medicare primary payer – Total Benefit Solutions Inc

Your New Medicare Card is on the way! Watch out for scams!

July 31, 2018July 31, 2018Ed MacConnell

Watch out for scams Your new Medicare card is on the way, so if someone calls and says you need to give them your personal information or money to get the new card, hang up! It’s a scam. Medicare will never call uninvited and ask for personal information or money for you to get your new Medicare Number and card. Learn what to do if you get a suspicious call like this. If you haven’t gotten your new Medicare card yet, don’t worry. Mailing cards to each group of states takes at least a month, so you might get your card at a different time than friends or neighbors in your area.… Read More

Your Medicare Card Is Changing!

March 22, 2018March 22, 2018Ed MacConnell

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that Social Security Number-based Health Insurance Claim Numbers (HICN) be removed from Medicare cards by April 2019; this is in an effort to lessen the current risk of beneficiary medical identity theft. A unique Medicare number, called the Medicare Beneficiary Identifier or MBI, will replace the current HICN. Beginning in April 2018, the Centers for Medicare and Medicaid Services (CMS) will begin the process of mailing new Medicare cards and will meet the statutory deadline for replacing all cards by April 2019. Educational Resources: CMS Transition to New Medicare Numbers and Cards – Fact Sheet CMS Website –… Read More

CMS publishes updated 2018 Medicare cost-sharing amounts

December 11, 2017December 11, 2017Ed MacConnell

The Centers for Medicare & Medicaid Services (CMS) recently published updated cost-sharing amounts for 2018 which are outlined below. 2018 Medicare Costs at a Glance Standard Part B Premium Most people pay $134 each month Medicare Part B deductible (Medical deductible) $183 per year Medicare Part A deductible (Hospital deductible) $1,340 for each benefit period Beneficiaries will pay $134 (or higher depending on income) if they: • Enroll in Part B for the first time in 2018, or • Are directly billed for their Part B premium, or • Are dually eligible for Medicaid and have their premium paid by state Medicaid agencies pay an income-related premium Some beneficiaries who were held… Read More

Medicare Exclusions-Who Pays First?

February 6, 2016February 6, 2016Ed MacConnell

Medicare primary payer rules are complicated. Especially when it comes to different employer sizes and special circumstances like End Stage Renal Disease and disabilities. Coverage issues can be significantly complex when mixing Medicare and employer coverage, or individual coverage for those who are early Medicare enrollees. Chances are, if you are already enrolled on Medicare, AND you are getting bills from providers, you are already experiencing these problems, or you are encountering a coordination of benefits issue. It’s always best to speak to a professional when encountering these problems, most especially a health insurance professional. If at all possible, before getting enrolled on Medicare. The documents below may help provide… Read More

2015 Compliance Compilation

January 30, 2016Ed MacConnell

The attached resource file is a compilation of all of our compliance bulletins for 2015 provided by our business partners at Emerson Reid and your benefits support team. Click the link below to download the entire 2015 compilation: 2015 Compliance Compilation

2014 Compliance Bulletin Compilation

January 19, 2015Ed MacConnell

Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year! Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.

Health Reform: Treatment of Interns for Employer Penalty Purposes

September 9, 2014Ed MacConnell

If large employers do not offer affordable, minimum value coverage to all “full-time employees” they can be penalized beginning in 2015. A full-time employee (“FTE”) is an employee under the common law standard who works on average at least 30 hours per week, determined monthly. Under the common law standard, an employment relationship exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only as to the result to be accomplished by the work, but also as to the details and means by which that result is accomplished. Under this standard, an employment relationship exists… Read More

Medicare Update: Medicare is no longer prevented from recognizing same-sex marriages

August 26, 2014Ed MacConnell

Medicare is no longer prevented from recognizing same-sex marriages Special Update: As a result of the June 2013 U.S. Supreme Court ruling invalidating part of the Defense of Marriage Act (DOMA), which denied federal benefits to legally married same-sex couples,Medicare is no longer prevented from recognizing same-sex marriages for determining entitlement to, or eligibility for, Medicare. The Social Security Administration is now processing requests for Medicare Part A and Part B Special Enrollment Periods, as well as reductions in late enrollment penalties, for certain eligible individuals in same-sex marriages. Click here for more information.

