pharmacies inside Target or Schnuck stores), in addition to ordering them by phone and online. This will make it even easier for members to take advantage of this popular benefit. Members can use the store locator link, or call 1-833-331-1573 (TTY: 711) to find a store. Contact your Total Benefit Solutions, Inc health insurance specialist at (215)-355-2121 if you have any questions or concerns.

Delta Dental Plans Association: Survey shows patients rate their experiences with dentists a 9.5

June 26, 2023Wendy Lopez

OAK BROOK, Ill., June 22, 2023 /PRNewswire/ — Delta Dental announced key findings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Dental Plan Survey, which provides feedback from Delta Dental patients about their oral health care experiences. Delta Dental is the only carrier utilizing the survey nationwide to continuously enhance patient experiences with its outstanding network of dentists. This trusted anonymous survey tool is used in the health care industry to evaluate a patient’s experience throughout their dental care journey and includes questions related to care from dentists and staff, access to dental care, and dental plan information and services. Recent CAHPS Dental Plan Survey findingsMore than 20,000 Delta Dental adult… Read More

Independence Blue Cross Announcing Value and Select formulary changes effective July 1

June 23, 2023June 23, 2023Wendy Lopez

We want to remind you that we are making changes to the Value and Select Drug Program (Select) formularies for July 1. Updates are made to these formularies on a quarterly basis. A flyer summarizing the changes to each formulary is available by clicking on Value formulary or Select Drug Program. The complete, updated lists for July 1 are available on our website. To view, choose the link to either the Value or Select formulary. The updated list is available under “Formulary drug documents.” Members, as well as their providers, who are impacted by the changes were sent letters in April (60 days in advance). Members are encouraged to talk with their provider about switching… Read More

Independence Blue Cross Announcing Teladoc virtual care services available January 1

June 22, 2023Wendy Lopez

We are pleased to announce that Independence Blue Cross has chosen Teladoc Health (Teladoc) as our vendor of choice for telemedicine, telebehavioral health, and teledermatology virtual care services! Teladoc will replace MDLIVE as the provider of these services effective January 1, 2024. Teladoc advantages Teladoc will triple the size of the virtual care provider network, which will help members receive the specific care that meets their needs. Offering services through Teladoc will allow us to expand our existing relationships with Livongo condition management programs, and offer the myStrength behavioral health tool, both of which are owned by Teladoc. MyStrength will replace On To Better Health in our portfolio of products.… Read More

Revised Form 720

June 21, 2023June 23, 2023Ed MacConnell

The IRS has released a revised Form 720, Quarterly Federal Excise Tax Return, the proper method to file and report PCORI fees. If you owe a PCORI fee, it must be paid using IRS Form 720 by July 31, following the last day of the policy year or plan year. Form 720 and the fee must be submitted on the same date. If your business does not owe a PCORI fee, IRS Form 720 does not need to be completed. Issuers and plan sponsors will only be required to file Form 720 once a year. Per the IRS, “Issuers and plan sponsors who are required to pay the PCORI fee… Read More

2023 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

June 14, 2023June 21, 2023Ed MacConnell

This update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2023. As background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which the applicable plan ended. The PCORTF fees fund the Patient-Centered Outcome Research Institute (PCORI), established by Congress… Read More

Members receive letter about NationsBenefits security breach

May 7, 2023May 7, 2023Ed MacConnell

Some Aetna Medicare plans include benefits administered by a company called NationsBenefits or one of its affiliates (“the company”). Specifically, the company administers the hearing aid benefit, as well as the Extra Benefits Card benefit, on some plans. Recently, NationsBenefits learned that a third-party vendor they used to securely exchange files with certain health plans, experienced a data security incident. The security breach impacted members whose plans include the NationsHearing hearing aid benefit or the Nations Extra Benefits Card benefit. What you need to know: Member communication: Impacted members will receive a letter from NationsBenefits. View a sample of the member letter. Letters began mailing on April 27. The letter explains what happened, what… Read More

woman with face mask holding an alcohol bottle

Independence Blue Cross: Changes to the Select and Value formularies for July 1

May 1, 2023May 1, 2023Ed MacConnell

Independence Blue Cross (Independence) is making changes to the Select Drug Program (Select) and Value formularies for July 1. Independence routinely updates its prescription drug formularies and reviews the list of drugs requiring prior authorization as part of our procedures for safe prescribing. These changes are approved by our Pharmacy and Therapeutics Committee. Updates are made to the Select and Value formularies quarterly. The updated lists for July 1 will be available on the website on May 1. Select the link to either the Select or Value formulary. The updated list is available under “Formulary drug documents.” Standard changes can include: Members, as well as their providers, who are impacted by the… Read More

