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How to Time Your Medicare Enrollment

Click here to read a quick article in Time Magazine on How To Time Your Medicare Enrollment. The article explains the difference between initial, Medigap, general and special enrollments. If you’d like to talk to one of our specialists on setting up enrollment for your post-65 retiree group, contact us at retireebenefits@benistar.com.

New Medicare data available – Benistar

The CMS has released new data on hospital and physician utilization.  “These data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system,” said acting CMS Administrator Andy Slavitt. “It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.”  Read the full study here:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-01.html

Benistar focuses on the administration of retiree medical and prescription drug plans.

 

NEW rules for Medicare Shared Savings Program

Benistar shares announcement from the cms.gov website released June 5, 2015

The CMS finalizes rules for Medicare Shared Savings Program

Continued Growth in ACO Program is a Core Component of Delivery System Reform

The Centers for Medicare & Medicaid Services (CMS) today released a final rule updating the Medicare Shared Savings Program to encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model.  This final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people.

The Medicare Shared Savings Program final rule will both enhance the focus on primary care services and provide additional flexibility in the program, which should grow participation.  CMS is making these modifications to the proposed regulations after considering comments received from the December 2014 Notice of Proposed Rulemaking.

“Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt.  “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

The final rule issued today improves the program over the proposed rule in a number of areas, including but not limited to:

  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

The Medicare Shared Savings Program was created by Section 3022 of the Affordable Care Act to promote better health for Medicare fee-for-service beneficiaries by encouraging physicians, hospitals, and other health care providers to improve patient health and experience of care and to reduce growth in costs.  The program is voluntary and accepts applications on an annual basis in which organizations agree to participate for three years.

Over 400 ACOs are participating in the Medicare Shared Savings Program, serving over 7 million beneficiaries. Early results released last November indicated the Medicare Shared Savings Program ACOs starting in the first two years of the program improved quality of care for beneficiaries, as ACOs improved performance in 30 of 33 quality measures.

According to an independent evaluation report released by CMS earlier this month, the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care.  The Pioneer ACO Model is the first that meets the tests to have its elements incorporated into other Medicare programs.

ACOs are a part of the Department’s broader initiative to create a health care system that results in better care, smarter spending, and healthier people. The Administration earlier this year announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models, such as ACOs, by 2016 and 50 percent of payments by 2018.

For more information on the Medicare Shared Savings Program, please visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html.

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Benistar Emerges as Leader in Retiree Benefits

Benistar Emerges as a Nationwide Leader in Retiree Benefits Administration and Insurance Services

After providing extraordinary service for more than two decades, Benistar has now emerged as the leading organization in the nation for design, installation and administration of post-65 group retiree medical benefits.

With specialized service in health and related insurance, actuarial, underwriting, claims management, and third party administrative services, Benistar is now a preferred alternative for retiree benefits administration and insurance services. The company has gained the trust from benefits professionals and Medicare beneficiaries as their retiree benefits service provider of choice by offering much more than just administrative or advisory services. As seen at http://www.benistar.com/, Benistar designs, underwrites, delivers and administers complete welfare benefit solutions.

The benefit experts from Benistar are highly proficient in due diligence, restructuring, benefits liability evaluation, stakeholder assistance, advisor support, and investor services. The company operates an integrated portfolio of service solutions offering a full range of health care benefit services including Third Party Administration (TPA Services), Retiree Group Benefits Exchange, Employer Group Waiver Program (EGWP) and Prescription Drug (Rx) products, Reinsurance and Risk Management solutions, and Retiree Member Call Center services. Find out more about Benistar Professionals at https://www.linkedin.com/company/benistar-administrative-services-inc.

Retiree benefit solutions offered by Benistar include:

  • Retiree liability evaluations, carve-outs, OPEB liability transfers and settlements for medical, Rx, group life, and disability obligations
  • Benefit plan cost containment, reductions and financial recapture strategies
  • Welfare Benefit Plan design, installation, and administration
  • Eligibility, Coordination of Benefits, Subrogation and related Audit services
  • Traditional and specialty risk placement and other voluntary supplemental benefits
  • HSA, HRA, MSA and other account based solutions
  • Plan Sponsor Pre and post-bankruptcy filing solutions

For more information, see more about Benistar at https://www.facebook.com/BenistarInc.

