CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell  of  Total Benefit Solutions Inc  has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

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

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.

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Four Key Changes in the Biden Administration’s Final Rule on Medicare Enrollment and Eligibility

The Centers for Medicare & Medicaid Services (CMS) issued a final rule on October 28, 2022, to implement several changes in Medicare enrollment and eligibility that were included in the Consolidated Appropriations Act of 2021 (CAA). These changes are designed to minimize gaps in coverage for people who sign up for Medicare and improve access to care by shortening the gap between Medicare enrollment and coverage; creating new Special Enrollment Periods for individuals whose coverage would otherwise be delayed due to challenging circumstances, such as a natural disaster; and extending coverage of immunosuppressive drugs for certain beneficiaries with end-stage renal disease (ESRD) who would otherwise lose coverage for these drugs… Read More

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10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the PHE ends, millions of people could lose coverage that could reverse recent gains in coverage. The current PHE is in effect until January 11, 2023, and the Biden administration has said it will give states a 60-day… Read More

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Inflation Reduction Act: Establishing the Negotiated “Maximum Fair Price” for Medicare

The upper limit for the negotiated price of a drug (the “maximum fair price”) is equal to the lower of: The drug’s enrollment-weighted negotiated price (net of all price concessions) for a Part D drug; The average sales price for a Part B drug; or A percentage of the non-federal average manufacturer price (i.e., the average price wholesalers pay manufactures for drugs distributed to non-federal purchasers), depending on FDA approval date: 75% for small-molecule drugs more than 9 years but less than 12 years beyond FDA approval; 65% for drugs between 12 and 16 years beyond FDA approval; and 40% for drugs more than 16 years beyond FDA approval Financial… Read More

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Open Enrollment Tips!

As always, please contact your Total Benefit Solutions health insurance specialists at today at (215)355-2121.

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What plans are part of the Part D Senior Savings Model?

The Centers for Medicare & Medicaid Services (also known as CMS, the federal agency that approves Medicare plans) announced Medicare Advantage plans with prescription drug coverage (MA-PD) and Part D prescription drug plans (PDPs) that are participating in the Model for Calendar Year (CY) 2022 in September 2021. You can call 1-800-MEDICARE to ask questions about enrollment, eligibility, and the Model, or visit Medicare Plan Finder at https://www.medicare.gov/plan-compare/ to search for coverage in your area and compare Part D plan options with the lowest prices for your prescriptions. You can also find a list of participating plans on the Model website at https://innovation.cms.gov/media/document/pdss-2022-model-landscape-file. If you have any questions, please contact… Read More

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What is a Self-Insured Plan?

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered. Please contact your Total Benefit Solutions, Inc health insurance specialists today at (215)355-2121.

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Medicare Won’t Cover This Key Expense…

Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare. And many Seniors have to tap into their Retirement Funds to cover treatment.

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The Future of Employee Benefit Offerings: Student Debt Repayment Assistance

When looking for a job, the benefits offered to an Employee are definitely a big factor in consideration of accepting an offer of employment. Most people are willing to choose a company with a slight pay decrease if the benefit package compensates for the lost wages. With unemployment the lowest it has been since 2000 in the United States, attracting new talent isn’t as easy as it used to be and Employers are looking for ways to snatch up qualified applicants. When you think of benefit packages, you usually think of the basics: Health Insurance (with possibly an HSA, HRA, or FSA included), Dental and Vision coverage. “Good” benefit packages… Read More

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Why Offer an HRA to Your Employees?

Healthcare Reimbursement Arrangement, typically referred to as an HRA, can be utilized by employers to reduce their overall healthcare costs without placing additional financial burden on their employees. An HRA allows the employer to pay for eligible expenses with pre-tax dollars. The employer decides what expenses are eligible, within the IRS guidelines, leaving a lot of flexibility in plan design. Typically an HRA is coupled with a High Deductible Health Plan and the HRA pays for either the entire deductible or a portion of the deductible. With this type of a plan the premium savings often outweigh the potential claims that the employer would have to pay if every employee… Read More

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