#healthinsurance – Page 4 – Total Benefit Solutions Inc

Medicare Coverage of Home Health Care: Booklet

August 23, 2023July 12, 2023Wendy Lopez

This booklet describes the home health care services that Medicare covers, and how to get those benefits through Medicare. If you get your Medicare benefits through a Medicare health plan (not Original Medicare) check your plan’s membership materials and contact the plan for details about your Medicare-covered home health benefits. Download the Medicare Coverage of Home Health Care: Booklet to help you understand the home health services that Medicare covers and much more. 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

Are You Up To Date on Your Preventive Services?

August 22, 2023August 22, 2023Wendy Lopez

Medicare covers a full range of preventive services to help keep you healthy and find problems early when treatment works best. Ask your doctor what services are right for you and use the document below to track appointment dates, times, and other important information. Download our Medicare check list sheet below to help you keep track of your Preventive Services! If you have any questions or concerns, please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)-355-2121.

4R’s for Fighting Medicare Fraud

August 21, 2023July 11, 2023Wendy Lopez

This comprehensive and insightful factsheet is specifically designed to equip individuals who are enrolled in Medicare with invaluable knowledge and effective measures to actively combat Medicare fraud. With a focus on promoting awareness and prevention, this factsheet not only educates beneficiaries about the various types of Medicare fraud but also offers practical advice and actionable steps to detect, report, and prevent fraudulent activities. By implementing the recommended measures outlined in this factsheet, individuals can actively participate in safeguarding the integrity of the Medicare program, ensuring that their healthcare benefits are utilized for their intended purpose while mitigating the risk of falling victim to fraudulent schemes. This factsheet provides a person… Read More

What’s New in the 2023 ACA Open Enrollment?

August 21, 2023August 21, 2023Wendy Lopez

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

HOW PEOS ARE HELPING SMBS MEET MARKET DISRUPTORS HEAD ON

August 19, 2023August 19, 2023Ed MacConnell

The modern world is driven by convenience and customization, SMBs included. Digitization, remote-friendly roles, and a generational shift in the workforce all impact today’s employee experience. When this experience is lacking, it can be costly to companies in more ways than one. click here to read the story from PEO insider Total Benefit Solutions Inc is dedicated to providing a comprehensive selection of solutions for the small business owner including the comparison of PEO’s to the typical employee benefits experience. Contact us today at (215)355-2121 to inquire about the possibility of using a PEO for your organization.

What’s Medicare Supplement Insurance (Medigap)?

August 19, 2023August 18, 2023Ed MacConnell

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. You must have Original Medicare – both Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy. Ask us today if you have questions about Medigap enrollment, rates or coverage at (215)355-2121.

Independence Blue Cross aims to get more Black patients screened for colorectal cancer

August 17, 2023August 18, 2023Ed MacConnell

The COVID-19 pandemic drove a significant reduction in the number of Black patients who were getting screened for colorectal cancer, and Independence Blue Cross is aiming to change that in its home turf of Philadelphia… https://www.fiercehealthcare.com/payers/philly-blues-program-aims-get-more-blacks-screened-colorectal-cancer

Pros and Cons of PEO’s

August 13, 2023August 13, 2023Ed MacConnell

A Professional Employer Organization (P.E.O.) is a company that provides comprehensive HR outsourcing services to small and medium-sized businesses. As your independent broker, Total Benefit Solutions, Inc can shop and compare various PEO’s to help determine which one might be the best fit for your organization, if any. Just like we can do with insurance carriers ad TPA’s! We have had a lot of questions about PEO’s so we created these pro and com quick tips to give you a quick overview of the top points about PEO’s that are asked the most often. The professionals at Total Benefit Solutions are independent and can evaluate the PEO offerings of multiple… Read More

