Attention: The coverage for OneTouch diabetic supplies ends August 3

Loramei RomeoNo Comments

As of August 3, significant changes will occur regarding preferred diabetic testing supplies for Medicare Advantage plans. LifeScan OneTouch@ products will no longer be covered, and Ascensia Contour products will be introduced as a new preferred option effective June 1, 2025. Members will still have access to a selection of preferred brands with a $0 copay, including multiple Accu-Chek and Contour products such as: Member that are currently using LifeScan OneTouch supplies will soon receive an important letter from UnitedHealthcare, outlining new options and the need for updated prescription. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance… Read More

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Exiting news! Prior authorization reforms are set to simplify health insurance.

Loramei Romeo

On June 23, 2025, health insurance plans revealed significant commitments aimed at simplifying and streamlining prior authorizations for better care access. These initiatives are built on existing efforts to enhance patient connections to necessary care while reducing the administrative burden on healthcare providers. Such changes promise to improve overall patient experience and access to evidence-based treatments, aligning with the industry’s goal of delivering affordable healthcare. In line with state and federal regulations, new commitments across insurance segments aim to enhance health coverage for 257 million Americans. The six key commitments focus on : These steps are crucial for improving the overall health insurance landscape and fostering better patient experiences. We… Read More

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Big changes to Medigap plans start January 1, 2026!

Loramei Romeo

Attention to all current Medigap groups: As of July 1, 2025, new enrollments for MedigapSecurity and 65 Special products will no longer be accepted. It is crucial for future retirees to be aware that they will need to transition to a MedigapFreedom product. As we approach 2026, it’s essential for businesses and retirees to understand the upcoming changes to Medigap enrollment. If your Medigap group renewal dates fall between January 1 and June 1, 2025, you can continue enrolling future retirees into MedigapSecurity or 65 Special throughout 2025. However, starting January 1, 2026, any future retiree from an existing group will need to select from the MedigapFreedom products. As we… Read More

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The 2025 PCORTF Fee is on the horizon!

Loramei Romeo

The recent reauthorization of PCORTF fees by the Federal Government will continue to support the Patient-Centered Outcomes Research Institute through 2029. These fees play a crucial role in funding vital health research, which helps inform healthcare decisions and improve patient outcomes. As a reminder, the fee associated with your health plan is due by July 21, 2025. This deadline is crucial as it follows the calendar year immediately after the end of the applicable plan year. Staying compliant with these deadlines is essential for effective health insurance management. For plan years ending on or after October 1, 2023, and before October 1, 2024, the fee will be $3.22 multiplied by… Read More

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What It Takes to Stay Balanced While Running a Business

Loramei Romeo

Running a small business might be the most exhilarating decision you’ve ever made, but no one tells you it’s also an emotional woodchipper. Deadlines, payroll, unpaid invoices, looming tax forms — the pressure doesn’t clock out when you do. And the worst part? Most of the stress feels invisible, yet it colors every interaction, every strategy session, every hour of sleep you don’t get. But you don’t have to white-knuckle it through madness. There are ways to claw back a little peace. Maybe not perfect peace, but enough to make it through Thursday without screaming into a closet. Prioritize Self-Care Let’s start with the basics, the stuff you already know… Read More

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Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… Read More

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Cafeteria Plans (Section 125 Plans)

Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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IRS requires employers to offer MEC to employees!

Loramei Romeo

The IRS mandates that every applicable large employer (ALE) offer MEC plans to their employees to avoid significant penalties. Is your business compliant with MEC requirements? Knowing the rules can save you from penalties. Stay informed about the implications of compliance and the financial impacts of neglecting these requirements.  Whether you are a small or medium-sized business, individual, self-employed, a gig worker, or family, Total Benefit Solutions,  can help you find affordable health plans that suit your needs. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available… Read More

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Medigap Plans: Comparing Costs

Ed MacConnell

When selecting a Medigap policy, it’s important to compare offerings from multiple insurance companies, especially if you’ve already chosen a specific standardized plan. While policies with the same letter designation provide identical benefits, premium costs can differ between insurers. For example, Policy A from Company 1 offers the same coverage as Policy A from Company 2, but the two companies may set different pricing. At Total Benefit Solutions, Inc we look at many factors besides price including length of time in market, ease of use and client service availability. When choosing a Medigap, ask what factors the Medigap insurance company uses to set your premium. The following factors may affect… Read More

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The Three MEC plans categories

Loramei Romeo

All MEC plans fall under one of three categories. No matter the category, all MEC plans are ACA- compliant and will help your business provide affordable employee benefits. However, it is important to know the difference between categories, to choose the best option for your team. Standard MEC plans stand out for their cost-effectiveness, offering fully covered preventative services and prescription discounts. Enhanced MEC plans provide critical benefits such as preventive services, low-copay visits, and telehealth options. The highest-level MEC plans offers fully covered preventative services, low-copay visits, and prescription discounts. Whether you lean towards a standard plan for budgetary reasons, an enhanced plan for added benefits, or the highest-level… Read More

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MEC (minimum essential coverage) and MVP (minimum value plan) differentiation

Loramei Romeo

Despite both MEC and MVP plans stem from the ACA they differ significantly from each other. MEC plans meet the ACA’s individual mandate, while MVPs offer substantial coverage to avoid penalties for employers. Both concepts aim to ensure that individuals have access to comprehensive and affordable health care. However, knowing these differences can lead to better health decisions. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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The advantages and disadvantages of MEC plans!

