#medicaredonuthole – Page 2 – Total Benefit Solutions Inc

Prescription Drug Provisions in the Inflation Reduction Act

September 21, 2022August 17, 2022Ed MacConnell

For the first time, requires the federal government to negotiate prices for some top-selling drugs covered under Medicare Requires drug companies to pay rebates if prices rise faster than inflation for drugs used by Medicare beneficiaries Eliminates 5% coinsurance for catastrophic coverage in Medicare Part D in 2024, adds a $2,000 cap on Part D out-of-pocket spending in 2025, and limits annual increases in Part D premiums for 2024-2030 Limits monthly cost sharing for insulin products to $35 for people with Medicare Expands eligibility for Medicare Part D Low-Income Subsidy full benefits Eliminates cost sharing for adult vaccines covered under Medicare Part D and improves access to adult vaccines under… Read More

Understanding the Health Care Provisions in the Inflation Reduction Act

September 19, 2022August 16, 2022Ed MacConnell

The Inflation Reduction Act includes several landmark health care provisions that would lower prescription drug costs for people with Medicare, reduce Medicare drug spending and extend enhanced subsidies for Affordable Care Act marketplace coverage. On Thursday, August 11, a panel of KFF experts held a web briefing to explain these provisions and how they would affect people and federal health spending, followed by a Question and Answer session. Click here to open article and view Web Event video. The legislation for the first time would require the U.S. Secretary of Health and Human Services to negotiate directly with drug manufacturers over the price of some high-cost drugs in the Medicare… Read More

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

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.

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

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

SHOP Rules Finalized, Enrollment Forms Simplified

July 25, 2013February 6, 2022Ed MacConnell

The Small Business Health Options Program’s (SHOP) place along the Affordable Care Act’s (ACA) timeline. It’s now being packaged for mass consumption and soon will be stocked on store shelves across all 50 states. Click here to read more…

New York Health Exchanges Offer 50% Drop in Premiums

July 24, 2013February 6, 2022Ed MacConnell

Empire State approves plans to be sold by 17 insurers and lower expected premiums may ease fears that next year’s implementation of the biggest parts of the Affordable Care Act would send prices soaring… Click here to read the story

IBC: Important change to claims processing for PPO plans

July 22, 2013February 6, 2022Ed MacConnell

Independence Blue Cross (IBC) will begin notifying customers later this week regarding a change in how claims for certain out-of-network providers will be processed under their IBC Personal Choice® PPO health plan. This change impacts fully insured, self-funded, and Individual commercial Personal Choice® PPO plans only. There is no impact to Medicare plans. Effective November 1, 2013, members who have claims submitted by providers who participate in the Highmark Blue Shield (Highmark) professional provider network inside IBC’s five-county service area will be subject to higher out-of-pocket costs and may also be subject to balance billing. Currently, claims submitted by a participating Highmark professional provider are processed as out of network and applied… Read More

Health Reform: Research Filing Fees Due July 31

July 20, 2013February 6, 2022Ed MacConnell

The Research Fee filing deadline is July 31, 2013 for self-funded medical plans and HRAs Insurance carriers will report and pay the Fee for fully insured plans. If an employer has several self-insured arrangements with the same plan year, they are subject to a single fee. An HRA integrated with a self-funded plan providing major medical coverage will not incur a separate fee specific to the HRA if the HRA and plan are established or maintained by the same plan sponsor. Click below to download the bulletin Research Fees Due Interested in our free Health Care Reform Checklist? send an email

Health Reform: Aetna to distribute MLR rebates

July 19, 2013February 6, 2022Ed MacConnell

By August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. For group plans, rebate checks will be sent to the policyholder, with few exceptions. Please click the link below to download the bulletin. Click to download

NJDOBI Issues Amendments to Rating Rules under PPACA

July 19, 2013February 6, 2022Ed MacConnell

NJDOBI Issues Amendments to IHC and SEH Rating Rules under PPACA For rates applicable to all rating periods beginning on or after January 1, 2014, carriers are directed to: Formulate rates in the IHC market to achieve a required 300 percent maximum ratio between premiums for the highest rated individual policyholder and the lowest rated individual policyholder in the State. Age factor categories should be in the following increments: children ages 0 through 20, one-year age bands for adults ages 21 through 63, and a single age band for adults ages 64 and over; Formulate rates in the SEH market without regard to gender. Age factor categories should be in… Read More

Health Insurance Marketplaces (Exchanges): Informational Video

July 17, 2013February 6, 2022Ed MacConnell

Beginning in 2014, individuals and small businesses with up to 50 employees can purchase insurance through online exchanges, also called “health insurance marketplaces.” Each exchange will offer a choice of health plans that meet certain benefit and cost standards. In 2016, businesses with up to 100 employees will be able to participate. Coventry Health/Aetna recently released this easy to understand video that may help you understand the new exchange or” marketplace” system of buying health insurance. Click here to watch the six minute long video.

Medicare: What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)?

