Is The Covid 19 vaccine covered by Medicare in 2024?

I s The Covid 19 vaccine covered by Medicare? Medicare does cover the updated (2023–2024 formula) Moderna or Pfizer-BioNTech COVID-19 vaccine for people 5 and older. If you’re immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases), you can get a 3-dose series of updated (2023–2024 formula. Have more Medicare questions? For more information contact your Total Benefit Solutions, Inc health insurance professionals at (215)355-2121

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2024 Medicare Parts A & B Premiums and Deductibles

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The Medicare Savings Programs (MSPs) help more than 10 million people with coverage of Medicare premiums and, in most cases, other cost sharing. In their continued efforts to improve access to health care and lower costs for millions of Americans, the Department of Health and Human Services (HHS), through CMS, recently finalized a rule to streamline enrollment in MSPs, making coverage more affordable for an estimated 860,000 people. In addition, the… Read More

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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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Employer 2024 Penalties Associated with the ACA (Affordable Care Act)

Add New Post Employers with a large number of part time employees have unique challenges when it comes to ACA compliance. Those with 50 or more full-time or full-time equivalent employees must meet two important requirements of the Affordable Care Act (ACA), or be subject to penalties A and B, A PENALTY: Employers who fail to offer a Minimum Essential Coverage (MEC) plan that provides certain wellness and preventive care to full-time employees may face a penalty of $2,970 per fulltime employee (minus the first 30). B PENALTY: A penalty of $4,460 per full-time employee who enrolls in a subsidized plan throughout a government exchange if the employer fails to… Read More

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2023 RxDC Reporting Instructions Released

The Centers for Medicare and Medicaid Services (“CMS”) recently updated its Prescription Drugs Data Collection (“RxDC”) reporting instructions for 2023 data. There are some noticeable differences. As previously reported, group health plan sponsors (typically employers) are required to submit information to CMS on prescription drugs and health care spending on an annual basis (“RxDC reporting”). The first reporting deadline for calendar years 2020 and 2021 was December 27, 2022 (extended to January 31, 2023). The next deadline for reporting on calendar year 2023 is June 1, 2024, which, despite being a Saturday, is a firm date. It should be noted that carriers, pharmacy benefit managers (“PBMs”), and third-party administrators (“TPAs”)… Read More

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Cheapest Health Insurance in Pennsylvania (2024 Plans)

Premium costs on Pennsylvania’s health insurance marketplace, Pennie vary by Catastrophic, Bronze, Silver or Gold tier. In Pennsylvania, Highmark Blue Cross Blue Shield offers the most affordable Bronze and Catastrophic plans, while UPMC Health Plan and Jefferson Health Plans provide the lowest-priced Gold and Silver plans in 2024, respectively. Of course, just because one plan costs less to buy does not make it the best plan to meet your needs. The health insurance experts at Total Benefit Solutions, Inc can shop the entire market for you, taking into account the healthcare needs of your family and guide you to the best plan for you. Contact us today at (215)355-2121.

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Navigating the Basics of Medicare: Understanding the Four Parts

Medicare, a vital healthcare program for seniors and certain disabled individuals, comprises four key parts. This post breaks down each part’s coverage, providing a concise overview for better understanding. Medicare Eligibility: Eligibility kicks in at age 65 or after receiving 24 months of Social Security Disability payments. Unlike private insurance, Medicare doesn’t have family plans, allowing individuals to make independent coverage choices. The Four Parts of Medicare: Visit the website for a deeper dive into the intricacies and benefits of Medicare. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact… Read More

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ACA’s Contraceptive Coverage: New FAQs Guide

On January 22, 2024, the Departments of Labor, Health and Human Services, and the Treasury released a fresh set of Frequently Asked Questions (FAQs), shedding light on the Affordable Care Act (ACA)’s imperative for non-grandfathered medical plans to include specific preventive services, notably contraceptives, without imposing any cost-sharing on individuals. The aim of these FAQs is to address concerns from stakeholders, facilitating a better understanding of the contraceptive coverage mandate and encouraging compliance through an alternative method. For detailed insights and further information, download the PDF below. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at… Read More

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Special Election Period may be available to members affected by severe weather

The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP).  For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit.  Who is eligible?  Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and  What does this mean for beneficiaries?  Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More

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Horizon Members Get 15% Off YMCA Memberships!

