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Medicare Last Chance for 65 and Older

Medicare Last Chance for 65 and Older

by | Nov 24, 2019 | healthcare, MEDICARE

Already 65+? Good news, #Medicare Plan F still available. There are 2 weeks left before Dec 7th Open Enrollment deadline. With the new 2020 open enrollment changes its time to get the facts. Considering making changes to your coverage this fall or just want to learn more about this enrollment period? Get in touch now.

1.Medicare Supplement Plans F and C are still available 

While the Centers for Medicare and Medicaid (CMS) will no longer allow newly eligible Medicare beneficiaries to enroll in Medigap plans F and C, these plans aren’t disappearing completely. If you become eligible for Medicare before January 1, 2020 (and that’s everyone who can use the 2020 fall Medicare Open Enrollment Period), you can apply for these plans now and in the future—even if you aren’t already enrolled in Medigap.  

If you become eligible for Medicare on or after January 1, 2020, you won’t be able to enroll in Plans F or C now or in the future.

2.The Part D ‘donut hole’ will close

Beginning in 2020, the coverage gap for Part D plans won’t exist anymore. Previously, beneficiaries would see increased out-of-pocket costs after the value of the covered prescriptions they’ve purchased reaches $3,820. Starting January 1, 2020, beneficiaries will pay just 25% of drug costs in this coverage gap or “donut hole”—or about the same as what they paid before entering the donut hole.   Learn more about Part D.  

3.Changes in Medicare Advantage and Part D plans  

Every year, insurers make small changes to their Medicare Advantage and Part D plans. Typically, these changes include changes in premiums, deductibles, and other costs. Keep in mind, the Medicare program may not finalize these changes until right before fall Open Enrollment. 

 

While the Medicare program changes a bit each year, much of it stays the same. It never hurts to refresh your Medicare knowledge. We recommend starting with an overview of Medicare. This Medicare Glossary could come in handy, too, as you read through insurance documents.

 

 

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Learn more about your Medicare options please contact us at info@medicalsolutionscorp.com or (855)667-4621.

 

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2020 Oxford Metro Network NY

2020 Oxford Metro Network NY

by | Oct 28, 2019 | group health insurance, healthcare, Small Business Group Health

2020 Oxford Metro Network NY

Oxford has expanded on their successful Oxford Metro Network plan released in 2016. For 2020 the network has expanded 15% in NY and added NJ network last year.  In 2019 most Metro plans stayed flat and  for 2020 increasing single digits.

Oxford Metro Network:

The NY network has grown to approx. 13,000 Primary Care Providers, 32,000 Specialists and 85 hospitals.  Furthermore, the Oxford Garden State network has been added as well onto the Metro Network.  The Garden State network alone has access to 24,900 physicians and 67 hospitals.

All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists.  Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Caremount, formerly Mt Kisko Medical Group,  are NOT in the network.

Value:

Today’s largest networks with  in-network only GOLD  are  priced at  $12,000 /single annually. They typically are accompanied with $50 copays and  non-office exposures of $1,000 deductibles and coinsurance percent in network. By comparison, the new Metro network is approximately 25% smaller than NY Liberty network with up to 16% IN SAVINGS.  For example, a popular Oxford Liberty HMO Gold  is $910 vs.Oxford Metro Gold $770.

New 411 Plans Added 2020 new oxford plans

Innovative plan intended for the moderate user. Enhancements include four $5 PCP Copays, one $25 Urgent Care and one $25 Specialist Copay. The tier 1 Rx copays are only $5.The average family copay savings is $250/year. The network uses Liberty network.

The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network. Rates for Gold level plan are approximately 35% discounted. Want to learn more about Healthy NY? Schedule a 1-on-1 RSVP today.

Additional Features: 

  • MyUHC.com – member portal
  • Gym Reimbursement – Sweat Equity –Annual reimbursement $400 members and $200 dependents. now eligible age 13+ dependents qualify for reimbursements
  • Telemedicine – Virtual doctor visits on myuhc.com
  • Real appeal – a personalized weight loss program
  • Quit for Life – a tobacco cessation program
  • Enhanced customer service

DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze

Oxford Metro FAQ. Click Here

Drug Formulary: Click Here

Group Sample Rates:

2020 Metro, Freedom, Liberty prices

 

 

 

 

 

 

 

Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.

