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

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

Continue Reading

Blue KC: Enhanced ACA Subsidies to Extend Through 2025

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

Continue Reading

What are Qualified Medical Expenses?

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

Continue Reading

Prescription Drug Reporting Reminder

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.

Continue Reading

10 Steps to Use a Medicare MSA Plan

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

Continue Reading

Inflation Reduction Act: Eliminates Cost Sharing for Adult Vaccines in Medicare Part D and Improves Access to Adult Vaccines in Medicaid & CHIP

Medicare Part D: Eliminates cost sharing for adult vaccines covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices (ACIP), such as for shingles Medicaid and CHIP: Requires state Medicaid and CHIP programs to cover all approved vaccines recommended by ACIP and vaccine administration, without cost sharing Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Continue Reading

Inflation Reduction Act: Expands Eligibility for Full Benefits Under the Medicare Part D Low-Income Subsidy Program

The Part D Low-Income Subsidy (LIS) Program helps beneficiaries with their Part D premiums, deductibles, and cost sharing. Beneficiaries qualify for full or partial benefits depending on their income and resources. Current law: Beneficiaries qualify for full LIS benefits if they have income up to 135% of poverty and lower resources (up to $9,900 individual, $15,600 couple in 2022) Beneficiaries qualify for partial LIS benefits if they have income between 135-150% of poverty and higher resources (up to $15,510 individual, $30,950 couple in 2022) Inflation Reduction Act: Expands eligibility for full LIS benefits to individuals with incomes between 135% and 150% of poverty and higher resources (at or below the… Read More

Continue Reading

Why Use Medicareful to Find Your Plan?

Medicare insurance can seem complex on your own. We’re here to help! Medicareful is an easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a licensed sales agent who will guide you through enrollment. Whether it’s a Medicare Supplement, Medicare Advantage Part C Plan, or a Medicare Part D drug plan, we’ve got you covered. https://medicareful.com/totalbenefitsolutions

Continue Reading

Inflation Reduction Act: Limits Monthly Copayments for Insulin in Medicare

Beginning in 2023, limits copayments to $35 per month per prescription for covered insulin products in Medicare Part D plans and for insulin furnished through durable medical equipment under Medicare Part B, with no deductible. For 2026 and beyond, limits monthly Part D copayments for insulin to the lesser of: $35 25% of the maximum fair price (in cases where the insulin product has been selected for negotiation) 25% of the negotiated price in Part D plans Please call your Total Benefit Solutions Medicare health insurance specialists with any questions or concerns at (215)355-2121.

Continue Reading

Additional Guidance on New Prescription Drug Reporting Requirement

As previously reported in 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 requirements that proves some helpful clarification. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Continue Reading

Inflation Reduction Act: Capping Medicare Part D Out-of-Pocket Spending and Other Part D Benefit Changes

Changes would lower beneficiary spending, reduce Medicare’s liability for high drug costs, and increase Part D plan and manufacturer liability for high drug costs. Beneficiaries: Eliminates 5% coinsurance for catastrophic coverage in 2024 Caps out-of-pocket drug spending at $2,000 beginning in 2025 Allows spreading out of out-of-pocket costs over the year Limits premium growth to no more than 6% per year for 2024-2030 Medicare: Lowers share of costs above the out-of-pocket spending cap (“reinsurance”) Part D Plans: Increases share of costs above the out-of-pocket spending cap Modifies share of costs below the out-of-pocket spending cap Drug Companies: Requires a price discount on brand-name drugs above the out-of-pocket spending cap Modifies… Read More

Continue Reading

Did you know about Humana’s Neighborhood Centers?

Humana Neighborhood Centers give participants a safe, friendly place to enjoy personalized health and wellness programming, connect with peers and get compassionate customer service from our world-class support team. Whether they’re visiting one of our in-person centers or taking part in our virtual offerings, members can always expect a warm, welcoming experience that provides whole human care.  Watch the video below and contact your Total Benefit Solutions, Inc health insurance and supplememnt specialists for more information at (215)355-2121. Click here for more about Humana Neighborhood Centers

Continue Reading

Get ready for the Medicare Annual Enrollment Period with our centralized guide to AEP.

Every year, the AEP is your opportunity to enroll in or switch to a Medicare plan that fits your ever evolving health care needs. This special enrollment window only runs October 15 to December 7, so it’s important to be prepared to accomplish anything you’d like to during that time. If reviewing or changing your coverage seems a little daunting with all the different plans and benefits on the market and decisions to make, don’t worry! You don’t have to go it alone. Get Your Guide to the Medicare Annual Enrollment Period and Get ready for the Medicare Annual Enrollment Period with our centralized guide to AEP. Click here to… Read More

Continue Reading

Inflation Reduction Act: Requires Drug Manufacturers to Pay Rebates for Drug Price Increases Above Inflation

Requires drug manufacturers to pay a rebate if drug prices increase faster than the rate of inflation (CPI-U) for: Single-source drugs and biologicals covered under Medicare Part B All covered drugs under Medicare Part D except those where average annual cost is <$100 2021 is the base year for measuring cumulative price changes relative to inflation The rebate amount is based on units sold in Medicare multiplied by the amount that a drug’s price in a give year exceeds the inflation-adjusted price Price changes are measured based on the average sales price (for Part B drugs) or the average manufacturer price (for Part D); these measures include prices charged in… Read More

Continue Reading

Total Benefit Solutions, Inc appoints with Lasso Medicare Medical Savings Accounts Plans for 2022-2023 Open Enrollment Season

What is a Medicare Medical Savings Account (MSA) Plan? – A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account. Enrollees of Medicare MSA plans can initially use their savings account to help pay for health care, and then will have coverage through a high-deductible insurance plan once they reach their deductible. Medicare MSA plans can provide Medicare beneficiaries with more control over health care utilization, while still providing coverage against catastrophic health care expenses. Ask your Total Benefit Solutions, Inc. Medicare health insurance specialist of a Medicare Medical Savings Account could be worth considering… Read More

Continue Reading

Part D Senior Savings Model: Is there a cap on the number of units monthly to get the $35 copay?

