#healthinsurance – Page 3 – Total Benefit Solutions Inc

Medicaid Redetermination Updates: Your Next Steps

October 10, 2023October 10, 2023Wendy Lopez

The COVID-19 emergency has reshaped our lives in numerous ways since its onset in 2020. As we emerge from this challenging period, it’s crucial to stay informed about the changing landscape of healthcare programs, specifically Medicaid and CHIP (Children’s Health Insurance Program). The government is resuming its yearly process of Medicaid Redetermination to ensure that those who need these programs the most can continue to benefit from them. What is Medicaid Redetermination? Medicaid Redetermination is the process by which the government verifies the eligibility of individuals enrolled in Medicaid or CHIP. This procedure is vital to keep Medicaid strong and functional while ensuring that resources are allocated to those who… Read More

Medicare Supplement Insights: Protecting Your Wallet

October 9, 2023October 9, 2023Wendy Lopez

In a world where healthcare costs are a growing concern for many, Medicare Supplement coverage has emerged as a reliable solution to bridge the gaps in original Medicare. As we delve into the latest data from 2021, including insights from the National Association of Insurance Commissioners (NAIC), the California Department of Managed Health Care, and the Medicare Current Beneficiary Survey (MCBS) from 2020, a compelling narrative about the significance of Medicare Supplement plans unfolds. Key Takeaways: 1. A Majority Embrace Medicare Supplement: In 2020, a staggering 54% of original Medicare enrollees without additional insurance coverage, such as Medicaid or employer-provided insurance, turned to Medicare Supplement policies for added peace of… Read More

No Child Left Uninsured: Innovative Solutions in Healthcare

October 6, 2023October 10, 2023Wendy Lopez

Millions of children rely on Medicaid and the Children’s Health Insurance Program (CHIP) for their health and well-being. However, the redetermination process can sometimes pose challenges for their parents. In this article, we explore the innovative efforts undertaken by health insurance providers to ensure that children maintain access to healthcare, regardless of their parents’ circumstances. Medicaid plays a crucial role in American healthcare, improving the health and financial security of millions of individuals daily. It’s particularly vital for the 42 million children enrolled in Medicaid or CHIP. While parents may face hurdles during the Medicaid redetermination process, children often remain eligible for these programs or can transition to CHIP. Health… Read More

How should employers distribute Medical Loss Ratio (MLR) Rebate Checks?

October 5, 2023October 6, 2023Ed MacConnell

Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More

2024 Healthcare Premiums Revealed: The Impact Factors

October 4, 2023October 4, 2023Wendy Lopez

The American Health Insurance Providers (AHIP) Association is committed to ensuring that every American has access to affordable and comprehensive health coverage. With nearly 21 million Americans enrolled in the individual market for the 2023 plan year, it’s crucial to understand the factors that will influence individual market premiums in 2024 and beyond. In this blog post, we’ll delve into some of the key drivers shaping the future of individual market premiums. Factors Driving Premium Changes in 2024 As we look ahead to 2024, several key factors will influence individual market premiums: Increasing Provider Costs: The rising cost of medical services provided by doctors and hospitals contributes significantly to premium… Read More

Medicaid & CHIP Enrollment Extension!

October 3, 2023October 3, 2023Wendy Lopez

In a recent development, the Centers for Medicare & Medicaid Services (CMS) and the Departments of Labor (DOL) and the Treasury have issued a letter urging employers, plan sponsors, and carriers to consider extending the enrollment period for employer-sponsored health plans. This extension is aimed at helping individuals who have lost their Medicaid and Children’s Health Insurance Program (CHIP) coverage due to the resumption of normal eligibility and enrollment procedures. Traditionally, Medicaid coverage requires annual renewal of eligibility. However, during the COVID-19 Public Health Emergency, these renewal requirements were temporarily halted to prevent members from losing their coverage. Unfortunately, this pause in eligibility rules came to an end on March… Read More

What is your Medicare Part D ANOC?

September 30, 2023September 30, 2023Ed MacConnell

The Annual Notice of Change (ANOC) is a document that Medicare Advantage and Medicare Part D prescription drug plans are required to send to their members every year. The ANOC outlines any changes in coverage, costs, and more that will be effective in January 1. If you’re enrolled in a Medicare plan, your plan will send you an ANOC each fall. The ANOC includes information about any changes to your plan’s coverage, costs, and service area that will be effective in January 1. It’s important to review the ANOC carefully to understand how your plan’s coverage and costs may change in the upcoming year. If you have any questions or concerns about the changes, you can contact… Read More

Understanding the Updates to the Davis Bacon and Related Acts

September 28, 2023September 28, 2023Wendy Lopez

On August 8, 2023, the Department of Labor (DOL) made a significant announcement that will have a substantial impact on federal construction contracts and projects receiving federal assistance. The long-awaited final rule related to the Davis Bacon and Related Acts (DBRA) was released, ushering in a series of comprehensive updates and changes. In this blog post, we’ll delve into the key points of this final rule, with a focus on how it affects fringe benefit administration. The Davis Bacon and Related Acts (DBRA): A Quick Overview The DBRA, which has been in place for decades, is a set of labor laws that pertain to contracts issued by the federal government… Read More

