#healthinsurance – Page 8 – Total Benefit Solutions Inc

Prescription drug list updates effective January 1, 2023

December 28, 2022December 27, 2022Ed MacConnell

The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost. As a result, ACA small employer groups, non-ACA small employer groups (including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023. Click here to read for more information. As always, please contact your Total Benefit Solutions health insurance specialists today with any questions at (215)355-2121.

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

December 27, 2022December 27, 2022Ed MacConnell

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

What is a Family Premium?

December 16, 2022December 9, 2022Ed MacConnell

Under the Affordability for Employer Coverage for Family Members of Employees IRS rule, “family members” are individuals who will be on the same federal income tax return — so, an individual, plus their spouse if married and filing jointly, plus any dependents that they (and their spouse, if applicable) claim. The “family premium” is the premium for the lowest-cost employer plan that would cover all members of the tax household who are offered coverage by the employer. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is COBRA?

December 14, 2022December 7, 2022Ed MacConnell

A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Medicare Savings Programs

December 13, 2022December 9, 2022Ed MacConnell

Get help from your state paying your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums through a Medicare Savings Program. If you qualify, Medicare Savings Programs might also pay your Part A and Part B deductibles, coinsurance, and copayments. You’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for. Even if you don’t think you qualify, you should still apply. For more information about the Medicare Savings Programs, click here. Have any questions regarding this notice? Please contact your Total Benefit Solutions Medicare health insurance specialists today at (215)355-2121.

Oscar no longer accepting new members in Florida

December 12, 2022December 12, 2022Ed MacConnell

Today, Oscar announced that it is no longer accepting new membership in the state of Florida, beginning December 13 at midnight. We’re committed to building a great business that continues to provide innovative, affordable coverage for many years to come. To do that, we need to grow responsibly so that we can ensure our members receive the same level of care and service that we hold ourselves accountable for providing

What is Modified Adjusted Gross Income (MAGI)?

December 12, 2022November 29, 2022Ed MacConnell

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program (CHIP). MAGI is adjusted gross income (AGI) plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

What is Medicaid?

December 7, 2022November 29, 2022Ed MacConnell

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. Medicaid benefits, and program names, vary somewhat between states. You can apply anytime. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists with any questions today at (215)355-2121.

Using your health insurance coverage & getting emergency care

December 6, 2022December 6, 2022Ed MacConnell

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital. I’m having an emergency. Should I go straight to the hospital or do I need to call my insurer first? In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network. What does it mean that insurance companies can’t charge me more? Insurance plans can’t make you pay… Read More

What Marketplace health insurance plans cover

December 5, 2022November 30, 2022Ed MacConnell

All plans offered in the Marketplace cover these 10 essential health benefits: Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is the Summary of Benefits and Coverage (SBC)?

November 30, 2022November 22, 2022Ed MacConnell

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You’ll get the “Summary of Benefits and Coverage” (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Medicare Part D: A First Look at Medicare Drug Plans in 2023

November 29, 2022November 23, 2022Ed MacConnell

During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D prescription drug coverage, either a stand-alone prescription drug plan (PDP) for people in traditional Medicare, or a Medicare Advantage plan that covers all Medicare benefits, including prescription drugs (MA-PD). Highlights for 2023: For more information regarding Part D Plan Availability and Part D Premiums, click here. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Blue KC: Three hospitals added to BlueSelect Plus, BlueSelect networks

November 28, 2022Ed MacConnell

The BlueSelect Plus and BlueSelect networks have expanded their footprints. On November 15, three hospitals – Providence Medical Center, St. Joseph Medical Center, and St. Mary’s Medical Center – joined the networks, increasing the number of hospitals to 16 in BlueSelect Plus and 14 in BlueSelect. The addition of these hospitals applies to: Hospitals in BlueSelect Plus network The BlueSelect Plus network includes: AdventHealth College Boulevard; AdventHealth Shawnee Mission; AdventHealth South Overland Park; Cameron Regional Medical Center; Children’s Mercy Hospital; Children’s Mercy Hospital – South; Liberty Hospital; North Kansas City Hospital; Olathe Medical Center; Providence Medical Center; St. Joseph Medical Center; St. Mary’s Medical Center; University Health Truman Medical Center;… Read More

What is a Health Reimbursement Arrangement (HRA)?

November 25, 2022November 22, 2022Ed MacConnell

Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the arrangement. Health Reimbursement Arrangements are sometimes called Health Reimbursement Accounts. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is HIPP and can it help my company or our employees?

