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FEDlogic's March Newsletter
Navigating Medicare Changes: A Comprehensive Overview
Medicare, a cornerstone of healthcare for older adults, undergoes frequent updates, necessitating a keen understanding to aid informed decision-making among beneficiaries. Significant modifications have been made from 2020 to the present, and many people who are now or will soon be eligible should know how those changes may impact their decisions.
2024: Addressing Affordability and Access
The Inflation Reduction Act initiates pivotal changes:
Medicare Part D beneficiaries will bid farewell to the 5% coinsurance for catastrophic costs, with a $8,000 threshold initiating the coinsurance.
Insurers must cap annual Part D premium growth at 6% from 2024-2029, shielding enrollees from undue financial burdens.
Eligibility for full Medicare Part D Low-Income Subsidy (LIS) extends to beneficiaries with incomes up to 150% of the federal poverty level, alleviating prescription drug costs.
A new CMS regulation, effective October 2024, facilitates low-income Medicare beneficiaries in covering Parts A and B out-of-pocket expenses via Medicare Savings Programs, streamlining access to healthcare.
2023: Streamlining Enrollment and Enhancing Coverage
The Inflation Reduction Act provided transformative measures:
Drug manufacturers must now reimburse Medicare for Part D drugs exceeding inflation rates, deterring price hikes.
Monthly out-of-pocket costs for insulin were capped at $35, easing financial strains.
All ACIP-recommended vaccines became free for Medicare enrollees.
Gaps between the Initial Enrollment Period (IEP) and the General Enrollment Period (GEP) were eradicated, enabling prompt coverage upon enrollment and seamless coverage transitions.
2022: Embracing Telehealth and Cost Reductions
Key revisions in 2022 included:
Expanded telehealth services, including mental health consultations, extend accessibility and convenience.
The start of the gradual elimination of coinsurance payments for colorectal cancer screenings over a period of eight years, thus enhancing preventive care.
The addition of a second specialty tier to Medicare Part D fostered cost-effective access to medication.
Special Circumstances Special Election Periods were implemented to empower enrollees to rectify plan choices based on accurate information.
2021: Broadening Coverage and Improving Accessibility
Noteworthy changes in 2021 encompassed:
Medicare Advantage plans began to extend coverage to Acupuncture coverage, addressing chronic pain management.
End Stage Renal Disease (ESRD) patients gained access to Medicare Advantage plans, expanding their care options.
Personalized Initial Enrollment Period reminders enhanced informational support, understanding, and informed decision-making.
2020: Expanding Services and Enhancing Benefits
The Bipartisan Budget Act introduced substantive changes:
Coverage expansion for opioid treatment and indication-based formularies under Medicare Part B enhanced addiction services.
Medicare Advantage plans began covering supplemental benefits and prioritizing holistic care for chronic illnesses.
Medicaid alterations enabled smoother transitions for beneficiaries who were enrolled in Medicare Savings Programs, ensuring continued access to essential services.
Medicare's evolution reflects a commitment to adaptability and responsiveness, underscoring the importance of staying abreast of these changes for optimal healthcare decision-making.
All FEDlogic experts stay up to date on the latest changes in policies and legislation, providing accurate and valuable insight into the benefits available to your employees and their household members. A consultation with a FEDlogic expert can help discern when is the right time to file for the federal and state benefits for which employees have worked hard and paid in their tax dollars.
Source: "Major Medicare Changes from 2020 and Beyond,” National Council on Aging (NCOA), https://www.ncoa.org/article/major-medicare-changes-from-2020-and-beyond
A Guide for Understanding COBRA Coverage
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that may allow employees to remain covered by their employer group health plan for a limited time after their employment ends or if they lose coverage as a spouse or dependent of the covered employee.
Who is able to get COBRA?
In general, COBRA only applies to employers who have 20 or more employees. However, some states have “mini-COBRA” laws that require insurers who cover employers with fewer than 20 employees to allow them to keep their coverage for a limited time. It is important to check with your state insurance commissioner's office to see which coverages are required.
An employee may also be eligible for COBRA if they recently got divorced or legally separated or were a dependent child or a dependent adult child who is no longer eligible as a dependent. In these situations, the covered employee needs to report the change to the benefits administrator within 60 days.