Employer’s Guide to Medicare Compliance

September 25, 2023September 26, 2023Wendy Lopez

Medicare is a critical healthcare program in the US, covering seniors and certain disabled individuals. Employers offering group health insurance to Medicare-eligible individuals must meet specific requirements. In this blog, we’ll discuss three key Medicare requirements for employers: Employers must ensure compliance with these Medicare regulations to provide necessary healthcare information and process claims correctly. This ensures employees receive the coverage they’re entitled to. For comprehensive information and resources, refer to our PDF document below. Meeting these obligations supports employee well-being and eases healthcare coverage complexities. As always, if you have any questions or concerns about this bulletin, please contact your Medicare health insurance experts at Total Benefit Solutions, Inc.… Read More

Benefits of a PEO: How to Simplify your Business Operations

September 21, 2023September 20, 2023Wendy Lopez

If you’re a small- or mid-sized business owner, you’ve probably come across the term “PEO” in your quest to optimize your company’s operations. PEO stands for Professional Employer Organization, and it’s a dynamic solution designed to assist businesses in various crucial areas, such as payroll administration, human resources, risk management, and employee benefits. In this blog post, we’ll explore the advantages of partnering with a PEO and introduce you to a valuable resource to help you navigate this complex landscape. The Advantages of a PEO As beneficial as PEOs can be, the surge in their numbers can be overwhelming for business owners. The plethora of options often leads to confusion… Read More

Medicare Part D Notification Requirements

September 19, 2023September 15, 2023Ed MacConnell

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Also, following the plan’s annual renewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. This information summarizes these requirements in more detail. What are the Notification Requirements About? Medicare Part D, the Medicare prescription drug program, generally imposes a lifetime penalty for late enrollment if an individual delays enrolling in Part D after initial eligibility… Read More

Elevate Your Productivity with Better BenAdmin

September 18, 2023September 18, 2023Wendy Lopez

In a fast-paced world, time is of the essence. We’re all too familiar with the feeling of being buried under a mountain of administrative tasks, wishing for an extra set of hands or a few more hours in the day. Well, wish no more! Enter Better BenAdmin, the game-changer powered by EBM (Efficiency-Boosting Machine). Seamless Schedule Management Scheduling headaches? Not anymore. Better BenAdmin effortlessly handles your calendar, ensuring that appointments are well-organized and conflicts are a thing of the past. No more double-bookings or time wasted on manual scheduling. Effortless Email Handling Say goodbye to the endless email backlog. Better BenAdmin sorts, filters, and responds to emails with precision and… Read More

Choosing the Right Health Insurance: HMO vs. PPO

September 15, 2023September 15, 2023Wendy Lopez

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

Annual Health Insurance Check-Up: Don’t Miss Out!

September 5, 2023September 5, 2023Wendy Lopez

Health insurance is vital for your well-being, providing financial protection and access to essential healthcare. But it’s not a one-time decision. Did you know that reviewing your health insurance plan annually is crucial to ensure it still fits your needs and budget? In this blog, we’ll explore why this check-up is essential and provide key enrollment dates. Plus, we’re here to assist you every step of the way! Why an Annual Review Matters: Enrollment Dates: Let’s talk about the enrollment dates you need to remember: How We Can Help: Navigating health insurance can be complex, but you’re not alone. Our expert team is ready to assist you in reviewing your… Read More

Reasons Why You Need a Health Insurance Broker

September 2, 2023September 1, 2023Wendy Lopez

Navigating the world of health insurance can feel like a daunting journey through an intricate maze. That’s where a trusted health insurance broker comes in, acting as your guiding light and advocate. Here’s why you need one in your corner: 1. Expert Guidance: Your Healthcare GPS: Think of a health insurance broker as your personal healthcare GPS. They simplify the bewildering maze of insurance options, helping you choose the path that suits your needs best. With their expertise, you won’t feel lost in the insurance wilderness. 2. Advocacy: Your Fighter: Insurance claims, disputes, and paperwork can be a real hassle. But with a broker, you have a dedicated champion in… Read More

Medicare Diabetes Prevention Program: PDF Download

August 31, 2023July 12, 2023Wendy Lopez

Medicare covers a health behavior change program to help you prevent or delay type 2 diabetes. The program includes 22 group sessions with a behavior coach who works with you to make lasting diet and exercise changes. You’ll also get support to keep you motivated. For a comprehensive understanding of Medicare prevention programs, download this informative PDF today! As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)-355-2121

Open Enrollment 2023: Your Top 5 FAQs Answered

August 30, 2023August 29, 2023Wendy Lopez

Everything You Need to Know About Open Enrollment Are you ready for open enrollment? It’s that time of year when you have the opportunity to review and make changes to your health insurance plan. To help you navigate this important period, we’ve compiled a list of the top five frequently asked questions about open enrollment in 2023. Let’s dive in! 1. When is open enrollment?In Pennsylvania, open enrollment for individual health coverage typically runs from November 1 through January 15. The timing of open enrollment can vary depending on the organization or employer. It’s crucial to check with your specific company or health insurance provider to determine the exact dates… Read More