July 17, 2013February 6, 2022Ed MacConnell

Q:What Will Happen to Doctors’ Fees and Income Under the Affordable Care Act (ACA)? A: Business income has increased for doctors because many people on Medicare are now using free screenings and an annual “wellness visit” provided through the Affordable Care Act (ACA). Through Oct. 6, 2011, the government said, 20.5 million people enrolled in Medicare had received the free screenings or the annual visit, which is also free. Medicare is now offering a 10 percent bonus payment on the fees charged for primary care services, and a 10 percent bonus payment to surgeons who work in areas where there are shortages of doctors. For 2013 and 2014, Medicaid payments… Read More

Total Benefit Solutions Newest Brochure

July 11, 2013February 6, 2022Ed MacConnell

Download our latest brochure to read all about the valuable services we provide for our clients! Download our latest employee benefits brochure

PPACA employer mandate delayed until 2015

July 2, 2013February 6, 2022Ed MacConnell

PPACA employer mandate delayed until 2015 The Obama administration unexpectedly announced Tuesday it is delaying the employer mandate under the Patient Protection and Affordable Care Act until 2015. The mandate — which requires mid-sized and large employers to offer health insurance coverage to their workers — was one of the main requirements of the health care overhaul that was set to go into effect Jan. 1, 2014. But the Treasury Department announced Tuesday that it would delay its enforcement an entire year after hearing numerous concerns from employers about the challenges of its implementation. “We have heard concerns about the complexity of the requirements and the need for more time to implement… Read More

Prodigy Learning Center’s Executive Director is a Happy Client

June 15, 2013February 6, 2022Ed MacConnell

Hi Ed, I just wanted to let you know how great (our account manager) has been with our insurance issues. She has been so helpful to me. I don’t know if people take the time to tell you when your staff is doing a great job, but I wanted to let you know. She is great!! Thanks. Christine Viteo, R.N. Executive Director Prodigy Learning Center Philadelphia, Pa.19132

EMA Group to become Total Benefit Solutions Inc!

June 15, 2013February 6, 2022Ed MacConnell

The health insurance industry is on its way to a major overhaul by the end of this year. With the implementation of the Patient Protection and Affordable Care Act (PPACA), nearly every American will be affected by the new law and many already have. With this in mind, we have decided to refocus our efforts to better serve our clients in alignment with the new world of health benefits. We are proud to announce that beginning August 1, 2013; EMA Group Inc. will be known as Total Benefit Solutions Inc. Although our name is changing; our commitment to provide top notch guidance and support to our clients will never change.… Read More

IBC Requesting tobacco data

June 15, 2013February 6, 2022Ed MacConnell

Under the Affordable Care Act (ACA) and effective January 1, 2014, insurers are permitted to use the following four categories to determine premiums: Age Family Size Geography Tobacco To comply with this provision, IBC will be implementing a new process to collect tobacco usage as part of their rating methodology for groups with 2-50 employees and sole proprietors. Over the next several days, IBC will send letters to employers with January 1, 2014 renewal dates to gather this information. In the mailing, there will be a letter and a Tobacco Use Form, that must be completed for each of their employees and dependents age 21 and over… Read More

First PCORI Fees Due by July 31, 2013

June 10, 2013February 6, 2022Ed MacConnell

Revised IRS Form 720 Now Available for Employers Sponsoring HRAs and Other Self-Insured Plans to Report and Pay PCORI Fees First PCORI Fees Due by July 31, 2013 The IRS has revised Form 720, Quarterly Federal Excise Tax Return, for employers sponsoring certain self-insured health plans to report and pay new fees imposed under Health Care Reform to fund the Patient-Centered Outcomes Research Institute (PCORI). The fees, which must be reported annually on the second quarter Form 720 and paid by its due date, July 31st, are based on the average number of lives covered under a plan. Affected Self-Insured Plans PCORI fees are imposed on plan sponsors of… Read More

Heathcare Reform: Important New Guidance on Affordability

June 6, 2013February 6, 2022Ed MacConnell

In order to receive a subsidy in the Health Insurance Marketplace (formerly referred to as the Exchange), generally an individual must not be eligible for affordable coverage under an eligible employer sponsored plan that provides minimum value. Additionally, large employers looking to avoid penalty exposure must offer all full-time employees (and their dependents) affordable coverage that meets minimum value. Although final regulations were published back in February, further clarification was needed on the health benefits considered in determining the share of benefit costs paid by a plan. Click the link below to read the rest of the article. Minimum Value and Affordability-060513R

Health Reform: Cost Sharing Limits

June 6, 2013February 6, 2022Ed MacConnell

Effective the first plan year that begins on or after January 1, 2014, all non-grandfathered group health plans (both insured and self-insured) , regardless of size, must comply with annual cost-sharing limitations on out-of-pocket maximums. Click the link below to download and review the entire notice. Health Reform-cost sharing limits

89 charged in Medicare fraud busts in 8 cities

May 20, 2013February 6, 2022Ed MacConnell

WASHINGTON (AP) — Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. Click here for the story.

New Guidance on SBC’s

May 19, 2013February 6, 2022Ed MacConnell

Under health care reform, plan participants and beneficiaries must be provided a 4-page summary of benefits and coverage (“SBC”) and uniform glossary. This requirement is effective for open enrollment periods that begin on or after September 23, 2012. For participants and beneficiaries who enroll in group health plan coverage outside of open enrollment (e.g., newly eligible individuals and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012. This requirement is an ongoing one and, as open enrollment season approaches, the Departments of Labor, Health and Human Services, and Treasury have issued updated guidance and… Read More

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