Benistar
Share the love...

The Flexibility of the EGWP

benistar egwp

The Flexibility of the Employer Group Waiver Plan

There are several ways Benistar can help employers provide prescription drug benefits to their Medicare-eligible retirees. One way we do this is by providing flexibility in the plans that we offer, doing our best to reduce member disruption and noise for the employer. By attempting to match plan designs as closely as possible, we are able to provide a smoothest transition to both employer and retiree.

Subsidies and Discounts

The EGWP is particularly competitive in the marketplace because it offers government subsidies and discounts that are built into the premium. Two notable components are the Coverage Gap Discount Program and Catastrophic Reinsurance. CMS requires companies that wish to sell Part D drugs to give a 50% discount to Part D members inside the coverage gap. Catastrophic reinsurance is an 80% subsidy provided by CMS once the member hits a specific out-of-pocket expenditure.

The Coverage Gap

One of the most problematic issues with Part D is the coverage gap (often called “the donut hole”). The coverage gap is when a retiree has reached their initial coverage limit and has to start paying an increased out of pocket for his or her prescription drug costs. This is when the 50% discount from manufacturers kicks in. While the discount may help offset a significant portion of the expenditures from that point on, drug costs involving members who make it to this point are often-times becoming a serious financial issue for the member. With drugs costs always rising, these additional expenditures can be substantial.

A plan that exposes members to this additional out of pocket cost is known as a base plan. Benistar offers solutions that can help to keep the out of pocket costs low for retirees during this period by offering full-coverage and generic-only options. Full-coverage plans allow members to continue paying their initial coverage copay’s throughout the donut hole. Generic-only plans provide similar benefit to generic drugs while in the donut hole. Both types of plans work to both keep member cost low and keep patients healthy.

Formulary

The standard open formulary for Benistar’s Part D program is among the broadest Medicare formularies. Benistar’s ability to offer such generous plans stems from our excellent partnerships with carriers and large book of business.

Employer Contribution

The EGWP allows plan sponsors the freedom to choose how much they contribute to the cost of the premium. Plan sponsors can either pay for the full premium, for a portion of the premium or they may choose to have retirees enter the plan on a voluntary non-contributory basis. Unlike with the Retiree Drug Subsidy, the EGWP contribution level does not impact savings from subsidies and discounts. This means that regardless of how the premium is split between employer and member, premiums are still eligible for the cost savings and subsidies under the EGWP.

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.

###

 

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)

 

1 2 3