Medicare

Posted March 15th, 2018 in Producers, Employers

As a benefits professional, you know that navigating the benefits industry can sometimes be a tricky endeavor. Let’s face it; employee benefits can be confusing—even for those of us who deal with this stuff for a living. Whether you’re a Human Resource Manager, an insurance agent or benefits consultant, people are counting on you to have all the answers. Flex is here to make sure you get them.

Posted February 13th, 2018 in Producers, Employers, Individuals

Happy Fat Tuesday! Much like the paczki, we will soon be without a "donut hole"- for Medicare Part D. The donut hole, also known as the gap in Medicare prescription drug coverage, will close a year earlier than expected as a result of a budget deal signed by President Donald Trump this past Friday. The donut hole will now close in 2019 instead of 2020.

Posted October 3rd, 2017 in Producers, Employers, Individuals
Each year employers must provide a written notice to Medicare-eligible employees who are covered under their group health plan. The notice must include information about the creditable coverage status of the prescription drug benefit. In other words, the notice tells employees if the prescription drug benefit on the group health plan is at least as good as the standard Medicare Part D plan. 
 
Posted September 19th, 2016 in Producers, Employers, Individuals
Employers must provide a written notice on an annual basis to any Medicare-eligible individuals who are covered under a group health plan that includes prescription drug coverage. The notice is required to include information as to whether the prescription drug coverage is considered to be creditable. In other words, is the prescription drug coverage at least as good as the standard Medicare Part D plan? 
 
Posted July 22nd, 2016 in Producers, Employers
The Internal Revenue Service (IRS), Social Security Administration (SSA), and the Centers for Medicare & Medicaid Services (CMS) are required to share information that each agency has about whether Medicare beneficiaries or their spouses are working. This sharing of information is referred to as the IRS-SSA-CMS Data Match, and the purpose of the Data Match is to identify situations where another group health plan may be primary to Medicare. In general, a group health will be primary to Medicare when:
 
Posted December 10th, 2015 in Producers, Employers, Individuals
Below is a list of some key Affordable Care Act (ACA) changes and facts that will be effective in 2016:
 
  1. The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater. 
  2. The Employer Mandate expands to include all employers who have 50 or more employees. 
  3. The Employer Mandate offer rate increases from 70% to 95%. 
  4. Employer reporting related to the offer of coverage is due for the first time during Q1 2016. 
Posted November 20th, 2015 in Producers, Employers, Individuals
The Centers for Medicare and Medicaid Services (CMS) has released premium and cost sharing information for Medicare beneficiaries in 2016.  Approximately 70% of individuals will pay $104.90 per month for Part B, however, the premium cost will be higher for the remaining 30% of individuals who:
 
  1. Enroll in Part B for the first time in 2016; or
  2. Those who don’t currently receive Social Security benefits; or
  3. People who have Medicare and Medicaid, and Medicaid pays the Part B premium; or
Posted October 14th, 2015 in Producers, Employers

The 2016 Medicare Part D annual enrollment period will begin on October 15, 2015 and run through December 7, 2015. Medicare beneficiaries can enroll in a Part D drug plan or make changes to existing coverage during this time period. Enrollment can be done through a stand-alone drug plan or a Medicare Advantage plan that integrates coverage for medical and drug expenses.      

Posted April 17th, 2015 in Producers, Employers, Individuals
Since 1997, the federal government has used a system referred to as the Sustainable Growth Rate (SGR) to pay doctors that participate in the Medicare program. The SGR has aimed to slow increasing costs related to Medicare by limiting and reducing payments to doctors. However, the SGR has seen a lot of backlash from doctors, with many indicating they would not participate in the Medicare program if payments were reduced.
Posted March 16th, 2015 in Producers, Employers

The IRS has released Notice 2015-17 with some new information about Employer Payment Plans, which are plans that are used to reimburse employees with pre-tax dollars for individual market coverage (e.g. HRA). Previous guidance had essentially eliminated Employer Payment Plans as an option for actively employed workers because they would not be able to comply with all of the Affordable Care Act (ACA) market reforms. Notice 2015-17 elaborates on the IRS’ position of Employer Payment Plans.

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