CMS announces lower Medicare Part D premium for 2024

August 4, 2023August 2, 2023Wendy Lopez

According to an official statement by the Centers for Medicare and Medicaid Services (CMS) on Monday, the projected average total premium for Part D beneficiaries is anticipated to decrease by 1.8% in 2024. This reduction would bring the average monthly premium down to $55.50 from the 2023 figure of $56.49. The computed average monthly premium for Medicare Part D coverage in 2024, at $55.50, encompasses the combined average basic premium and the supplementary premium for plans featuring enhanced coverage. CMS emphasizes that this projection offers the most precise estimate of individuals’ 2024 Part D premium expenses. In addition to this update, CMS has disclosed several other important figures for the… Read More

Orlando Health Patients Face Coverage Loss Amid Contract Dispute

August 1, 2023August 1, 2023Wendy Lopez

UnitedHealthcare’s contract with Orlando Health is set to expire on July 31. If an agreement is not reached before the deadline, most services will no longer be covered for individuals on various plans, starting from August 1. The affected plans include employer-sponsored and individual plans, Medicare Advantage (including the Group Retiree PPO plan), and Medicaid (including the Dual Special Needs Plan). Both parties have been engaged in months of negotiations to establish new terms. With less than two weeks remaining, tensions have escalated, and accusations of delaying negotiations, disseminating misleading information, and proposing unreasonable terms have been exchanged by both sides. United Healthcare has taken proactive measures to notify approximately… Read More

Top 10 Ways to Make Your Health Benefits Work for You

July 31, 2023July 31, 2023Wendy Lopez

Unleash the Full Potential of Your Health Coverage! Are you making the most of your health benefits? The Employee Benefits Security Administration (EBSA) administers crucial health benefit laws that cover employer-based health plans. These laws safeguard your rights to essential information about your health plan, guide you on qualifying for benefits and making claims, ensure continued health benefits during job transitions, and offer protections for special medical conditions. Start by exploring your health coverage options, delving into different plans, and matching them with your needs. Not sure if your plan covers mental health or substance use disorder services? We’ve got you covered with essential information on these benefits too! Your… Read More

Why Short Term Heath Insurance is not “ JUNK” insurance.

July 29, 2023July 29, 2023Ed MacConnell

Short-term health insurance, also known as temporary health insurance, is a type of health coverage designed to provide temporary medical insurance for a limited duration, typically ranging from a few months to a year. While short-term health insurance may not be suitable for everyone, it does offer certain benefits for specific situations. When people label Short Term health as “ JUNK” it is clear they do not understand that many people still need short term health insurance coverage. The ACA solved many problems when it comes to access to coverage, but first problem is the COBRA prohibition which specifically disallows ACA tax credits for people who can get on COBRA.… Read More

What is Health Insurance for?

July 20, 2023July 20, 2023Wendy Lopez

Health insurance is a type of insurance coverage that helps individuals and families manage the costs of medical expenses and healthcare services. It provides financial protection against the high costs of medical treatments, hospitalizations, prescription drugs, and other healthcare-related services. Health insurance is designed to help people access the medical care they need without facing significant financial burdens. Health insurance provides a safety net against unexpected and costly medical events, allowing individuals to seek necessary medical care without facing crippling financial burdens. It also promotes preventive care, encouraging people to get regular check-ups and screenings to detect potential health issues early. It’s important to note that the coverage and cost-sharing… Read More

Will health insurance cover a swimming pool?

July 18, 2023July 18, 2023Wendy Lopez

Health insurance typically does not cover the cost of a swimming pool for personal use. Health insurance is designed to provide coverage for medical services, treatments, and supplies that are necessary for the diagnosis and treatment of illnesses or injuries. Swimming pools are a comfort item and are generally not considered medically necessary. However, there may be some exceptions in certain cases where a swimming pool is prescribed as part of a medical treatment plan for specific conditions such as physical therapy or rehabilitation. In such cases, coverage for a swimming pool may be possible, but it would require a thorough evaluation and approval process by the insurance company. It’s… Read More

Navigating Health Insurance for “gig” Economy Entrepreneurs

July 11, 2023July 11, 2023Wendy Lopez

For self-employed individuals or today’s gig workers, obtaining health insurance can be a bit different compared to traditional employer-sponsored plans. Empower yourself with a range of valuable choices to explore! Take a moment to peruse the document below, where you’ll find a comprehensive list of options available to you. We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121. We’re here to answer any questions or address any concerns you may have.