Health Care Reform Updates: Updated Model COBRA Election Notice

June 10, 2014Ed MacConnell

Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces). COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

SAME SEX MARRIAGE PA COURT DECISION

May 23, 2014May 23, 2014Ed MacConnell

Prepared by Vince Phillips, PAHU Lobbyist May 22, 2014 On May 20, 2014, Federal Judge John Jones III issued a landmark ruling in Whitewood et al vs. Michael Wolf (Commonwealth of PA) that struck down Pennsylvania’s 1996 Marriage Law specifying that a marriage is defined as being between a man and a woman. The ruling also forced PA to recognize same-sex marriages conducted in other states. On May 21, Governor Corbett said that although as a Catholic, he disagreed with the ruling, he would not appeal it. The ruling is effective immediately but an unanswered question is effective date for employer-offered health plans. Is it now? Is it a month… Read More

Health Reform: Find out if You Qualify for a Health Insurance Coverage Exemption

April 18, 2014April 17, 2014Ed MacConnell

The Affordable Care Act calls for individuals to have qualifying health insurance coverage for each month of the year, have an exemption, or make a shared responsibility payment when filing his or her federal income tax return. You may be exempt from the requirement to maintain qualifying health insurance coverage, called minimum essential coverage, and may not have to make a shared responsibility payment when you file your next federal income tax return. You may be exempt if you: Have no affordable coverage options because the minimum amount you must pay for the annual premiums is more than eight percent of your household income, Have a gap in coverage… Read More

Health Reform: New Guidance Clarifies Rules on Health FSA Carryovers

April 15, 2014April 14, 2014Ed MacConnell

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. Click here to download the bulletin

IBC and DaVita HealthCare Partners Announce Joint Venture

April 14, 2014April 14, 2014Ed MacConnell

Tandigm Health’s innovative coordinated care model will provide higher-quality care, lower costs Independence Blue Cross (Independence) and DaVita HealthCare Partners today announced the creation of Tandigm Health. This unique joint venture, based in Philadelphia, Pa., will help deliver high-quality, affordable care to the region by combining the expertise of one of the country’s largest, most innovative Blue insurers and a nationally recognized pioneer of physician-centric coordinated care. Click here to read the bulletin Click here to read the press release from the IBC website

Health Reform: Law Repeals Deductible Limits for Small Group Plans

April 14, 2014Ed MacConnell

The Protecting Access to Medicare Act of 2014, legislation extending the “doc fix” for Medicare payments, also includes a provision that repeals the maximum deductible limits applicable to many small group health plans. As you recall, deductible limits for non-grandfathered small group plans are capped under the ACA at $2,000 for single coverage and $4,000 for family coverage effective for the first plan year on or after January 1, 2014. This legislation repeals the deductible limits as of the date health care reform was enacted (March 23, 2010). Click here to download the bulletin

Health Reform:Legislative Update-Relief for Small Groups Under the Affordable Care Act (ACA)

April 3, 2014April 2, 2014Ed MacConnell

On Monday, Congress and President Obama together repealed one of the Affordable Care Act’s most onerous provisions, which prohibited so-called “small groups” (mostly groups with less than 50 employees) from offering health plans with deductibles higher than $2,000 for single coverage and $4,000 for family coverage. This comes as very welcome news to small businesses, who are frequently the most in need of additional options and flexibility when it comes to offering employees comprehensive, affordable health insurance via higher deductibles and other cost-sharing mechanisms. It is also great news for employers wanting to couple their insurance plans with health reimbursement arrangements (HRAs), which federal agencies previously rejected as permissible ways… Read More

Crozer-Keystone Health System No Longer In Network with Cigna-Healthspring MAPD Plans