Guidance Issued on Emergency Period Expiration

April 24, 2023April 24, 2023Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below. It is possible that FAQ 58 will be updated to reflect new dates. The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.** On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

Horizon BCBSNJ Updated COVID-19 Resource Guide

April 11, 2023April 11, 2023Ed MacConnell

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

12 Tips for Maximizing Your High Deductible

April 6, 2023April 6, 2023Ed MacConnell

Nearly 40% of people have a health care plan with a high deductible. An even higher percentage of people wish they had a lower deductible (who wouldn’t?!). And with medical bills being the leading cause of bankruptcies, it is important to understand how to maximize your high deductible so that you can stay afloat in case something unexpected were to happen. 1. Find Out What’s Free Many routine services are free. Instead of staying home to save money, you could get a free screening for preventative care. Common services covered are colonoscopies, mammograms, and vaccinations. About 90% of people with high deductible plans don’t know that such services are free.… Read More

IBC: How to read your new EOB

March 31, 2023March 24, 2023Ed MacConnell

Your EOB helps you understand your out-of-pocket costs when you receive covered services. The new, easier-to-read format lets you quickly find out how much a provider charged for services, what your Independence Blue Cross (IBC) health plan paid, and how much you owe. As always please contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any additional questions or concerns!

Independence: Wellness Guidelines for all ages

March 29, 2023March 24, 2023Ed MacConnell

Your health and wellness are important. That’s why we provide you with these wellness guidelines to help you and your family stay healthy. The wellness guidelines are a summary of recommendations from the U.S. Preventive Services Task Force and other nationally recognized sources. We encourage you to take the time to review these guidelines. Use them as a starting point for conversations with your and your family’s health care providers. Your health care provider may recommend alternatives to the information outlined in these wellness guidelines based on your specific needs and the history of health or illness in your family

IBC: Employer Portal Handbook

March 28, 2023March 24, 2023Ed MacConnell

Not sure how to use your IBC billing and enrollment portal? Download this helpful guide. As always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 for any further questions or concerns.

Did You Know? Cigna + Oscar plans in Pennsylvania offering you a simple, non-tiered network?

March 21, 2023March 21, 2023Ed MacConnell

That’s right! ? Cigna + Oscar plans in Pennsylvania utilize Cigna‘s Open Access Plus Network. Offering you a simple, non-tiered network. This includes facilities you know and use, such as: View the full Pennsylvania network here. Please contact your health insurance specialists at Total Benefit Solutions, Inc iat (215)355-2121 f you have any further questions or concerns about Oscar heath!

How to activate your OSCAR account

March 11, 2023March 9, 2023Ed MacConnell

We want you to get the most of your plan. Setting up your Oscar account will help you do that by putting care right at your ﬁngertips .

Medicare Advantage plans denying more inpatient claims

March 10, 2023February 23, 2023Ed MacConnell

MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More

Individual Coverage HRA: Choice and affordability in employee health benefits

March 6, 2023March 3, 2023Ed MacConnell

How HRAs work Health Reimbursement Arrangements are employer-funded accounts that reimburse employees for eligible medical expenses. No employee contributions are allowed. Since an HRA is funded only by the employer, the employer sets the rules of the plan. The ICHRA works much the same as other HRAs, with the following important differences: ICHRA rules Traditional group health plans An employer may not offer an ICHRA and a traditional group health plan (GHP) to employees within the same class. However, an employer may offer an ICHRA to one class of employees and a traditional GHP to another class. Also, a traditional GHP may be grandfathered for current employees while all new… Read More

ACA coverage rule for dependents up to age 26

March 4, 2023March 3, 2023Ed MacConnell

One of the most notable changes brought about by the Affordable Care Act (ACA) is the ACA coverage rule for dependents up to age 26. Employers offering health care plans to employees must include this extended coverage. Purpose of the ACA coverage rule for dependents up to age 26 The ACA extended the eligibility for a child to be covered under a parent’s health plan from (usually) age 21 and if a full-time student to age 26 regardless of student status. The goal is to provide peace of mind to parents and their young adult children during a time in life when the dependent is likely to be completing their… Read More

Get Your FSA, HRA, HSA Health Accounts Comparison Chart

February 19, 2023February 19, 2023Ed MacConnell

What’s the difference which spending account you use at your company? Download our comparison chart for a quick, simple side by side comparison. Contact your health insurance experts at Total Benefit Solutions, Inc to find out which account might be the best fit for your organization!

Broker Change Leads to Better Results

February 15, 2023February 15, 2023Ed MacConnell

Broker Change Leads to Better Results Sometimes a benefits consultant may become a bit complacent and fail to aggressively pursue available cost containment strategies for a client. When that happens, it may be time to consider a change. Read for a case study on how we handled a situation like this for one of our clients. The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner… Read More

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