About Benistar:  Benistar was established in 1978 and is a nationwide leader in the design and installation of post-65 retiree medical benefits plans.  The company focuses its efforts on administration of retiree health insurance and prescription drug plans and works with consultants and brokers to provide medical and prescription solutions for companies worldwide.

 

 

For More Information:

Jeff Gordon, Media Director

Benistar Admin Services, Inc.

25 Seir Hill Road

Norwalk, CT 06850

(203) 969-6000

info@benistar.com

http://www.benistar.com

 

Benistar Introduces New Retiree Medical Benefits Plans

Benistar, the nationwide leader in the design, installation and administration of group retiree medical benefits, has just launched a series of new retiree medical benefit plans.

Benistar proudly announces the introduction of their new retiree medical benefit programs. Since the original inception of the company in 1978, Benistar has steadily emerged as a trusted provider of group retiree medical benefits. The company’s primary area of specialization is the administration of employer group retiree medical and prescription drug plans. Benistar provides retiree benefit solutions for publicly and privately-held companies, labor unions, city and county government entities, educational organizations, and religious organizations. To find out more, please visit the official website of Benistar as seen at http://www.benistar.com/.

Benistar’s group retiree medical plans are designed to pay for the costs that are recognized but not covered by Medicare Parts A and B. The experienced and knowledgeable service representatives of the company will assist the plan sponsor in developing a cost effective and sustainable solution for its retirees from design through communication and ongoing service support. The company assists plan members in seamlessly transitioning from current arrangements without the need for enrollment forms or other challenging technology. The company’s efficient Retiree Customer Service Center representatives are available over the phone and in person to help the retirees with all of their benefit needs and questions.

The retiree prescription drug plans from Benistar are tailor-made specifically for groups under Medicare Part D. In collaboration with its national PBM and insurance carrier partners, Benistar is fully compliant with all CMS regulation related to Part D plans that are supported by Benistar.

Benistar Retiree Medical Plans News Summer 2014

Here are some of this summer’ss trending news in the Retiree Medical Plans.

Connecticut Medicare Beneficiaries Saved On Drugs Due To ACA (Click to read more about this article on Retiree Medical Plans)
The Norwich (CT) Bulletin: (4/13, Benson) reports that “a lesser-known part of the Affordable Care Act has resulted in more than $14 million in savings on prescription drug costs for 12,000 Eastern Connecticut Medicare beneficiaries in 2013,” an amount that is expected to increase “through 2020.” Then, the “so-called ‘doughnut hole’” for drug costs will be “phased out of Medicare Part D coverage.” The Bulletin adds that “in 2013, Medicare beneficiaries who reached the Part D doughnut hole received a 52Se.5 percent discount on brand-name drugs and a 21 percent discount on generic drugs.” 

Retiree Health Plans Prescription Drugs

Benistar Retiree Health Plans Prescription Drugs

WPost: Medicare Payment Information Release Is “Just What The Doctor Ordered.” (Click to read more about this article on Retiree Medical Plans)
The Washington Post: (4/13) editorializes that the Obama Administration’s release of doctor-specific information about Medicare payments made last week “a breakthrough week for health-care transparency,” illuminating “the workings of a complex system of fee-for-service medicine whose seemingly uncontrollable costs have challenged U.S. policymakers for decades.” The Post expects that the pressure caused by the police should present no problem “for the vast majority of doctors who play by the rules,” and is “just what the doctor ordered” for those who don’t.

WPost: Medicare Payment Information Release Is “Just What The Doctor Ordered.” (Click to read more about this article on Retiree Medical Plans)
The Washington Post: (4/13) editorializes that the Obama Administration’s release of doctor-specific information about Medicare payments made last week “a breakthrough week for health-care transparency,” illuminating “the workings of a complex system of fee-for-service medicine whose seemingly uncontrollable costs have challenged U.S. policymakers for decades.” The Post expects that the pressure caused by the police should present no problem “for the vast majority of doctors who play by the rules,” and is “just what the doctor ordered” for those who don’t

CMS To Test New Hospice Program (Click to read more about this article on Retiree Medical Plans)
Reuters: (5/15, Belisomo) reports on a new CMS program, the Medicare Care Choices Model, which may make it easier for patients to receive hospice care while still receiving curative care. CMS, in testing the program, will assess whether offering hospice services earlier can improve quality of life and cut Medicare costs. The program will be limited to those with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, and HIV/AIDS.