March 24, 2014Ed MacConnell

Please be advised of a change in the Cigna-HealthSpring provider network which may impact some of your customers. Starting May 1, 2014, Crozer-Keystone Health System will no longer be available to Cigna-HealthSpring members for hospital, home health or ancillary (surgery and other similar treatments) services. In a few days, we will mail the attached letter to the affected membership to advise them of this change. Please note that Crozer-Keystone health system primary care and specialty group doctors are still part of the Cigna-HealthSpring network. Only hospital, home health and ancillary services are leaving the network beginning May 1, 2014. Cigna-HealthSpring members currently under an active treatment plan may continue to… Read More

Humana: My Medicare Answers

March 19, 2014March 18, 2014Ed MacConnell

Humana introduces mymedicareanswers.com MyMedicareAnswers.com is an unbiased online community intended to educate, engage and capture conversations around the Medicare decision making process, ultimately offering clear, concise guidance to users – See more at: https://www.mymedicareanswers.com

2014 Updated Medicare Deductibles & Official Medigap Handbook

March 18, 2014Ed MacConnell

Click the link below to download an updated sheet with the Medicare deductibles for 2014. Download also includes the official CMS Handbook Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. Click this link to download: BA9917ST (04-13)_lo res

IBC: Important Changes Regarding Medicare Part B Exclusion

March 18, 2014September 9, 2014Ed MacConnell

From IBC November 2013: We are writing to let you know that we will be contacting your group customers to communicate the Medicare Exclusion and application of this exclusion to their benefit plan. What is the Medicare Exclusion? The Medicare Exclusion applies to members for whom Medicare would be the primary payer but they have not elected to enroll. These members will be responsible for paying their doctor, hospital, or other medical professional the amount Medicare would have paid and any applicable copayments, coinsurance, and deductibles. In turn, their group health benefit plan will only pay the remaining balance on claims submitted as if the member had enrolled in Medicare… Read More

IBC: Medicare as Secondary Payer

March 17, 2014Ed MacConnell

Medicare Secondary Payer (MSP) requirements determine when Medicare is the primary insurance payer. If your company has 19 or fewer full- and part-time employees, Medicare is almost always primary. If your company is larger, various rules apply to determine whether your group plan is the primary or secondary payer. MSP requirements also apply for Medicare-eligible employees who are disabled or have endstage renal disease. The following information provides a summary of the MSP requirements. This information may help you to correctly target benefits for your Medicare-eligible participants and avoid potentially costly penalties and litigation. You should, of course, also refer to the actual laws and regulations with the assistance of your own legal counsel. Click… Read More

Tag: medicare primary payer

Your New Medicare Card is on the way! Watch out for scams!

Like this:

Your Medicare Card Is Changing!

Like this:

CMS publishes updated 2018 Medicare cost-sharing amounts

Like this:

2015 Compliance Compilation

Like this:

2014 Compliance Bulletin Compilation

Like this:

Health Reform: Treatment of Interns for Employer Penalty Purposes

Like this:

Medicare Update: Medicare is no longer prevented from recognizing same-sex marriages

Like this:

Health Care Reform Updates: Updated Model COBRA Election Notice

Like this:

SAME SEX MARRIAGE PA COURT DECISION

Like this:

Health Reform: Find out if You Qualify for a Health Insurance Coverage Exemption

Like this:

Health Reform: New Guidance Clarifies Rules on Health FSA Carryovers

Like this:

IBC and DaVita HealthCare Partners Announce Joint Venture

Like this:

Health Reform: Law Repeals Deductible Limits for Small Group Plans

Like this:

Health Reform:Legislative Update-Relief for Small Groups Under the Affordable Care Act (ACA)

Like this:

Crozer-Keystone Health System No Longer In Network with Cigna-Healthspring MAPD Plans

Like this:

Humana: My Medicare Answers

Like this:

2014 Updated Medicare Deductibles & Official Medigap Handbook

Like this:

IBC: Important Changes Regarding Medicare Part B Exclusion

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: