Anfuso Benefit Consulting, LLC

08/15/2024

Are you, or do you know a DACA recipient? They are now eligible to apply for Marketplace health insurance.

The Centers for Medicare & Medicaid Services May 3 released a final rule that would allow DACA recipients, young undocumented immigrants authorized to work in the U.S., to purchase coverage through the Health Insurance Marketplace, qualify for Marketplace subsidies based on income, and apply for the...

08/15/2024

Are you familiar with GA Pathways? Are you NOT eligible for a Marketplace plan? Do you make to much to qualify for Medicaid. This may be the plan for you.

For Georgians to qualify for Pathways, single people need to be making roughly $15,000 per year or less. Members of a family of three need to have a household income of less than $26,000.

08/15/2024

Is this as good as it sounds? It will benefit those who take numerous and/or expensive medications but hurt those that do not. Your drug card is going to cost more, your formulary is going to be more limited, many drugs will not be covered and you will have to get more pre authorizations for drugs you are already taking. Insurance carriers are already talking about cancelling certain plans.

Some people with Medicare will pay less for some Part B drugs if the drug’s price increased faster than the rate of inflation.

08/15/2024

The Inflation Reduction Act1requires drug companies to:
Negotiate prices with drug companies for certain single-source brand-name drugs or biologics without generic or biosimilar competitors covered under Medicare Part D (starting in 2026) and Part B (starting in 2028)12.
Pay rebates to Medicare if drug prices increase faster than the rate of inflation for certain drugs34.
Calculate and invoice these rebates to Medicare4.
Potentially save Medicare beneficiaries between $1 and $3,575 per average dose depending on their individual coverage

08/15/2024

There are going to be lots of health insurance changes for the 2025 open enrollment period. This will be one of them.

Georgia is switching to a state-run portal to shop for and enroll in health insurance plans.

07/23/2024

What is Medicare?
Medicare is federal health insurance for people 65 or older, (some younger people with disabilities).

To qualify for Medicare, you must meet certain requirements, including age, citizenship, and work history:
• Age: You must be 65 or older. However, you may be eligible earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease).
• Citizenship: You must be a U.S. citizen or permanent legal resident.
Work history: You or your spouse must have worked for at least 10 years (or 40 quarters) in Medicare-covered employment. You may also qualify if you receive Social Security or railroad retirement benefits, or if you've worked long enough to be eligible for those benefits but aren't yet collecting them.

Medicare Part B premiums will start at $180 in 2025.Medicare Part B premiums are based on income and can range from 35% to 85% of the total cost2.
You can sign up for Medicare during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after. If you apply for Social Security three months before you turn 65, you can sign up for Medicare at the same time.
Types of Medicare:
• Original Medicare – Part A & B Part A provides hospital coverage, while Part B covers doctor's visits and other aspects of outpatient medical care. These plans aren't competitors but are intended to complement each other. The annual deductible for all Medicare Part B beneficiaries will be $263 in 2025 then Part B will pay approximately 20% of all Medicare approved fees
• Medicare Supplement - You must generally have Medicare Part A and Part B These costs include deductibles, copayments, and coinsurance. Medigap plans vary in what they cover, so you can choose one that fits your needs. Out of pocket costs are limited
• Medicare Advantage - A Medicare Advantage (MA) plan, also known as a Part C plan, is a health plan that provides Medicare Part A and Part B coverage through a private company that has been approved by Medicare. MA plans can include additional services like wellness programs, hearing aids, and vision services. They can also have lower monthly premiums, lower out-of-pocket costs, and a maximum amount that you have to pay out-of-pocket each year. However, MA plans may have more restrictive provider networks, and you may need to get referrals to see specialists.
• In 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Part D12. This spending cap will apply to original Medicare enrollees who have a Part D prescription drug plan and beneficiaries with a Medicare Advantage plan that includes prescription drug coverage. This could mean more prior authorizations to get prescriptions, additional restrictions on which medications the plans cover, and hikes in Part D premiums and co-pays. Or some combination of these.

ANFUSO BENEFIT CONSULTING, 510 WINDER TRAIL, CANTON, GA 404-276-7554

07/09/2024

Medicare Part D is changing in 2025

Saving money with the prescription drug law A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare. This law improves access to affordable treatments and strengthens the Medicare program. Here’s what the law means for you: More vaccines cov...

02/04/2024

great article

You’re denied care, and your doctor is burned out. Why? Prior authorizations and claim denials.

02/15/2023

In a Medicare Advantage Plan?

You can still make a change!
From Jan 1 – March 31, if you’re in a Medicare Advantage Plan, you can switch plans or return to Original Medicare and join a separate Medicare drug plan.

01/29/2023

Are you receiving a subsidy?

Have you received your Form 1095-A – Health Insurance Marketplace Statement in the mail? If so, make sure to keep it with your other important tax records, like the W-2 you get from your employer. If not, keep an eye on the mail as it should arrive by mid-February.