Benistar News on Retiree Medical Plans Summer 2013

The Benistar Senior Star Brings You the Latest News on Retiree Medical Plans.

[message type=”custom”]“One of the secrets to winning the game is making the right alliance.  That way you can not only survive, but thrive.” James Lloyd, motivational speaker.[/message]

Benistar Retiree Medical Plans

Benistar Retiree Medical Plans

Retirees’ Medical Bills Are Bringing Down Detroit
“Pension and retiree-health-care obligations make up the bulk of the city’s unsecured debt, and their costs are rising rapidly. The emergency manager, Kevyn Orr, is right that Detroit must reduce its retirement-related debt to secure its future, but he has to be more specific about his target. Cutting retiree health care … should take priority over pensions.” (Bloomberg)

 

Even More Retirees Coming After Baby Boomers
“The number of Americans reaching age 65 each year will continue to grow beyond the Baby Boomers, according to a trend analysis from LIMRA…. Specifically, 3.4 million individuals are projected to reach age 65 in 2013. By 2023, 4.1 million Americans will reach 65 and then 4.2 million by 2050.” (PLANADVISER.com)

 

Report sees first drop in traditional prescription spending in 20 years

The aggregate trend for 2012 was a bump of 2.7%, similar to that of 2011, according to pharmacy benefit manager Express Scripts. However, the company also finds that the spending decline was offset by an 18.4% rise in spending on specialty medications.read more »

 

Step Onto the Cable Car and Deposit $13,487 for San Francisco’s Retiree Health Care
“To cover the gap [in pension funding for San Francisco city workers], each household in the city would have to fork over $1,677…. But when it comes to retiree health care costs, it’s another story. San Francisco has saved less than one percent of its $4.4 billion tab — and each household would have to pay $13,487 to make up the difference.” (SFGate)

 

Cost of Retiree Healthcare Benefits for States and Municipalities: The Next Shoe to Drop?
“Kentucky is … opting to issue bonds in order to cover its annual costs for ‘other post-employment benefits’ (OPEB), which includes benefits like health care and life insurance for retired workers. In fiscal 2012, the state’s five main retirement health insurance plans combined for a total unfunded liability of more than $6 billion, while the state’s OPEB cost that year was nearly $850 million … The tactic of borrowing money to pay for those costs has not won the state favor with ratings analysts.” (Governing)

Senior Star 1st Quarter 2013

 

Retiree benefits costs push California city into bankruptcy
By Tracie Cone

All retirees get health insurance for themselves and a dependent for life. Read More

 

Text of CMS 2012 Report on ACA Effect on Costs for Medicare Beneficiaries (PDF)
“This second annual report details how millions of seniors and people with disabilities with Medicare continued to experience lower costs on prescription drugs and improved benefits in 2012 because of the [ACA]. Since the law’s enactment, 6.1 million Americans with Medicare who reached the Part D coverage gap also known as the ‘donut hole,’ have saved over $5.7 billion on prescription drugs. Drug savings of $2.5 billion in 2012 are higher than the $2.3 billion in savings for 2011…. [Projected] average savings per Medicare beneficiary [are] approximately $5,000 from enactment through 2022, while those with high prescription drug spending are projected to save much more — over $18,000.” (Centers for Medicare & Medicaid Services)

 

A Widening Gap for Cities: Shortfalls in Funding for Pensions and Retiree Health Care
“Besides pensions, many localities also have promised health care, life insurance, and other non-pension benefits to their retirees, but few have started saving to cover these long-term costs. These unfunded liabilities loom even larger than for pensions … As of fiscal year 2009, the cities in this report had promised at least $118 billion more than they had in hand to cover retiree health care benefits. Wide disparities exist in how prepared cities are to fulfill their pension obligations … Cities have more in common when it comes to gaps in funding for retiree health care and other non-pension benefits. As of fiscal year 2009 … Only Los Angeles and Denver had even half of the money needed.” (Pew Center on the States)

 

Sacramento City Manager Details Unfunded Retiree Healthcare Liability
“Most worrisome … is $440 million in retiree medical benefits that the city has no plan to fund besides annual payments of $11 million from the already battered general fund budget, which funds core city services such as police protection, park maintenance and fire personnel. The total unfunded liability stemming from medical benefits has grown by $60 million in the past five years.” (Sacramento Bee)