Cracking the Code: Navigating Health Cost Surge in 2023

July 10, 2023July 10, 2023Wendy Lopez

Managing Health Costs in 2023 Multiple industry and benefits sources are predicting health insurance premium increases in the range of five to eight percent for 2023. An analysis by Aon is forecasting a 6.5% increase. The Society for Human Resource Management (SHRM) is expecting a bump of 5.6%, based on a prediction by Mercer. The International Foundation of Employee Benefit Plans says employers are anticipating a 7.5% increase. The country’s oldest actuarial consulting firm, Buck, has forecast an increase in the range 5.8% to 6.9%. If you have any questions or concerns about this news please contact your Total Benefit Solutions, Inc health insurance specialists at (215)-355-2121

Insights into Self-Funding and Deductibles: A Look at Healthcare Trends for Large Firms

July 8, 2023July 7, 2023Wendy Lopez

Self-Funding Popular – Especially for Large Firms Many larger firms self-fund their health plans or pay for some workers’ health services directly – rather than through the use of health insurance. Nearly two-thirds (65%) of covered workers are in self-funded plans. That includes 20% of workers at small firms and 82% at large firms. Deductibles for Most Most employees with health insurance have a cost share before their insurance begins to pay benefits. Among those with single coverage, the average annual deductible is $1,763, similar to the $1,669 average in 2021. For most plan types, the single coverage deductible is higher for employees at small firms. The average is $2,543… Read More

Request to lower an Income-Related Monthly Adjustment Amount (IRMAA)

July 7, 2023July 7, 2023Wendy Lopez

If you’ve had a life-changing event that reduced your household income, you can ask to lower the additional amount you’ll pay for Medicare Part B and Part D. Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment. Amended income tax returns Call +1 800-772-1213 and tell the representative you want to lower your Medicare Income-Related Monthly Adjustment Amount (IRMAA) if you had an amended income tax return. Fax or mail your request Fill out the Medicare Income-Related Monthly Adjustment Amount-Life-changing Event (SSA-44) (PDF) form. Fax or mail your completed form and evidence to a Social Security office. For support completing this task call +1 800-772-1213… Read More

What are the preferred plans for insured employees?

July 6, 2023June 28, 2023Wendy Lopez

Preferred Provider Organization plans remain the most common plan type. Nearly half (49%) of insured employees enrolled in a PPO in 2022. That compares to 29% enrolled in an HDHP, 12% enrolled in an HMO, nine percent in a Point-of-Service (POS) plan, and one percent in a conventional (indemnity) plan. If you have any questions or concerns about this bulletin, please contact your Total Benefit Solutions Inc health insurance account manager at (215) 355-2121

How much do employees contribute towards their insurance expenses?

July 5, 2023June 30, 2023Wendy Lopez

Average Contributions Most employees do make a contribution toward their insurance costs. Covered workers, on average, contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its EHBS in 2021. The average contribution for workers at small firms is $7,556, which is more than a third higher than the average for those at large firms ($5,580). Workers at private, for-profit firms contribute a higher percentage of the premium versus those at public firms, regardless of coverage type. A fortunate one-third of employees (33%) at small firms are enrolled in coverage where the employer pays… Read More

Increases in Premium Found in Health Benefits Survey

July 4, 2023June 28, 2023Wendy Lopez

The latest survey by the Kaiser Family Foundation (KFF) concerning employer-sponsored health benefits found modest increases in employers’ and employees’ costs in 2022. In its 24th Employer Health Benefits Survey (EHBS), KFF found the average annual premiums for employer-sponsored health insurance in 2022 were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years. Small vs. Large Employers In 2022, workers insured through their employers at both… Read More

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.

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