To get COBRA coverage, an employee must tell the plan administrator why they qualify. Once the plan administrator is notified, the plan must let the employee know they have the right to choose COBRA coverage.
How long does COBRA coverage last?
COBRA coverage is generally offered for 18 months but can be extended to 36 months in some cases. Employees should ask their employer's benefits administrator or group health plan about their COBRA rights if they find out their group health plan coverage is ending and they don't receive a notice or if they get divorced.
How does COBRA work with Medicare?
If an employee is eligible for COBRA and they are eligible for Medicare but not enrolled, COBRA may only pay for a small portion of the healthcare services they receive. They may have to pay most of the costs themselves. In these situations, employees can contact their COBRA plan and ask what percent they will pay.
Avoid gaps in coverage & the Part B late enrollment penalty.
If an employee has COBRA before signing up for Medicare, COBRA will probably end once they sign up. Employees have up to eight months after they stop working, or lose their health insurance, if that happens first, to sign up for Medicare Part B without a penalty, whether or not they choose COBRA. If they miss this period, they will have to wait until the General Enrollment Period, which runs January 1st through March 31st of each year, to sign up, and their coverage will start the month after they sign up. This may cause a gap in their coverage, and they may have to pay a lifetime Part B late enrollment penalty. To avoid unexpected medical bills, employees may need to sign up for Medicare as soon as they are eligible.
Generally, coverage with Medicare will be more affordable for employees than with COBRA, though many are not aware it might be an option for them. A consultation with a FEDlogic expert can help them understand their true options and navigate the process.
FEDlogic has a dedicated email inbox for referrals from employers to assist employees who are interested in scheduling a consultation. Email [email protected] to help employees get started with their consultation.
FEDlogic’s Monthly Webinar Series
Hosted the last Wednesday of each month at 1:00pm CST, our webinars are designed to provide your employees with valuable insights and knowledge on various federal and state benefits topics.
March’s webinar includes an overview of federal benefits, how FEDlogic can help, and an in-depth look into benefits for children, including children of retired and disabled workers, children who have lost a parent, and disabled adult children.
We take a deep dive into a different topic nearly every month. Don't miss this opportunity to learn about the FEDlogic experience along with your employees and teammates. For those unable to attend the live sessions, the webinars are recorded and available to access through the employee resources page on our website.
Register now and secure your spot for our upcoming webinars in 2024 by clicking on the image below!
Client Feature: Hexion
Hexion, Inc. is a global producer of adhesives and performance materials. Hexion is based out of Columbus, Ohio, and its materials are sold globally. Hexion has been advancing chemicals for over 100 years with the goal of being as sustainable as possible. They show their dedication to that goal with their coined phrase, “Responsible Chemistry.”
Thank you for placing your trust in FEDlogic. We are grateful for the opportunity to serve your families.
Check out the FEDlogic LinkedIn page for this and all new client features.
New Employee Highlight
In March, FEDlogic welcomed Max Osbun, Vice President of Business Development, to the team.
Max is focused on cultivating collaborative partnerships with brokers and employers to ease healthcare costs for both employees and companies. His focal point lies at the intersection of clinical care and business.
Max enthusiastically supports our aim to support employees during challenging phases in their lives by facilitating access to FEDlogic experts who offer guidance and resources, enabling informed decision-making. He knows first-hand how difficult the U.S. healthcare system can be to navigate for a disabled family member. As a seasoned and impassioned leader in market access, payer policy, and reimbursement, he is deeply committed to leveraging his insights to develop strategies that promote enhanced, cost-efficient care.
Max holds a B.S. from Ball State University. He is a co-founder and board member of a national nonprofit organization. He enjoys volunteering to help others, traveling, spending time outside hiking, biking, etc., and spending time with family and friends.
Welcome to the FEDlogic family, Max. We are so happy you’re here.
FEDlogic Holiday Observation
Please note that our operations will be closed on Friday, March 29th, 2024. We look forward to providing the exceptional level of service our clients have come to expect when we reopen on Monday, April 1st, 2024.
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