Exciting news for Horizon members in New Jersey! We’re thrilled to share that you can now enjoy a 15 percent discount on monthly memberships at select New Jersey YMCAs. Plus, for new YMCA members, the initiation fee is completely waived when you present your Horizon member ID card. This fantastic offer is valid until December 31, 2024, providing you ample time to take advantage of the savings and embrace a healthier lifestyle. Whether you’re a fitness enthusiast or looking to kickstart your wellness journey, this exclusive discount is designed to make your YMCA experience even more accessible. Remember, this exclusive discount is a limited-time offer, so make the most of… Read More

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Aetna: Small Business Updates

As the year wraps up, businesses with 2 – 50 employees enrolled in Aetna Funding AdvantageSM groups need to act quickly. We’re filing 1095-B tax forms on your behalf, but it’s crucial to ensure your information is accurate. Deadline: End of December The federal deadline for 1095-B tax forms is approaching. Both businesses and customers must verify and update their details by the end of December to avoid potential IRS rejections. Why It Matters Accurate information on these forms is vital for complying with tax regulations. 1095-B forms provide essential health coverage details, impacting Affordable Care Act compliance. Any discrepancies could lead to filing complications. Review and update your information… Read More

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Case Study: A Voluntary Benefits Strategy

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees. Our Solution They already had done most of the things we had recommended in past years, but there was one area left that could help…voluntary benefits. We suggested they offer a portfolio of programs that included life and disability coverage, allowing them to reduce the scope of their “rich” company paid plans and enabling anyone interested to supplement the reduced benefits by purchasing the coverage on their own. This, we felt, was a great way to save premium dollars without creating too… Read More

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Empire BCBS Now Anthem BCBS!

In a momentous move, Empire BlueCross BlueShield has officially transformed into Anthem Blue Cross and Blue Shield, marking a significant milestone for the renowned health insurance provider. The company is thrilled to announce the launch of Anthem Blue Cross and Blue Shield in both their downstate and upstate markets, reinforcing their commitment to enhancing the overall customer experience. The transition to the Anthem brand is not merely a change in name; it represents a strategic effort to simplify operations and reduce complexities in the market. Anthem is a nationally recognized name, offering a host of advantages for members residing out of state who are affiliated with New York-based companies. By… Read More

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IBC’s Latest Updates: Weight Loss Drug Policy

The International Benefits Consortium (IBC) has recently revamped its weight management medication coverage, responding to the FDA’s approval of Zepbound—a potent combination of GIP and GLP-1 receptors. This aligns Zepbound with existing options like Wegovy® and Saxenda® under IBC’s coverage criteria. Key Points: Weight Loss Drug Policy Update: IBC’s weight loss drug policy now includes Zepbound, showcasing their commitment to staying current with pharmaceutical advancements and ensuring robust coverage options for members. CAA Gag Clause Attestation: Addressing transparency concerns, IBC acknowledges the CAA’s impact on healthcare communication by eliminating “gag clauses” that restrict information exchange between providers and patients. Healthy You Program Options: IBC introduces new program options for self-funded… Read More

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Important Updates: Plan Changes for 2024

As we transition into 2024, it’s crucial for you to be aware of recent changes in your healthcare coverage. If you were auto-renewed for Plan Year 2024 after being enrolled in the Marketplace for Plan Year 2023, read on for key information. Auto-Reenrollment: Clients not actively selecting a Plan Year 2024 plan by December 15, 2023, were auto-renewed with coverage effective from January 1, 2024. This info was visible on HealthCare.gov and partner sites starting December 16, 2023. Exploring Options: Consider exploring other coverage options or adjusting your Plan Year 2024 selection. Changing plans or enrolling between December 16, 2023, and January 16, 2024, ensures an effective date of February… Read More

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Healthcare Compliance: 2023 Q4 Digest

Stay ahead in healthcare compliance with the 2023 Fourth Quarter Compliance Digest, a consolidated resource featuring all Q4 bulletins from October to December. This document is your one-stop-shop for the latest in health care reform, simplifying the complexities of compliance. Key Features: Up-to-Date Information: Get the latest developments in healthcare compliance from Q4 2023. Convenience in One Document: Access all relevant information in a single, downloadable PDF. Streamlined Access: Easily download the digest for quick and efficient access to essential updates. To explore further, download the PDF below: We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists… Read More

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Cigna Healthcare and Tower Health Contract Updates

In a recent development, Tower Health is no longer part of the network as of January 1, 2024. Negotiations for a contract extension are ongoing, but Tower Health has not committed to continuing collaboration. The main point of contention is significant rate increases demanded by Tower Health, which could lead to higher healthcare costs for clients and their members. To assist affected customers, the healthcare provider assures support in finding alternative, in-network providers nearby. One Guide representatives are available 24/7 at the number on Cigna ID cards or (800) 244-6224. Online tools on myCigna.com and the myCigna mobile app help locate in-network hospitals and providers. Members have been proactively notified… Read More

