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Medicare and the Budget Deal
Old 02-10-2018, 06:01 AM   #1
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Medicare and the Budget Deal

The recently passed budget deal includes the following provisions.

Section 53116. Closing the Donut Hole for Seniors. This section would accelerate the closure of the Part D program coverage gap, the phase known as the “donut hole” where beneficiaries are responsible for a greater portion of their prescription drug costs, with the beneficiary contribution decreasing to 25 percent of prescription costs in 2019, instead of 2020 under current law. In addition, it would increase the percentage that a drug manufacturer must discount the cost of prescriptions in this phase from 50 percent under current law to 70 percent, with the plan responsible for 5 percent, starting in 2019, thus reducing federal spending. The 70 percent manufacturer discount would continue to count toward beneficiary true out of pocket cost as under current law.

Section 53114. Adjustments to Medicare part B and part D premium subsidies for higher income individuals. This section would, starting in 2019, increase the percentage that beneficiaries with a modified adjusted gross income (MAGI) of at least $500,000 ($750,000 for a couple filing jointly) pay in Part B and Part D premiums from 80 percent to 85 percent. It would freeze this new income threshold through 2028, at which point the threshold would be indexed to inflation.

Section 50202. Repeal of Medicare payment cap for therapy services. This section would permanently repeal the annual payment limits (“caps”) for outpatient therapy services, including physical therapy, speech- language pathology services, and occupational therapy, beginning January 1, 2018.

References: Summary of Provisions Relevant to the National Committee in the Budget Deal/Continued Resolution

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Old 02-10-2018, 06:49 AM   #2
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Interesting- I get regular e-mails from AARP urging me to contact my local member of Congress and advocate for or against various things and if I remember, they were going to cap Medicare outpatient therapy services. Maybe enough people complained that they backed down.

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Old 02-10-2018, 01:57 PM   #3
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This is good news for me as I had rotator cuff surgery last October and my therapist indicated I'd be running up against the therapy payment cap soon. Looks like that won't be a problem now.
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