Loramei Romeo

After being informed themselves, employers should empower their employees with knowledge about the pros and cons of MEC plans and encourage them to explore their options. Pros: Affordable premiums– lower monthly premiums than more comprehensive health plans. Basic Coverage– coverage for essential health benefits. Regulatory compliance– helps ALEs meet regulatory requirements and avoid tax penalties Cons: Very Limited coverage– it doesn’t cover certain healthcare expenses, such as elective procedures or specialty medications. High-out-of-pocket-costs– In exchange for cheaper premiums, members will face higher deductibles, copayments and coinsurance. Minimal flexibility– limited customization options  Limited provider networks– it may limit members’ choice for healthcare providers After weighing the advantages and downsides of a… Read More

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How will Aetna’s departure affect ACA exchanges?

Loramei Romeo

Aetna’s decision to withdraw from the Affordable Care Act (ACA) marketplaces in 17 states by the end of 2025 raises questions about the stability and future of these exchanges. While it’s uncertain if other carriers will follow Aetna’s lead, the history of the ACA marketplace has been marked by a dynamic pattern of exits and entries. We understand that navigating the ever-changing regulations and economic challenges can be daunting for consumers seeking health insurance. The future of health insurance exchanges is uncertain, which is why it’s crucial to emphasize policy stability and market adaptability. The ACA exchanges play a vital role in providing access to health insurance, but they do… Read More

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Examples of MEC plans

Loramei Romeo

The centers for Medicare & Medicaid Services provides MEC recognition to healthcare carriers, creating a reliable list of national health plans. Additionally, any plan that falls under the following categories is considered MEC:   Minimum Essential Coverage encompasses various health plans, including employer-sponsored options, individual market plans, and government programs like CHIP and Medicare. Understanding these categories is vital for making informed and effective health insurance decisions. Reach out to us for personalized guidance! We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any… Read More

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What is the concept of a MEC plan?

Loramei Romeo

MEC stands for minimum essential coverage and is a type of healthcare plan that fulfills the minimum criteria established by ACA, the Affordable Care Act. MEC plans are designed with affordability in mind, providing essential coverage at lower premiums compared to traditional health plans. In a few words, MEC plans are a popular way to provide baseline coverage to businesses, individuals, and families simply looking for standard healthcare. Understanding MEC plans is vital for applicable large employers to ensure compliance and employee health. These plans offer essential benefits while helping businesses avoid tax penalties.  Small- and medium-sized businesses must evaluate the pros and cons of MEC plans to ensure the… Read More

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ACA Individual Market Highmark

Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

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Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

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Small Shifts, Big Impact: Simple Strategies to Elevate Your Overall Well-Being

Loramei Romeo

Feeling your best—inside and out—doesn’t always require a drastic overhaul. Sometimes, the smallest shifts in daily habits can yield the biggest results. The goal isn’t to chase perfection but rather to create a sustainable routine that fosters both physical and mental wellness. From the way you start your mornings to ensuring you have the right safety nets in place, every choice you make contributes to your overall well-being. Here are a few simple yet powerful strategies to help you feel more energized, balanced, and at peace with yourself. Begin Your Day with Purpose Mornings set the tone for the rest of your day, and a chaotic start can leave you… Read More

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Next Year Cost for Pennie Customers May Increase

Loramei Romeo

Pennie has announced that enrollees receiving advance premium tax credits will likely face higher costs in 2026 due to the expiration of enhanced federal tax credits at the end of 2025. This change will result in increased monthly premiums for most enrollees unless Congress acts to extend these credits. Pennie is committed to keeping customers informed through various communications, including postcards, emails, and text messages, to help them understand the upcoming changes and find the lowest costs on high-quality health coverage. The enhanced tax credits, introduced in 2021, have provided significant financial savings, but their expiration means reduced savings for many enrollees starting January 2026. We are dedicated to providing… Read More

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Price Transparency Rules Addressed in New Executive Order

Loramei Romeo

On February 25, 2025, Executive Order 14221 was signed, enhancing health care price transparency rules. This order builds on previous regulations by requiring actual prices for health care services, standardizing pricing data reporting, and strengthening enforcement policies. Employers with fully insured plans must ensure their carriers comply, while those with self-funded plans should contract with third-party administrators to meet disclosure requirements. The new guidance is expected by May 26, 2025, and employers should prepare to update service agreements accordingly. Have Questions? and want to read more about the changes click New Executive Order Addresses Price Transparency Rules for more details. We are dedicated to providing exceptional service, so please do… Read More

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South Jersey Radiology is in the Clover Network

Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025.  New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

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Benefits 101 Comparison HSAs HRAs FSAs

Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Stretching Your Healthcare Dollars

Loramei Romeo

We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

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Enhancing the security of member portal registrations

Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

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