#Medicare – Page 4 – Total Benefit Solutions Inc

CMS Updates Medicare Enrollment Rules for 2023

September 17, 2022September 15, 2022Ed MacConnell

On April 22, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed implementation of parts of the Consolidated Appropriations Act, 2021 (CAA) to simplify Medicare enrollment. According to Medicare.gov, these changes will go into effect January 1, 2023. Generally speaking, the new Medicare enrollment rules will allow for a more straightforward enrollment process that reduces potential gaps in coverage. They also allow for more Special Enrollment Periods and extend some Part B coverage to certain beneficiaries. But, what are the specifics? All facts and figures can be found in CMS’ fact sheet on the provisions, unless specifically linked elsewhere. Current Medicare Enrollment Rules Currently, when Medicare coverage actually starts after enrollment… Read More

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

When is the Part D Senior Saving Model expected to end? How many years is the model?

September 14, 2022August 10, 2022Ed MacConnell

Since CMS is testing the Part D Senior Savings Model to lower costs and improve health care quality, it has a set period for when it’s available. Part D plans participating in the Model first became available on January 1, 2021. The Model extends until December 31, 2025, but the plans participating in the Model may change each year. Please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121, if you have any questions or concerns.

Medigap Open Enrollment Period

September 13, 2022July 28, 2022Ed MacConnell

Most beneficiaries get ONE Medigap Open Enrollment Period. The Medigap Open Enrollment Period cannot be changed or repeated. Under 65 Medicare beneficiaries get another Medigap Open Enrollment Period when they turn 65. As always, please contact your Total Benefit Solutions, Inc health insurance specialists with any questions or concerns at (215)355-2121.

What is a Medicare Coverage Gap?

September 8, 2022August 11, 2022Ed MacConnell

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again. As always, please contact your Total Benefit Solutions Medicare health insurance specialists today at (215)355-2121.

Over-the-Counter Hearing Aids May Help People with Medicare

September 8, 2022Ed MacConnell

The Food and Drug Administration (FDA) recently finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may make hearing aids more affordable for as many as 30 million adults who believe they have mild to moderate hearing loss, even if they have not had a hearing exam. Last week, the Food and Drug Administration (FDA) finalized a rule that will permit people with Medicare, and others, to purchase hearing aids online or in stores, at lower costs, and without a prescription. The long-awaited rule, which will go into effect in October, may… Read More

What employers or plans are subject to TEFRA and MSP ( Medicare as Secondary Payor) rules?

September 8, 2022September 8, 2022Ed MacConnell

Employers with 20 or more employees for each working day in each of 20 or more work weeks in the preceding or current calendar year are subject to TEFRA and MSP rules. Full-time, part-time, union, and non-union employees are counted as one employee each. For the purpose of group size, employees are counted regardless of whether they are eligible or enrolled in the employer plan. Changing from non-TEFRA to TEFRA status occurs on the date that the employer has 20 or more employees for each working day in each of 20 or more work weeks in the preceding or current calendar year. Whereas changing from TEFRA to non-TEFRA can only… Read More

Guaranteed Issue Rights

September 7, 2022July 29, 2022Ed MacConnell

Guaranteed Issue (GI) rights are rights the beneficiary has in certain situations when insurance companies must offer certain Medigap policies. There are ONLY 7 situations where Guaranteed Issue Rights apply. Two of the most common are: Beneficiary is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or the beneficiary moves out of the Medicare Advantage plan’s service area. Beneficiary has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. Just like with the Medigap Open Enrollment Period, during a Guaranteed Issue: No eligibility… Read More

What plans are part of the Part D Senior Savings Model?

September 2, 2022August 10, 2022Ed MacConnell

The Centers for Medicare & Medicaid Services (also known as CMS, the federal agency that approves Medicare plans) announced Medicare Advantage plans with prescription drug coverage (MA-PD) and Part D prescription drug plans (PDPs) that are participating in the Model for Calendar Year (CY) 2022 in September 2021. You can call 1-800-MEDICARE to ask questions about enrollment, eligibility, and the Model, or visit Medicare Plan Finder at https://www.medicare.gov/plan-compare/ to search for coverage in your area and compare Part D plan options with the lowest prices for your prescriptions. You can also find a list of participating plans on the Model website at https://innovation.cms.gov/media/document/pdss-2022-model-landscape-file. If you have any questions, please contact… Read More

Medicare Advantage (MA) Quick Facts

August 30, 2022August 3, 2022Ed MacConnell

What is it? A Medicare Advantage Plan is a type of Medicare health plan offered by a private company, such as Independence Blue Cross, that contracts with Medicare to provide all Part A and Part B benefits. If enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Plan types offered: Medicare Advantage Plans include Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), for example. Independence offers Keystone 65 HMO as well as Personal Choice 65 PPO. Medical Coverage: If enrolled in a HMO, members must choose a PCP (which also will coordinate referrals) and must stay In-Network. PPO… Read More

What kind of plans can participate in the Part D Senior Savings Model?

August 26, 2022August 26, 2022Ed MacConnell

Most Medicare Part D plans that people choose from during Open Enrollment can participate in the Model. This includes stand-alone Medicare Part D Prescription Drug Plans (PDPs) as well as Medicare Advantage Prescription Drug plans (MA-PDs) that offer enhanced alternative Part D coverage. Private fee-for-service plans (PFFS plans), employer/union only direct contact plans (local coordinated care plans, prescription drug plans, PFFS plans), section 1876 cost contract plans, dual-eligible special needs plans (D-SNPs), section 1833 health care prepayment plans, Program of All-Inclusive Care for the Elderly (PACE) organizations, Medicare-Medicaid plans, and religious fraternal benefit plans (local coordinated care plans and PFFS plans) aren’t eligible to participate in the Model. Please contact… Read More

Medigap Quick Facts

August 23, 2022August 3, 2022Ed MacConnell

What is it? A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Play types offered: Insurance companies can sell only a “standardized” policy identified in most states by letters. Independence Blue Cross offers Plans A, B, F, F-HD, G, G-HD, and N. Medical Coverage: No selection of a PCP is required; members are able to choose any doctor or hospital as long as they accept Original Medicare. This also allows for no referrals and no network. Prescription Drug Coverage:… Read More

What is the Part D Senior Savings Model?