Michigan Cities Have $12.7B In Retiree Health Costs
“Michigan cities and townships that provide health care for retired public workers face nearly $13 billion in unfunded costs … with half setting aside no money to cope with a bill gobbling up more of their budgets…. [Detroit] is not alone in grappling with how to pay promised health benefits to retirees. More than 300 cities, townships and villages — home to two-thirds of state residents — face a combined $12.7 billion in unfunded liabilities in the next 30 years.” (CBS Detroit)

Retiree benefits costs push California city into bankruptcy

By Tracie Cone

All retirees get health insurance for themselves and a dependent for life. Read More

 

Text of CMS 2012 Report on ACA Effect on Costs for Medicare Beneficiaries (PDF)
“This second annual report details how millions of seniors and people with disabilities with Medicare continued to experience lower costs on prescription drugs and improved benefits in 2012 because of the [ACA]. Since the law’s enactment, 6.1 million Americans with Medicare who reached the Part D coverage gap also known as the ‘donut hole,’ have saved over $5.7 billion on prescription drugs. Drug savings of $2.5 billion in 2012 are higher than the $2.3 billion in savings for 2011…. [Projected] average savings per Medicare beneficiary [are] approximately $5,000 from enactment through 2022, while those with high prescription drug spending are projected to save much more — over $18,000.” (Centers for Medicare & Medicaid Services)

 

A Widening Gap for Cities: Shortfalls in Funding for Pensions and Retiree Health Care
“Besides pensions, many localities also have promised health care, life insurance, and other non-pension benefits to their retirees, but few have started saving to cover these long-term costs. These unfunded liabilities loom even larger than for pensions … As of fiscal year 2009, the cities in this report had promised at least $118 billion more than they had in hand to cover retiree health care benefits. Wide disparities exist in how prepared cities are to fulfill their pension obligations … Cities have more in common when it comes to gaps in funding for retiree health care and other non-pension benefits. As of fiscal year 2009 … Only Los Angeles and Denver had even half of the money needed.” (Pew Center on the States)

 

Sacramento City Manager Details Unfunded Retiree Healthcare Liability
“Most worrisome … is $440 million in retiree medical benefits that the city has no plan to fund besides annual payments of $11 million from the already battered general fund budget, which funds core city services such as police protection, park maintenance and fire personnel. The total unfunded liability stemming from medical benefits has grown by $60 million in the past five years.” (Sacramento Bee)

 

Michigan Cities Have $12.7B In Retiree Health Costs
“Michigan cities and townships that provide health care for retired public workers face nearly $13 billion in unfunded costs … with half setting aside no money to cope with a bill gobbling up more of their budgets…. [Detroit] is not alone in grappling with how to pay promised health benefits to retirees. More than 300 cities, townships and villages — home to two-thirds of state residents — face a combined $12.7 billion in unfunded liabilities in the next 30 years.” (CBS Detroit)

 

Quote of the Quarter:

 

“Our business in life is not to get ahead of others, but to get ahead of ourselves — to break our own records, to outstrip our yesterday by our today.”

Stewart B. Johnson (British artist known for his figurative work)

 

Senior Star Third Quarter 2012

QUOTATION OF THE QUARTER

For every sale you miss because you’re too enthusiastic, you will miss a hundred because you’re not enthusiastic enough.”

 Zig Ziglar

 


Stockton Retirees File Lawsuit To Retain Health Benefits.

The Los Angeles Times (7/12, Marcum) reports, “A group of Stockton retirees has filed suit in US Bankruptcy Court asking for a restraining order against the city’s moves to cut their health benefits.” The move to cut benefits is said to be part of the Stockton’s “pendency plan” keep that will keep the city solvent as it seeks protections from creditors under federal bankruptcy law. The suit “seeks class-action status covering all retirees,” although several of the managers with higher incomes have indicated they would be willing to give up their benefits. The Times notes that “two-thirds of the city retirees do not meet poverty requirements for California’s low-income healthcare program but cannot afford private insurance.”


HHS plans to announce Wednesday that in the first six months of this year, “more than 1 million seniors and people with disabilities saved $687 million on prescription drugs in the doughnut hole” as part of the President’s healthcare law, USA Today  (7/25, Kennedy) reports. That amounts to a savings of “$629 per patient” and administrators “expect to see larger savings in the second half of the year because more people will have hit their coverage limit by then.”