Generally, the maximum $35.00 copayment under the Model applies to one month’s supply of insulin. This may be limited by a physician’s prescription or by plan rules on drug dosage to ensure patient safety. Please note that if an enrollee uses multiple types of insulin or has multiple prescriptions for select insulins covered under the Model, each prescription would have a copayment of a maximum $35.00 for a one month’s supply. Have any questions or concerns regarding this notice? Don’t hesitate to call your Total Benefit Solutions Medicare specialists today at (215)355-2121.

Continue Reading

Inflation Reduction Act Requires the Secretary of HHS to Negotiate Medicare Drug Prices

Modifies the current law “non-interference” clause to require the HHS Secretary to negotiate drug price with manufacturers for some drugs covered under Medicare Part B and Part D. Which drugs qualify for negotiation? The Secretary selects drugs to be negotiated from the 50 “negotiation-eligible” drugs with the highest total Medicare Part D spending and the 50 “negotiation-eligible” drugs with the highest total Medicare Part B spending. Which drugs are excluded from negotiation? “Negotiation eligible drugs” include brand-name drugs or biologics and exclude the following drugs: Drugs that have a generic or biosimilar available Drugs less than 9 years (for small-molecule drugs) or 13 years (for biological products) from their FDA-approval… Read More

Continue Reading

Key Differences: Medigap Open Enrollment, AEP, and ICEP

Medigap Open Enrollment Period: six (6) month period starting the first of the month a beneficiary turns 65 or enrolls into Part B, whichever is later. Once in a lifetime EXCEPT for Guaranteed Issue situation or beneficiaries under 65. Annual Election Period (AEP): Medicare Advantage or PDP ONLY. Every year from October 15th to December 7th. Initial Coverage Election Period (ICEP): Medicare Advantage Only. With most ICEPs, occurs 3 months prior, the month of and 3 months after a beneficiary’s 65th birthday. 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.

Continue Reading

Part D Senior Savings Model: Will there be a plan with higher premiums for insulin at a lower cost?

The Part D Senior Savings Model allows drug manufacturers to offer their discounts in the coverage gap, even when a Part D plan enhances cost sharing. This allows plans to offer a fixed, consistent cost sharing on insulin. This structure is estimated to save enrollees who take insulin $446 in annual out-of-pocket costs. Part D sponsor plan premiums vary and beneficiaries should find a Part D plan that provides coverage they want at the lowest total annual cost, premiums and out-of-pocket costs combined. As always, please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any questions or concerns.

Continue Reading

Inflation Reduction Act: Establishing the Negotiated “Maximum Fair Price” for Medicare

The upper limit for the negotiated price of a drug (the “maximum fair price”) is equal to the lower of: The drug’s enrollment-weighted negotiated price (net of all price concessions) for a Part D drug; The average sales price for a Part B drug; or A percentage of the non-federal average manufacturer price (i.e., the average price wholesalers pay manufactures for drugs distributed to non-federal purchasers), depending on FDA approval date: 75% for small-molecule drugs more than 9 years but less than 12 years beyond FDA approval; 65% for drugs between 12 and 16 years beyond FDA approval; and 40% for drugs more than 16 years beyond FDA approval Financial… Read More

Continue Reading

How to File a Medicare Appeal

Medicare beneficiaries have the right to file an appeal when they or their physicians disagree with a treatment or claim denial. Luckily Medicare provides a step by step instruction guide to filing those appeals. Please click the link below to downlead the Medicare appeals guide. As always please contact your Total Benefit Solutions Inc Medicare health insurance specialist at (215)355-2121 if you have any additional questions or concerns.

Continue Reading

Part D Senior Savings Model: Will step therapy apply with insulin drugs?

Step therapy is when a Part D plan requires enrollees to first try certain drugs to treat a medical condition before the plan will cover another drug for that condition. The Model doesn’t change Part D sponsors’ formulary requirements. Enrollees can find out if the insulin or insulins they use have any additional step therapy requirements or limits by looking at the Part D plan’s formulary. Have any questions regarding this notice? Please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121.

Continue Reading

What Insulin Drugs are Covered Under the Part D Senior Savings Model?

Part D sponsors are required to include at least one vial and pen dosage form for each of the different types of Model insulins, where available – rapid acting, short-acting, intermediate-acting and long-acting – at a maximum $35 copay for a one-month supply through the deductible, initial coverage, and coverage gap phases of the benefit. Part D sponsors are encouraged to include additional insulin formulations, such as concentrated insulins, at the same $35 copay for a one-month supply. The Model doesn’t affect the cost sharing of insulin covered under Part B. For a full list of the insulin drugs covered by each plan, as well as which drugs are covered… Read More

Continue Reading