2020 New Oscar Circle Plus

2020 New Oscar Circle Plus

by | Oct 27, 2019 | group health insurance, healthcare, Small Business Group Health

2020 New Oscar Circle Plus

Background:

The Google of health insurance?  Oscar entered the NY market on Jan 1, 2014 and had around 16,000 members. In 2015, it expanded coverage to New Jersey and grew to about 40,000 members. In 2016, Oscar had 145,000 members in New York, New Jersey, California, and Texas. Oscar’s cutting edge technology and pioneering benefits have simplified the consumer health insurance experience propelled easier access and understanding of health plans.  Examples of success have been ease of physician locator, online appointment setting and no cost telemedicine 24/7.  Additionally, some plans have $0 Copay generics and annual 3 free office visits

The Numbers:

  • NY based with 900+ employees
  • 260,000 members across 6 states
  • $890M raised from top investors (Fidelity, Goldman Sachs, Google, etc.)
  • $375M investment from Alphabet Inc. (Google parent company)

Oscar Member Engagement: 

  • 27% of Oscar members utilize DocOnCall vs. industry average of 3%
  • 35% of first time doctor appointments start with Oscar
  • 2x customer satisfaction score vs. the industry average
  • 48% of all Oscar members use the Oscar app, compared to 7% of other health insurance carriers
  • Doctor on Call has led to approximately $600 in savings per member
  • Concierge Team has led to an approx. $3,600 in savings in member OON claims
  • Pre-medicare population almost 2x Concierge Team utilization vs. the “younger” demographic 
Oscar Concierge Usage by Age Group 

New Oscar 2020Oscar NJ MapNorthwell Health, MSK, WestMed

  • Oscar’s current network will be rebranded as Circle Network.  Circle Network – 27,000 Providers, 298 Urgent Care Centers  and – Mt. Sinai, Montefiore, LI Health network
  • 15 plans across 4 metal tiers
  • NEW Circle Plus Network include. 45,800 Providers, 298 Urgent Care Centers and the following hospitals in addition to Circle Network. 
    • Northwell (formerly North Shore LIJ)New Oscar Circle Plus
    • Memorial Sloan-Kettering
    • Multiplan National Network for out of state
    • Westchester Expansion –  Northern Westchester Hospital (Mt. Kisko), Phelps Hospital (Tarrytown) and the Westmed Medical Gorup added. 
  • NEW:  Only $0 deductible required Silver Plans!

Additional Features:

  • Step Rewards Program – a step rewards program that links to the mobile app. Members are rewarded when they meet their step goals for the day with $100 Amazon gift cards.
  • Mobility – simple and easy to use. Oscar has the highest member engagement.  Example: members can also renew Rx through the dr. on call feature on their app.
  • Pharmacy – No more Dyane Reade, Walgreens and Rite Aid.
  • Concierge Service: Every member is placed on a team of 5 care guides and 1 nurse that help members achieve better health outcomes and lower costs.
  • Doctor on Call: 24/7, free and unlimited telemedicine that works nationwide. This is a great way to care of basic primary care at the member’s convenience
  • Member Experience –
Oscar Health Plans 2020 Rates Increase 17%

2020 Group Rates – Click Above

Doctor Search:  click here

Hospital Map click here 

Group App (editable PDF):  click here

Employee App (editable PDF):  click here

Contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.

 

2020 Healthfirst Plans

2020 Healthfirst Plans

by | Oct 25, 2019 | group health insurance, healthcare, Hospitals, Small Business Group Health

2020 Healthfirst Plans

Healthfirst has released affordable new 2020 plans for NY small businesses and not a moment too soon. The only non-profit Health Insurer owned by hospitals has kept market low rates with a 4.7% DECREASE for 2020. By integrating Hospital/Provider medical approach Healthfirst has been successfully delivering value for the 5 boroughs.

About HealthFirst

Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.4 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.

Rate Trend

2018:  +4.8%

2019:  +6.4%

2020:  -4.7%

Value

  • Members have access to a broad network of providers and dozens of industry-leading hospitals.
  • Community locations throughout New York City, Long Island and parts of Westchester.
  • Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.

All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.

