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.

01/13/2023

Did you know -

VantageScore® is removing medical debt from its credit-scoring model
If you have medical debt, changes may be coming to your credit score in the near future.
Here’s what you need to know
• As of July 2022, paid medical debt no longer appears on consumer credit reports.
• Starting in 2023, medical debt under $500 won’t be included on consumer credit reports.
• Beginning January 2023, VantageScore® 3.0—which is monitored by CreditWise—will no longer include medical debt in credit score calculations.

01/11/2023

Happy New Year! The below article is from UHC but has some good interesting trends for 2023.

5 health care trends impacting employers in 2023
Behavioral health challenges, the end of the public health emergency and rising health care costs are all going to be top of mind for employers in 2023.

Jan. 4, 2023
All states

As the new year begins, employers have their hands full. Not only is a looming recession top-of-mind,1 the competitive labor market is forcing many employers to do more with less. The demand for higher salaries and better benefits are making it increasingly difficult to attract and retain talent, and other dynamics within the health care industry are adding to the challenge.

1. The concern around health care costs amid economic uncertainty
Health care costs continue to rise, and the economy isn’t helping. A 2022 report found that health care costs increased 3.2% in 2022, and employers are bracing for an even bigger increase at 5.4%.2 Another survey revealed that 7 in 10 employers expect their health care costs to rise moderately or significantly over the next 3 years, which likely contributes to the fact that more than 50% of respondents expect their costs to be over-budget in 2023.3

What does this mean for an employer’s health care strategy? Today’s competitive labor market, coupled with economic uncertainty, has many employers looking for ways to contain their costs without having to sacrifice the quality of coverage they offer their employees.
As we enter this time of heightened economic uncertainty, the ability to control costs from a health care perspective is going to become more and more important.

— Craig Kurtzweil, Vice President of the Center for Advanced Analytics at UnitedHealthcare
2. The “return to health” phenomenon
During the pandemic, some Americans put off preventive care appointments and procedures. But 2022 UnitedHealthcare claims data shows that members are making a “return to health,” as many are back to scheduling appointments with their primary care providers and getting routine tests like colonoscopies and mammographies at levels in line with pre-pandemic years.4

What does this mean for an employer’s health care strategy? While the “return to health” could initially mean higher medical costs, the long-term benefits of preventive care may result in better health outcomes and lower overall costs. For instance, routine appointments and screenings may help catch conditions early that could be treated in a more successful and cost-effective way.

3. The need for more behavioral health support
It pays to have happy employees, but recent research finds that frequent mental distress has increased among adults.5 In fact, according to America’s Health Rankings 2022 Annual Report, the prevalence of frequent mental distress increased 11% among adults between 2020 and 2021.5 That’s concerning in more ways than one. Employees with unresolved depression may experience a reduction in productivity, which may also affect their employers’ profitability and the wider economy. On the other hand, a 2019 study from Oxford University found that happy workers are 13% more productive.6

What does this mean for an employer’s health care strategy? More employers will be looking for benefits that integrate medical with behavioral and give their employees improved access to behavioral health services. For example, UnitedHealthcare is focused on expanding its network of behavioral health care providers and enhancing its virtual behavioral health support. Discover the ways UnitedHealthcare is advancing behavioral health.

4. The (continued) rise of specialty drugs
Enormous investments continue to be made in pharmaceutical research and development. From 2014 to 2022, the industry has seen a 78% increase in the number of available drugs.7 But the cost of specialty drugs has continued to grow with it. In 2021, the total cost of specialty drugs amounted to $301 billion, an increase of 43% since 2016.8

What does this mean for an employer’s health care strategy? Employers are looking for strategies that can help them better manage their pharmacy care costs. One way UnitedHealthcare does this is by putting the data and tools into the hands of employees and their providers to help steer them to more cost-effective drug alternatives, when applicable. Learn how UnitedHealthcare is working to make pharmacy and specialty drugs more affordable, such as by eliminating out-of-pocket costs on certain, vital prescription drugs.

High prices are a significant barrier to prescription drugs for many people, so we are using our unique capabilities to deliver savings for consumers. We are doing what we can to shield people from the prices set by pharmaceutical companies and hope all stakeholders also will act to make prescription drugs more affordable.

— Brian Thompson, Chief Executive Officer of UnitedHealthcare
5. The potential end of the public health emergency (PHE)
Another trend employers are keeping an eye on is the end of the PHE, which was established by the federal government in January 2020 due to the 2019 novel coronavirus outbreak. When the PHE is lifted, about 18 million Americans9 who received Medicaid coverage during the pandemic will be reevaluated or “redetermined” – over a 14-month period on a state-by-state basis – as to whether they’re still eligible for Medicaid or whether they will need to seek health care coverage through their employer or on the individual exchange. Early industry research shows that about 40% will become eligible for employer-sponsored coverage.10

What does this mean for employers? Since more employees may be seeking another insurance option, employers should prepare for 1) an influx of questions about “redetermination” from their employees and 2) the financial impact of enrolling more employees in their benefits.