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PART D....
President Trump Signed These Medicare Changes into Law. Here’s What to Watch For
The law has already been signed by President Trump, so whether these are good changes or not is moot for the time being
by Philip Moeller - PBS Making Sense - 2/14/18
Seemingly overnight, big changes to Medicare morphed from being an item on various congressional wish lists into reality as part of last week’s budget deal, diverting me on my way to this week’s reader questions.
The Congressional Budget Office’s estimate of the financial impact of the budget deal includes five pages of detailed health care changes, and I suspect there are others that have yet to be reported. However, the law has already been signed by President Trump, so whether these are good changes or not is moot for the time being.
Medicare’s Independent Payment Advisory Board has been killed. It was authorized by the Affordable Care Act to serve as a check on higher Medicare expenses. It was quickly labeled a death panel by opponents and became such a lightning rod that no board members were ever named.
The rules for Medicare’s Part D drug plans were changed. The much-maligned coverage gap (or donut hole) in these plans has been shrinking for years under the Affordable Care Act, and was supposed to end in 2020, at which time consumers in the gap would pay no more than 25 percent of the costs of their drugs. That end date was moved up a year to 2019.
Consumers who have spent a lot on drugs and have entered the so-called catastrophic phase of Part D plans will pay no more than a few dollars for each prescription or, for costly drugs, no more than 5 percent of the cost of the drug. While this percentage will not change, the responsibility for paying the other 95 percent of the cost will be borne even more heavily by the government, and is expected to save pharmaceutical companies billions of dollars. Taxpayers, of course, ultimately will be on the hook for those higher government expenses. It’s a more significant if largely invisible change.
Medicare’s caps on covered expenses for outpatient therapy have been officially repealed. People with persistent therapy needs have bumped against these caps for more than 20 years, and Congress has regularly eased those rules. While claims above current cap levels may be subject to review, people who legitimately need extensive therapy will not have to depend on year-to-year congressional fixes.
Medicare’s high-income premium surcharges will carry even more of a bite for wealthier enrollees. Those making more than $500,000 a year ($750,000 for couples) will pay 85 percent of the actual costs of Part B and D in 2019, up from 80 percent this year. Most Medicare enrollees pay premiums that equal about 25 percent of these costs.
Congress also made numerous and potentially far-reaching changes to the rules for Medicare Advantage plans. That includes allowing such plans to pay for limited long-term care expenses – something that until now has not been covered by Medicare.
If this wasn’t enough, the Trump administration finally seems ready to make good on its repeated commitment to do something to lower high prescription drug prices for Medicare beneficiaries. The Council of Economic Advisers issued a report late last week laying out many ideas.
The White House reportedly will back a plan to permit those on Medicare to share in substantial discounts that drug manufacturers currently pay to Medicare drug insurers. People with commercial health insurance regularly get manufacturer discounts, which can save them thousands of dollars a year on costly medications. Medicare prohibits such manufacturer discounts, and while pharmaceutical companies do provide hefty discounts to Part D insurers, they are not passed along to consumers.
Part D insurers generally oppose the change, saying that the industry currently uses the discounts to subsidize Part D premiums, and that all consumers would face sharply higher premiums if discounts were shared with the relatively small number of consumers who need expensive medications.
The Trump budget also proposes removing even the 5 percent that people in the catastrophic phase of their drug plan must pay, permitting them to get their drugs for free. While this would be a great deal for the million or so people who spend that much money on prescriptions, other elements of the proposal would raise out-of-pocket spending for other people with Part D plans.

 For the Senior Citizens of today, Medicare can be very difficult for them to understand (myself included). What is paid for and what is not. Generally, it isn't until they get their bill that they finally realize what they must pay. I am on Medicare myself and I think my monthly out of cost pocket is about $109.00/month. I believe I am enrolled in Part D.

 When I was no longer covered under my work contract insurance after retirement, it was suggested to me that I go to a local city run/senior citizens building to talk to an official regarding what is right for me. I needed advice on what supplemental insurance and prescription plan would be best for me. I was joined by another retired member as well, who had the same concerns.

 We both met with a woman who specialized in that field. She was GREAT. She advised us to bring in all of our current prescriptions that we take and then she compared everything to get the best deal for each of us. What she found for us was a plan to supplement our Medicare coverage at the best price. She ended up saving us a couple of hundred dollars each and every month.

 It didn't cost us ONE PENNY for her expert advise. The guy who sent us there was also a retired member we worked with, who had very high medical expenses himself being treated for cancer. 

 What I say here might be a little off topic. But I just wanted to pass on some advice that not only helped me, but others as well.


My friend's monthly Social Security benefit went up by 2% and the Medicare deduction from his monthly Social Security increased by over 20 per cent. 


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