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  • Category Congressional Corner Page 8

    The Centers For Medicare and Medicaid Services (CMS) recently announced a bold new model to save money and improve healthcare quality by changing the way the government pays doctors. The Administration is taking steps to ensure that, by 2018, up to half of all payments to doctors won't be for visits and procedures, but rather for providing "high quality" care. The plan is to pay doctors on how they perform. .The Senate bill also would change Medicare Part D by adding an out-of-pocket maximum for beneficiaries of ,100 starting in 202No such out-of-pocket cost cap currently exists. According to our 2019 Senior Survey, about one-in-five survey participants report out-of-pocket spending this high for prescription drugs. Advisor editor Mary Johnson estimates that this legislation would protect almost 14 million Medicare beneficiaries from out-of-pocket drug costs exceeding ,100 in the first year of enactment if signed into law. .This week, three new cosponsors – Reps. Bradley Schneider (IL-10), Matt Cartwright (PA-27), and Andre Carson (IN-7) – signed on to Rep. Peter DeFazio's (OR-4) Consumer Price Index for Elderly Consumers (CPI-E) Act (H.R. 1030). The cosponsor total is now up to eighteen. If signed into law, Rep. DeFazio's bill would base the Social Security cost-of-living adjustment (COLA) upon the spending patterns of seniors. Currently, it's based upon the way young, urban workers spend their money – a method that underestimates the spending inflation that seniors experience each year. … Continued

  • S 64 Preserve Access Affordable Generics Biosimilars Act

    Insurers make major changes in their plans every year, like increasing premiums, co-pays, dropping coverage and even closing plans altogether. But according to a survey conducted by TSCL earlier this year, less than 18 percent of respondents said they switched their Part D or Medicare Advantage health plan for 201Medicare's annual Open Enrollment period starts earlier this year -- on October 15th -- and ends December 7th. Medicare beneficiaries should start the process now to find out what their choices are and how much they could save with a new Part D or Medicare Advantage plan. .What are the waiting periods and exclusions? You can find dental plans that cover two cleanings and check-ups a year, but it's not uncommon for dental plans to require a year or two waiting period before covering basic fillings, or crowns and implants. Some plans will not cover pre-existing conditions, so if you are switching dentists and you are in the middle of getting bridge work done, the new dental plan may not cover prior dental work in progress. .Recent healthcare cost data have the experts perplexed. According to a new analysis from actuaries of the Centers of Medicare and Medicaid Services, national healthcare spending in 2011 grew at just 3.9 percent. This is the third consecutive year it's grown so slowly, making it the slowest pace in the more than 50 years such data have been tracked. Federal officials don't know for sure if it's a temporary fluke due to prolonged recessionary effects, or part of a long-term trend. … Continued

As far as the other three orders are concerned, it has been reported that consumers may not notice immediate changes since the orders must be carried out by the federal bureaucracy and could face court challenges. .TSCL agrees that lawmakers must take action soon to stabilize the individual health insurance market and to bring down skyrocketing prescription drug prices. In the coming months, our legislative team will continue to monitor and support legislation like the Improving Access to Affordable Prescription Drugs Act (S. 771, H.R. 1776), which would reduce costs and improve care for older Americans. For updates on this bill and others like it, visit the Bill Tracking section of our website or follow TSCL on Twitter. .TSCL has been concerned that the coronavirus pandemic could accelerate the impending insolvency of the Medicare Trust Fund. With record numbers of Americans out of work, fewer payroll taxes are coming in to fund Medicare spending. At the same time, the number of beneficiaries is rising and, earlier this year, Congress accessed Medicare's reserves to fund COVID-19 relief efforts. .Unlike the experience of the general public who access state or federal health care exchanges to choose coverage, the choices offered to Members of Congress are dramatically different than those from many other parts of the nation. For 2017, Members had 57 plan options in "Gold" plans alone on the DC shop exchange. In many areas of the nation, particularly rural ones, Gold plans aren't even available. Unlike the Silver and Bronze level plans, Gold plans have lower deductibles, and cover 80% of costs with patients paying only 20%. Silver plans, for example, typically come with deductibles ranging from ,500 - ,000, and pay 70% of costs while patients pay the other 30%. And in some areas of the country, people are happy if they have a choice of more than six silver plans. Certain parts of the country have only one. .On Thursday, lawmakers in the House and Senate advanced a two-week stopgap measure to keep the federal government operating past Friday, December 7th. President Trump had not yet signed it into law at the time of writing this week's legislative update, but he is expected to do so before the midnight deadline. As a result, lawmakers have an extra fourteen days to reach a deal to avoid another government shutdown on December 21st. .Set up a healthcare worksheet with your basic expenses. That can include Medicare premiums for Part B (deducted from your Social Security), Medicare supplement premiums and Part D premiums OR Medicare Advantage premiums. You also need to include deductibles, out-of-pocket co-pays or co-insurance. In addition, include the costs for premiums or out-of-pocket costs for services that Medicare does not cover, including dental, vision and audio. Include the cost of glasses and hearing aids and batteries if you use them. .The majority of seniors aged 65 who get Social Security depend on it for at least 50 percent of their income. Average benefits today only total about ,200 a year. .Our legislative team was pleased to see the Protecting Seniors' Access to Medicare Act advance out of the Ways and Means Committee this week, and we will be sure to monitor its progress as it moves to the House floor. Leaders expect it to be taken up during the week of June 15th, and it is expected to pass there with bipartisan support as well. For updates on the status of H.R. 1190, visit the Legislative News section of our website. .As your mom moves through stages of Alzheimer's, she will need more care over time. The medicines used to treat Alzheimer's only control symptoms, such as memory loss and confusion, but cannot cure the disease. The symptoms inevitably will get worse and because of this, eventually your mom will need more help than you can supply at home.