#MedicareInformation – 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

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.

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.

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 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.

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

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.

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.

The History of Medicare

September 13, 2018September 17, 2018Ed MacConnell

A brief history of Medicare in America Landmark social program now covers 58.5 million Americans By Steve Anderson Discussion about a national health insurance system for Americans goes all the way back to the days of President Teddy Roosevelt, whose platform included health insurance when he ran for president in 1912. But the idea for a national health plan didn’t gain steam until it was pushed by U.S. President Harry S Truman.On November 19, 1945, seven months into his presidency, Truman sent a message to Congress, calling for the creation of a national health insurance fund, open to all Americans. The plan Truman envisioned would provide health coverage to individuals, paying for such typical expenses… Read More

Tag: #MedicareInformation

Understanding the Health Care Provisions in the Inflation Reduction Act

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

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What is a Medicare Coverage Gap?

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Guaranteed Issue Rights

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

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Medicare Advantage (MA) Quick Facts

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What is the Part D Senior Savings Model?

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MACRA: Medicare Access and CHIP Reauthorization Act of 2015

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Medicare & Coronavirus

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

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

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The History of Medicare

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