Network Overview:

Healthfirst EPO Pro Network – Provider count expanded to 39,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk and Southern Westchester. 136+ Urgent Care locations and 60+ hospitals included. Examples: Healthfirst 60+ Hospitals

Hospital for Special Surgery City MD Urgent Care
NY Columbia Presbyterian Modern MD
NYU Langone Urgent Care
Mt Sinai Health System Northwell Go-Health
Montefiore PM Pediatrics
Westchester Medical Center Midtown NY Doctors
Maimonides Cure Urgent Care
Staten Island University Hospital Riverdale Urgent Care
SUNY Stoneybrook Throgs Neck Urgent Care
Northwell Health (formerly North Shore LIJ) Statcare
Winthrop Rapid MD
LI Health Network Express Medical Care
Bon Secours Excel Urgent Care

 

2020 Healthfirst Pro Plans

Additional Features:

  • Free 24/7 Telemedicine Through Teladoc –Members can speak to a doctor anytime, anywhere, with a $0 copay.Telemedicine accessed via phone call or video chat.
  • Gym Reimbursement – Annual $400/member and $200/spouse reimbursementEmerecencies vs Urgent Care vs Telemedicine
  • Accupuncture Covered Benefit
  • CVS/Caremark – 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
  • Free Flu Vaccine
  • Free HSA Account. Healthfirst will pay for set-up and monthly maintenance.
  • Pro Plus EPO plans Option
    • Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow up care and limited orthodontia.
    • Vision – Exams, Lenses, Frames or Contacts covered every 12 months
  • SHOP Credits – SMB groups can enroll on tax credit program directly with our Brokerage
    • A business must have fewer than 25 employees
    • Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Healths Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer

 

Healthfirst 2020 1Q
DOCTOR SEARCH:  CLICK HERE

2020 HEALTHFIRST PROVIDER NETWORK

HEALTHFIRST BENEFITS SUMMARY

 

Learn how a Healthfirst on your very own Private Exchange can help your group. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.

2020 EmblemHealth

2020 EmblemHealth

by | Oct 25, 2019 | group health insurance, healthcare, Small Business Group Health

2020 EmblemHealth GHI and HIP

EmblemHealth, formerly GHI and HIP, has recapitalized and reloaded dynamic plan offerings for 2020. They have had stable 3 years of single-digit increases. Emblem has added a new 3rd network, Millennium Network, to their stellar lineup of Hip Prime and Select Care Network. The discounts vary between 8% and 15% discount

1. Prime Network: Largest Emblem Network. – newly expanded 110,000 Providers Tristate.

All plans are non-gated and include Pediatric and Adult Dental and Vision.

NYS – EmblemHealth has expanded small group Prime Network to include both the QualCare Network in New Jersey another ConnectiCare Network in Connecticut. This is in addition to the current HIP Prime Network in New York. Members can choose from over 90,000 private and group practice health professionals, facilities, and 144 hospitals in 28 New York State counties — all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties, and upstate areas that stretch north of Albany.

CT – The ConnectiCare HMO Network has 17,000 primary care providers and specialists, and 33 hospitals in all eight counties in the State of Connecticut.

NJ – The QualCare HMO Network includes 26,000 primary care providers and specialists, and 76 hospitals in all 21 counties across the State of New Jersey.

2. Select Care Network – Balance between cost/size – 48,000 Providers. 28 Counties NY Only.

It is a smaller subset of the larger Prime Network. It includes over 48,000 health care professionals, facilities, and hospitals throughout 28 counties in New York State. PRIME vs. SELECT NETWORK: Click Here

All plans are non-gated and include Pediatric and Adult Dental and Vision.

3. New Millennium Network – Balance between cost/size – 22,000 Providers. Downstate NY Only.

Tailored to an 8 County downstate New York service area. Focused around key 6 independent practice associations (IPA’s) and several prominent hospital  systems, such as NY Presbyterian and Mount Sinai. All Millennium plans are Gated (need referrals).

New Plan Features

  • 3 free copays for PCP on selected plans.
  • Urgent Care no deductible
  • Labs no deductible
  • Adult & pediatric preventive dental no deductible
  • FREE Telemedicine through Teledoc. Members can get non-urgent medical care. It’s convenient, immediate, and available 24 hours a day, 365 days a year. Telemedicine doctors can even prescribe certain medicines.
  • FREE Acupuncture
  • Vision Included – free annual exam and lenses at 20% coinsurance.
  • Gym Reimbursements – up to $400 for member and $200 for spouse.

Emblem has been a NYS mainstay for 80 years.  They insure 612,000 members. Notable clients are Union plans such as the NYC Teachers Union.Emblem new Millennium Network rates

DOCTOR SEARCH:  Click Here

PRIME vs. SELECT NETWORK: Click Here

BENEFITS SUMMARY:  Platinum Premier,  Gold Choice,  Silver Plus(gated)  and Bronze Plus HSA (gated)  

EMBLEMHEALTH SMALL BUSINESS OVERVIEW. Click Here

Group Sample Rates:

 

 

 

 

 

 

 

 

Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.

