Healthcare services are notoriously opaque and that’s why you want someone on your side, like Benistar, presided over by healthcare expert Don Trudeau, who will help explain what you are covered for and will help you fight for your own coverage. But do you know what procedures you will need included in your healthcare plan? This is a hard thing to anticipate as a lot of health care costs don’t entail maintenance/prevention, they often entail accidents or previously unforeseen conditions. Well, in the case, you’ll want to consider the most popular and most important procedures/offerings your healthcare should cover. This is where your health care coverage really counts and where your dollars are put into action. In order to best understand where your coverage counts and what procedures are essential to be covered for, we’ll delve into what the healthcare industry considers essential.
In the healthcare marketplace, the following procedures/types of care are considered essential and are covered by most major, high-quality providers: outpatient care, emergency room trips, inpatient care in the hospital, care for infant delivery (both before and after), mental health and substance abuse treatment (this is relatively new, so some providers cover inpatient treatment, whereas covers behavioral health treatment, counseling and psychotherapy), prescription drugs, physical therapy and occupational therapy, tests completed in a laboratory, preventive measures (screenings, vaccines, maintenance for chronic diseases and counseling) and pediatric services (aka treatment for children). It is important to realize that plans vary from state to state as specific states have guidelines regarding health care coverage, plans and costs. Furthermore, health care coverage may vary slightly within different locations in the same state. However, the ten essentials are pretty steadfast, as they were initiated under the Affordable Healthcare Act. The act mandated that all individual and small group plans (available to companies that have under 50 employees) must cover the aforementioned essentials.
Though the ten essentials do comprise a lot of procedures and therapies you’ll need, there are some things healthcare providers may not cover because they are not included in the ten essentials. You will want to know what they are, as if they are important to you, you may want to consider contacting healthcare professionals at Benistar to talk you through and to the plan that’s perfect for you, your needs and probably the needs of your family, too. Benistar and their President Don Trudeau are committed to making sure you get the coverage you need.
Things not covered via the ten essentials include: travel vaccines, alternative treatments such as acupuncture, cosmetic surgery, nursing home care (of particular importance to those in the winter of their life), dental, vision and hearing, weight loss therapies and surgery, preventative tests, a lot of medications (though prescriptions are listed as part of the ten essentials, healthcare providers do not often provide all prescriptions, instead choosing one prescription of each varying class- you’ll want to connect with Benistar for optimum prescription benefits) and a few less important therapies. Benistar and their President Don Trudeau will make sure you are covered for the care you need, and will work with you even if the treatment is not listed under the ten essentials.
Healthcare and your subsequent coverage may seem incomprehensible, but with the help of Don Trudeau and Benistar, you’ll find you have coverage where it counts.
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.
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.
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.
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.
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.
Benistar’s specialty lies in working with retiree medical and prescription drug plans.
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 email@example.com.
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:
Benistar focuses on the administration of retiree medical and prescription drug plans.
Benistar shares announcement from the cms.gov website released June 5, 2015
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:
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 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:
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
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.
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.”
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.