November 23, 2022November 23, 2022Ed MacConnell

Health Insurance Premium Payment (HIPP) Program The Health Insurance Premium Payment (HIPP) Program is a program developed to help Pennsylvania families, who have at least one person enrolled in Medical Assistance (MA), pay for private health insurance through an employer. HIPP is administered by Pennsylvania’s Department of Human Services (DHS). It was designed as a cost containment program in order to save taxpayers money by purchasing cost effective employment related health insurance available to a Medical Assistance recipient. Read more by clicking here As always if you have any additional questions please contact your group health insurance specialist at Total Benefit Solutions , Inc (215)355-2121.

What is the Children’s Health Insurance Program (CHIP)?

November 23, 2022November 23, 2022Ed MacConnell

Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. You can apply any time. If you qualify, your coverage can begin immediately, any time of year. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a Medicare Medical Savings Account (MSA) Plan?

November 18, 2022October 14, 2022Ed MacConnell

Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Accounts Plans available outside of Medicare. You can choose your health care services and providers (MSA plans usually don’t have a network of doctors, other health care providers, or hospitals). Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C).… Read More

Blue KC: Enhanced ACA Subsidies to Extend Through 2025

November 17, 2022October 20, 2022Ed MacConnell

The American Rescue Plan Act of 2021 has provided enhanced ACA premium subsidies for people who purchased a plan through the Marketplace. It did so by removing the income cap, which limited subsidies to households with incomes from 100% to 400% of the federal poverty line. With no income cap, premiums have been limited to just 8.5% of income – for everyone. The Inflation Reduction Act, which was signed into law on August 16, extends these subsidies for three years for millions of Americans who buy individual coverage under the ACA. This bill will “save millions of people an average of $800 a year on health insurance premiums,” said Chiquita… Read More

What are Qualified Medical Expenses?

November 16, 2022October 20, 2022Ed MacConnell

Qualified Medical Expenses are generally the same types of services and products that otherwise could be deducted as medical expenses on your yearly income tax return. Some Qualified Medical Expenses, like doctors’ visits, lab tests, and hospital stays, are also Medicare-covered services. Services like dental and vision care are Qualified Medical Expenses, but aren’t covered by Medicare. Qualified Medical Expenses could count toward your Medicare MSA Plan deductible only if the expenses are for Medicare-covered Part A and Part B services. Each year, you should get a 1099-SA form from your bank that includes all of the withdrawals from your account. You’ll need to show that you’ve had Qualified Medical… Read More

What is the total cost estimate for health coverage?

November 15, 2022September 29, 2022Ed MacConnell

The total amount you may have to pay for health plan coverage, which is estimated before you actually have the coverage and have health expenses under the coverage. Generally, your total cost is your premium + deductible + out-of-pocket costs + any copayments/coinsurance. When you preview plans at Healthcare.gov, you’ll see an estimate of your total costs, but your actual expenses will likely vary. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists at (215)355-2121.

Prescription Drug Reporting Reminder

November 12, 2022November 3, 2022Ed MacConnell

As previously reported, plan sponsors of group health plans must submit information annually about prescription drugs and health care spending to the Centers for Medicare and Medicaid Services (“CMS”). The first deadline is December 27, 2022, for reporting on calendar years 2020 and 2021. Additionally: To learn more, click here to download the document. Have any questions regarding this notice? Please call your Total Benefit Solutions health insurance experts today at (215)355-2121.

10 Steps to Use a Medicare MSA Plan

November 11, 2022October 19, 2022Ed MacConnell

Choose and join a high-deductible Medicare MSA Plan. You set up an MSA with a bank the plan selects. Medicare gives the plan an amount of money each year for your health care. The plan deposits some money into your account. You can use the money in your account to pay your health care costs, including health care costs that aren’t covered by Medicare. When you use account money for Medicare-covered Part A and Part B services, it counts towards your plan’s deductible. If you use all of the money in your account and you have additional health care costs, you’ll have to pay for your Medicare-covered services out0of-pocket until… Read More

What is a Qualified Health Plan?

November 10, 2022September 23, 2022Ed MacConnell

An insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage.” As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is cost sharing?

November 9, 2022September 28, 2022Ed MacConnell

The share of costs covered by your insurance that you out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is a Special Enrollment Period (SEP) and what qualifies a consumer for an SEP?

November 8, 2022September 23, 2022Ed MacConnell

A Special Enrollment Period (SEP) is a time outside the annual Open Enrollment period when individuals may enroll in or change qualified health plans (QHPs). Individuals qualify for SEPs based on certain life events. Note that consumers can also qualify for an SEP during Open Enrollment; in certain situations, such as an SEP due to the birth of a child, an SEP during Open Enrollment can allow qualifying consumers’ coverage to start sooner than it would have if they had enrolled during Open Enrollment without the SEP. Events that permit an SEP include: Loss of qualifying health coverage (Note: This SEP does not include loss of coverage due to nonpayment… Read More

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