Empire Strikes Back – 2020 Health Plans

Empire Strikes Back – 2020 Health Plans

by | Oct 24, 2019 | healthcare, Hospitals, NY News, Small Business Group Health

Empire Strikes Back – 2020 Health Plans

Empire Blue Cross Blue Shield has added a 3rd network – Empire Connections to their 2020 roster. The Downstate Network will be the smallest of the 3 featuring top hospitals & providers. The discounts are 11% and 20% discount off of #1 Empire EPO/PPO and Blue Access networks respectively. The middle network Blue Access has expanded significantly adding Memorial Sloan Kettering. Blue Access shares 92% of #1 Empire EPO/PPO network. Empire Blue Cross New Network Trifecta_2020

Additionally, all 3 networks, Empire EPO/PPO, Blue Access, Empire Connections will offer access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.

Network Overview

  1.  PPO/EPO Network – a traditional non-gatekeeper large network of approximately 91,000 physicians, 160 facilities and the BlueCard PPO. This is the #1 broadest network. All major NY hospitals. National Access with Blue Card PPO. Uses the Traditional Open Formulary (except for one PPO Fair Health Plan)
  2. Blue Access Network –hybrid of broad PPO/EPO 160 facilities and 83,000 physicians network. BlueCard PPO Access from home. All of #1 Empire EPO/PPO Hospitals except Stoney Brook Hospital in Suffolk County.  Uses the Traditional Open Formulary (this is better than the Select Formulary from 2019)
  3. Connections Network-will have a 70% provider match with PPO/EPO network. Network tailored to deliver the greatest premium savings, 20% off EPO/PPO.Available in 9 downstate counties (Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester). Offers the BlueCard PPO National Access, however, Gated plans must have PCP referral for Out-of-Network coverage.  Uses the Select Formulary (mostly generic).  Examples of hospitals:

    Empire Blue Cross 2020 Participating Hospitals (Click Above)

    • NY Columbia Presbyterian
    • Mt Sinai Health System
    • Montefiore
    • Westchester Medical Center
    • Maimonides
    • Staten Island University Hospital
    • Northwell Health (formerly North Shore LIJ)
Resource:Best Hospitals – US News 2019-2020

Additional Features:

  • Telemedicine will be $0 on all products except H.S.A. which will cost $49.
  •  Vision – Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
  •  Dental –  price competitive plans with 127,000 Dentists and 385,000 locations. empires-whole-health-connection
  • New Pharmacy – Empire will be using their own Ingenio Rx as Pharmacy Benefit Management. With Pharmacy becoming a 22% average expense and close second only to hospitalization its novel focus on whole-health cost management is crucial. Enhanced digital tools, 24/7 support with no intermediary is a welcome All plans use their large BCBS formulary Except Empire Connections. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
  • Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
  • Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
  •  Online Resources – wellness coaching, discounts, health assessments, and The Weight Center.
  • Travel – BlueCard PPO national access and Blue Cross Blue Shield Global Core Program.
  • Sydney Health – new mobile app. Uses artificial intelligence to meet member’s needs. A personalized dashboard that recommends programs and contact based on claims. Interactive smart chat feature to help members find what they need faster.A complete view of medical, pharmacy, dental, and vision benefits.Access to the member’s well-being programs and incentives Digital ID card that can be emailed or printed.
  •  Gym Reimbursements Cash Rewards and Healthy Support – Wellness program offers easy ways to earn up to $700 per member, per year.  Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150, and $50 Tobacco-free certification online.

Empire Blue Cross Enhanced Embedded Dental and Vision Plans **New for 2020**

Empire’s new model – Enhanced Embedded Dental & Vision Plans – is a care ecosystem where plans work together seamlessly to coordinate care Empire can afford to add these benefits at 50% discount below the stand-alone plan. For example, an individual Gold Blue Access Plan with Dental/Vision is only $20/month.

 

 

DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY:  Empire Blue Cross 2020 Top Plans 

Small-Group Rates:  2020 Small Group NYC    

Drug Formulary: 

Ask us about Empire’s flexible low participation voluntary group dental, vision,  disability, and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead  for ACA, Benefits, Payroll, and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

empire-voluntary-ancillary-dental-whole-life

 

 Contact Us Now    Learn how our Agency is helping businesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.