It’s D-Day for the Post Office

“Wednesday, Aug. 1 … the Postal Service is obligated, by statute, to make a $5.5 bil.lion payment … to ‘prefund’ health benefits for future retirees. But, with less than $1 bil.lion in the bank, the Postal Service announced on Monday that it would not be making the payment. It has a second payment, for $5.6 bil.lion, due in September. Unless lightning strikes, it won’t be making that one either…. [T]hat prefunding requirement … has cost the post office more than $20 bil.lion since 2007—a period during which its total losses amounted to $25.3 bil.lion. Without that requirement, the post office would still likely be struggling, but it would have a lot more wiggle room—and a lot more cash. (Its pension obligations are also overfunded by around $11 bil.lion.)” (The New York Times; free registration required)


How California Has Failed to Prepare for its Accumulating Retiree Health Care Obligations

“Retiree health care is the largest component of these Other Post-Employment Benefits (OPEBs). As the Baby Boomer generation has begun to retire, we have seen an upswing in the number of retirees accompanied by both longer predicted life spans for those retirees and an overall increase in health costs. In short, more people are earning benefits for longer periods of time at higher costs. Together, these factors will make it increasingly difficult for California to pay for these benefits in the future. Unlike pensions, which the State pre-funds by setting aside money for benefits when they are earned, retiree health care benefits are currently paid out of the State’s operational budget, forgoing potential savings from investment profits.” (California Common Sense)


The Chicago Tribune.  There are still many brand name prescription drugs losing patents this year and next.  For a list of the drugs going off patent, click into the article.  (Elejalde-Ruiz, 8/1)  Full story


City Bankruptcies Target Retiree Health Care Costs

“Lifetime retiree health care from an employer, rare in the private sector, is an important benefit [for] public employees… In 2007 [the California state Controller] made the first estimate of the cost of providing retiree health care for current state workers and retirees: $50 bil.lion over the next 30 years. Last February his actuaries increased the estimate to $60 bil.lion.” (CalPensions)


Public Employer Retiree Health Costs Rising

“State and local governments in New York will have to come up with an additional quarter of a trillion dollars to pay the entire tab for retiree health care, according to a new report. The $250 billion bill for retiree health coverage is up from $210 billion two years ago, said the study issued by the Empire Center for New York State Policy on Wednesday. Referred to as ‘other post-employment benefits,’ or OPEB, the unfunded obligations represent a troubling strain on budgets.” (The Wall Street Journal)

Senior Star July 2012

The Benistar Senior Star keeps you informed of the news in the world of Retiree Benefit Plans. Here are some of the recent news articles we think will be of interest to you.

As Retiree Drug Subsidy Program Becomes Less Attractive, Employers Consider Using ‘Group Waiver Program’         
"Employers who currently receive a federal tax subsidy for providing retiree prescription drug coverage under the retiree drug subsidy program, or RDS, will no longer be able to take a deduction for that subsidy as of 2013 … Therefore, many employers are considering an alternative subsidy program referred to as the Employer Group Waiver Program, or EGWP, as an attractive way to achieve significant plan savings and are weighing the benefits of the EGWP against the RDS." (G http://www.benefitspro.com/2012/05/10/retired-couples-may-need-240000-for-health-careroom Law Group)


Final Medicare Part D Regulations Include Coverage Gap Discount Program
"The regulations include changes reflecting HHS’ experience to date in administering Part D and will be of interest to sponsors of Part D prescription drug plans. In addition, some group health plans must coordinate with Part D prescription drug plans, among other reasons, to determine which coverage pays first and to disclose to Part D individuals whether the group health plan coverage is creditable." (Practical Law Company)


Medigap gets high marks

By Kathryn Mayer

Nine in 10 seniors enrolled in Medigap say they are satisfied with their coverage and the vast majority (91 percent) say they’d recommend the coverage to a friend or relative when they turn 65, a survey from America’s Health Insurance Plans finds…Read more


New York State Retiree Health Liability Rises to $72 Bil.lion; NYC’s Is $84 Bil.lion
"Most states cover retiree health benefits on a pay-as-you go basis. They don’t set aside money annually to pre-fund the obligations, as they do with pensions. Last year, New York, the third-biggest U.S. state by population, spent $3.3 bil.lion on health care for active and retired employees as health-care spending rose 6 percent." (Bloomberg)


Walgreens, Express Scripts in new deal

(Crain’s) — The Deerfield chain will participate "in the broadest Express Scripts retail pharmacy network available to new and existing clients."

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