Tag Archives: Medicare

Medicare Part D Notices required by 10/14

Each year, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D and to the Centers for Medicare and Medicaid Services (CMS) whether the health plan’s prescription drug coverage is creditable. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2016-the start date of the annual enrollment period for Medicare Part D. CMS has provided model disclosure notices for employers to use.

When Is Social Security Income Taxable?

Social Security checks

The answer depends on your income.

Your Social Security income could be taxed. That may seem unfair, or unfathomable. Regardless of how you feel about it, it is a possibility.

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You’ll be surprised at how much this one mistake can cost you

From Employee Benefit Advisor

There has been a long-standing rule that employers are prohibited from offering an incentive of any kind to an individual who is Medicare-eligible to enroll in Medicare in lieu of the employer’s group health plan.   Encouraging your older employees to leave your plan and financially incenting them to do so can cost you – big time.

While there are fines that can be assessed for encouraging or enticing the employee to take Medicare ($5,000 per situation), the bigger “hit” is the bill for claims that Medicare paid as primary versus what they should have paid as secondary. This claim can typically be for a scary big amount; representing what the carrier (if fully-insured) or employer (if self-funded) must repay Medicare for the discovered individuals.

The IRS and CMS, in a joint data-matching program, are mailing out demand for payment letters.   “Nearly every employer who has received one of these letters is usually in shock at the amount demanded that they (or the carrier) repay. Often your client is pointing the finger at you for suggesting that Bob (who turned 65 last year and is one of the reasons their renewal was so high) go on Medicare and encouraged them to pay for his Med Supp and Part D plan premium (which you probably handled for Bob, too).”

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CIGNA banned from Medicare Sales

Cigna was temporarily banned from marketing its Medicare products to new customers, after the U.S. found deficiencies in how the health insurer ran its plans, citing widespread violations that the government said threatened patients’ health.  This means that existing customers can keep their policies but no new customers can be brought on board.

I appears this relates more to the Medicare Advantage plans than Prescription Plans.

It will remain to be seen if this impacts the pending merger with Anthem Health.

Aetna Medicare gets new Pharmacy Benefits Manager

New Pharmacy Benefits Manager (PBM) for Coventry, Altius, HAPA and
First Health Part D members

In 2016, members of Coventry, Altius, HAPA and First Health Part D plans have a new Pharmacy Benefits Manager (PBM). A PBM manages their prescription drug benefits on behalf of our plan.

In 2015, the PBM was Express Scripts (ESI). In 2016, the PBM is CVSHealth. Because of this change, members may see or hear the CVSHealth name.

What you need to know

  • Members can use any 2016 network pharmacy to get their prescription drugs. Even though CVSHealth is now the PBM, they don’t have to use a CVS pharmacy to fill prescriptions. 
  • If members get mail-order drugs today, they may need to call us to keep getting them. To be sure, members should call Member Services.
  • Members received a letter about these changes in the 4th quarter. If they have any questions, they can call Member Services at the number on their ID card.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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