August 19, 2022August 19, 2022Ed MacConnell

The Part D Senior Savings Model allows participating Part D prescription drug plans to offer a broad set of formulary insulins at a maximum $35.00 copayment per month’s supply, throughout the deductible, initial coverage, and coverage gap phases of their Part D drug coverage. This means that participating Part D plans offer enrollees predictable, stable copayments for insulin to help enrollees save money on their drug costs. If you have any questions, please contact your Total Benefit Solutions Inc Medicare specialists at (215)355-2121.

New Prescription Drug Reporting Requirement

August 18, 2022August 2, 2022Ed MacConnell

As previously reported in December 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirement that provides some helpful clarification. Employers with fully insured or self-funded (includes level funded) group health plans, including grandfathered plans, church plans subject to the Internal Revenue Code, and governmental plans. The term “group… Read More

MACRA: Medicare Access and CHIP Reauthorization Act of 2015

August 16, 2022July 29, 2022Ed MacConnell

Since January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are no longer available to people who were “new to Medicare” on or after January 1, 2020. For this situation, people “new to Medicare” are people who turned 65 on or after January 1, 2020, and people who got Medicare Part A (Hospital Insurance) on or after January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or you were covered by one of these plans before January 1, 2020, you will be… Read More

Medigap Guaranteed issue rights

August 12, 2022July 28, 2022Ed MacConnell

Guaranteed Issue Rights (Also Called “Medigap Protections”) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind.… Read More

Best Time to Buy a Medigap Policy

August 8, 2022July 27, 2022Ed MacConnell

The best time to buy a Medigap policy is during the Medigap Open Enrollment Period. The Medigap Open Enrollment Period lasts for 6 months and begins on the first day of the month a beneficiary turns 65 or enrolls in Part B, whichever is later. Under 65 Medicare beneficiaries get a second Medigap Open Enrollment Period when they turn 65. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare health insurance choices. Call us today at (215)355-2121.

Medicare & Coronavirus

July 27, 2022July 14, 2022Ed MacConnell

Medicare covers the COVID-19 vaccine at no cost to you. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Be sure to bring your Medicare card. To learn more about Medicare and the COVID-19 vaccine and boosters, click here. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You may need to give them your Medicare Number for billing, but there’s… Read More

What’s Not Covered by Part A & Part B?

July 25, 2022July 14, 2022Ed MacConnell

Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include: Long-Term Care (also called custodial care ) Most dental care Eye exams related to prescribing glasses Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting them Routine foot care To find out if Medicare covers a test, item, or service you need, click here. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare Health Insurance choices. Call us today at (215)355-2121.

Did you know? Aetna Medicare Supplement Members can pay their premiums now at CVS stores?

July 23, 2022July 19, 2022Ed MacConnell

Members with Aetna Medicare Supplement policies can now pay their monthly premiums at their local CVS store. Their billing statements (for premiums less than $999) will have a unique barcode, which they can take to their local CVS store. The cashier will scan it just like they do any other CVS merchandise. Members can then pay their premiums by cash, debit card, or credit card. NOTE: The pay in store option is not available at CVS in Target stores at this time. If you have any questions, please contact your Total Benefit Solutions, Inc Medicare supplement specialists at (215)355-2121

Time to Prepare for Medicare Part D Notice Requirements

July 20, 2022July 6, 2022Ed MacConnell

An important deadline is approaching quickly – October 15 for the Medicare Part D notice requirement. The creditable-coverage notice must be given to all Part D-eligible individuals who are covered under, or apply for, an employer’s prescription drug benefits plan. This requirement applies to Medicare beneficiaries who are active employees and those who are retired, as well as Medicare beneficiaries who are covered as spouses under active or retiree coverage. Click here for a video explaining Medicare Part D notices. Please contact your Total Benefit Solutions Inc Medicare health insurance specialists at (215)355-2121 if you have any questions or concerns.

Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

July 8, 2022June 29, 2022Ed MacConnell

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

What are Medicare Supplements? Medicare Basics The Series

June 30, 2022June 18, 2022Ed MacConnell

The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare Health Insurance choices. (215)355-2121

What is the Medicare Part B Premium Give Back?

May 29, 2022May 27, 2022Ed MacConnell

The Part B give back benefit helps those on Medicare lower their monthly health care spending by reducing the amount of their Medicare Part B premium. When you enroll in a Medicare Advantage Plan that offers this benefit, the carrier pays either a part of or the entire premium for your outpatient coverage each month

How Medicare Works Part A

May 24, 2022May 24, 2022Ed MacConnell

How Medicare Works Medicare is a federal insurance program that provides health insurance for people 65 and older and individuals younger than 65 who may qualify due to certain disabilities. There are four different parts to Medicare — Part A, B, C, and D. Click the icons below to learn more about each part! Medicare Part A Medicare Part A can be thought of as your hospital insurance. It helps to pay for your stay at a health care facility, whether that be a hospital, skilled nursing facility, or nursing home, among others. If you’re admitted as an inpatient, Medicare Part A covers many services like meals, a semi-private room,… Read More

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