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Alert: Chicago Employers, Brace for Paid Leave Shifts in 2024

In a recent development, the Chicago City Council has made significant changes to the Paid Leave, Paid Sick, and Safe Leave Ordinance, pushing the effective date from December 31, 2023, to July 1, 2024. This delay provides employers with additional time to adapt to the impending modifications. Key amendments include a redefined “Covered Employee,” now requiring a minimum of 80 hours worked within any 120-day period in the city. Employers must communicate their time-off policies in writing, emphasizing clarity in the primary language of each Covered Employee. Medium-sized employers benefit from a partial payout period extension until July 1, 2025, allowing more time for adjustment. Additionally, irrespective of Covered Employee… Read More

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Key Reminders for Individual Health Plan Payments

In the realm of health insurance, timely payments are non-negotiable. Whether it’s an on-exchange or off-exchange policy, paying your first monthly premium promptly is crucial to avoid termination for non-payment—a situation not considered a Qualifying Life Event. Reinstatement after termination may not always be possible, emphasizing the need for proactive payment. ID cards are issued only once payment is up to date. Understanding grace periods is key. Off-exchange policies typically have a 30-day grace period, while on-exchange policies with subsidies enjoy a 90-day window. Consult with your carrier to know your policy’s specifics. Stay informed to navigate the complexities and ensure uninterrupted coverage for you and your loved ones. We’re… Read More

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Ambetter Health Members: Ensure Coverage for January 2024!

As we approach the end of the year, we want to remind you of a crucial deadline to ensure uninterrupted coverage for the upcoming year. Payment Deadline: December 31, 2023: Ambetter Health members must make their January premium payment by December 31, 2023, to guarantee seamless coverage for the start of 2024. To make this process quick and convenient, we recommend using Quick Pay option for a fast, one-time payment. For Assistance: If you have any questions or require assistance, don’t hesitate to reach out to your dedicated Ambetter Health Account Executive. You can contact them at 1-855-700-7985, selecting option 3. Alternatively, you can email ambettersales@centene.com. Ensuring your premium payment is processed… Read More

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Case Study: Achieving Success Through Broker Change

In the dynamic landscape of employee benefits, staying complacent can hinder progress and cost an organization significant financial resource. At Total Benefit Solutions, we take pride in our proactive approach to addressing complex employee benefit challenges. In this blog post, we highlight a case study that exemplifies our commitment to providing innovative solutions and delivering tangible results for our clients. Broker Change Leads to Better Results The Challenge: A mid-sized group prospect approached us with a pressing issue – dissatisfaction with their current benefits broker. Faced with a 17% health insurance renewal, the client felt that their existing broker was not adequately exploring cost containment strategies. Seeking guidance, they turned… Read More

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ACA Compliance: Key Calendars for 2024 Revealed!

Stay ahead of the compliance curve with crucial information on Affordable Care Act (ACA) deadlines for 2024. In our latest update, we’ve compiled comprehensive compliance calendars tailored for both small groups (less than 50 employees) and larger groups (50 or more employees). It’s your go-to resource for understanding and meeting important deadlines to ensure a seamless compliance journey. 2024 Small Group Compliance Deadlines: For fully and self-insured groups operating on a calendar year plan, we’ve outlined essential deadline dates for 2024. Please note that some reporting deadlines may vary for plans with a start date other than January 1st. Whether you have a small group or a larger organization, staying… Read More

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Decisions for someone who is nearing age 65

As you near age 65, you need to learn about Medicare coverage choices and make several important enrollment decisions. This fact sheet will give you a list of the steps you shouldtake and tell you about resources to help you make your Medicare enrollment decisions. There can be penalties if you do not enroll on time, so it is best to complete these tasksat least 3 months BEFORE you turn 65. Please note you can enroll on Medicare Parts A & B with Medicare about 90 days before your 65th birthday. IF YOU ARE STILL WORKING and your company has less than 20 employees you still MUST enroll on Medicare… Read More

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What is the Part D Donut Hole in 2024?

The Medicare Donut Hole, officially called the Coverage Gap, refers to a stage in Medicare Part D plans where beneficiaries have to pay more for prescription drugs. Historically, after reaching a certain spending threshold, beneficiaries faced higher out-of-pocket costs for drugs until catastrophic coverage began. The Donut Hole was designed to encourage the use of more cost-effective medications and generic alternatives. As of 2024, the Donut Hole is not completely ending, but the percentage beneficiaries pay for prescriptions during this stage has been reduced. When a beneficiary and their plan have spent a total of $5,030 in 2024, they enter the Donut Hole. In this phase, they pay 25% of… Read More

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