A Voluntary Benefits Strategy

August 29, 2023August 13, 2023Ed MacConnell

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…click here to continue

Annual Enrollment Period: Your Path to Tailored Medicare Coverage

August 29, 2023August 28, 2023Wendy Lopez

Are you ready to take charge of your healthcare journey? The Annual Enrollment Period (AEP) is swiftly approaching, and it’s your golden opportunity to customize your Medicare coverage to align perfectly with your evolving health needs. At Total Benefits, we’re here to guide you through this crucial period, ensuring that your Medicare plan reflects your unique requirements and aspirations for a healthy future. AEP: Your Key to Tailored Coverage: Circle the dates on your calendar: AEP commences on October 15 and concludes on December 7. These six weeks are a window of empowerment, during which you hold the reins to make changes that suit you best. Whether you’re seeking enhanced… Read More

Mark Your Calendars for These Crucial Medicare Dates!

August 28, 2023August 28, 2023Wendy Lopez

We’ve got some important dates coming up that you’ll want to circle on your calendars. Your Medicare choices are about to take center stage, and we’re here to help you navigate them like a pro! Pre-Annual Election Period (Pre-AEP) – Starting 10/1 Get ready to dive into the world of Medicare choices! The Pre-AEP is your head start, your chance to gather information and get prepared for what’s ahead. It’s like laying the groundwork for a solid plan that suits your needs. Medicare Annual Election Period (AEP) – Starting 10/15 This is the moment you’ve been waiting for! The AEP kicks off on October 15, and it’s your golden opportunity… Read More

Understanding When Your Medicare Coverage Starts

August 27, 2023August 25, 2023Wendy Lopez

Approaching 65 or exploring Medicare? Knowing when your coverage begins is vital for your protection and preparation. Enrollment timing is key for activating your benefits. Let’s simplify the essentials of when your Medicare coverage starts. Initial Enrollment Opportunity Medicare coverage launch centers around your Initial Enrollment Period, typically when you turn 65. This 7-month period spans 3 months before and after your 65th birthday. Coverage Commencement Date Your coverage initiation hinges on your sign-up month during the Initial Enrollment Period. Note that coverage always begins on the first day of the month. Late Part A Enrollment Opting for Part A after 65? Coverage begins six months back from your sign-up… Read More

Medicare Covers Diabetes Supplies & Services for Your Health

August 26, 2023July 24, 2023Wendy Lopez

Discover the power of Medicare, a federal health insurance program in the US designed for individuals aged 65 and older, as well as certain younger people with disabilities, providing access to essential medical services and supplies. Don’t miss the invaluable “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” booklet available on Medicare.gov/publications. This comprehensive guide highlights coverage options for individuals with diabetes, including supplies and services, preventive programs, and access methods. Plus, it features a must-have checklist for your next doctor’s visit, empowering you to ask the right questions about treatments, preventive services, covered supplies, and lifestyle recommendations. Take control of your diabetes management and overall well-being with this… Read More

Medicare Diabetes Prevention Program

August 25, 2023August 25, 2023Wendy Lopez

If you have been diagnosed with prediabetes, it’s essential to take proactive steps to manage your condition and reduce the risk of developing type 2 diabetes. The good news is that there are programs available designed specifically to assist individuals like you in preventing or delaying the onset of type 2 diabetes. These programs often encompass a comprehensive approach that includes education, lifestyle modifications, and support systems tailored to your specific needs. Let us help, don’t miss this opportunity to take control of your health and potentially prevent the development of type 2 diabetes. Download this PDF for more information! As always if you have any questions or concerns about… Read More

Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs: Booklet

August 24, 2023July 12, 2023Wendy Lopez

This booklet explains Medicare coverage of diabetes supplies and services in Original Medicare and with Medicare drug coverage (Part D). Original Medicare is fee-for-service coverage. The government usually pays your health care providers directly for your Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) benefits. If you have other insurance that supplements Original Medicare, like a Medicare Supplement Insurance (Medigap) policy, it may pay some of the costs for some.services described in this booklet. For a comprehensive understanding of Medicare coverage for diabetes supplies and services, download this informative booklet today! As always if you have any questions or concerns about this bulleting please contact your Medicare health… Read More

Understanding the Plan Annual Notice of Change (ANOC) in Medicare

August 23, 2023August 23, 2023Wendy Lopez

Staying informed about your healthcare coverage is vital, especially when it comes to Medicare plans. One key document that plays a significant role in this process is the “Plan Annual Notice of Change” or ANOC. What is the ANOC? If you’re enrolled in a Medicare plan, the ANOC is your compass for upcoming changes. Every fall, your plan sends you this crucial document, detailing any adjustments that will take effect in January. These changes encompass a range of aspects, from coverage modifications to shifts in costs and more. When Can You Expect It? Mark your calendars for September. This is the month when the ANOC usually arrives, providing you with… Read More

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