News
-
Benefit Bulletin May 2015
Specialty-tier drugs are defined by Medicare, as those that cost more than 0 per month in 2019, and include drugs used to treat cancer, hepatitis C, multiple sclerosis (MS), and rheumatoid arthritis. Even when Part D enrollees reach the Medicare Part D catastrophic coverage phase, when co-insurance drops to 5%, beneficiaries who take these drugs can continue to face thousands of dollars in annual out-of-pocket costs, according to the Kaiser study. The study found that annual out-of-pocket costs for specialty drugs in 2019 are expected to average ,994 across the 28 specialty-tier drugs that are covered by drug plans. .While the policy will mean that Medicare would spend less, patients will spend more— often, a lot more, and the charges would broadside most beneficiaries, coming as a complete surprise. TSCL is strongly opposed to this type of backdoor benefit cut, and has written a letter to President Biden urging him to rescind this CMS rule. Please sign our petition! .It closed the Medicare outpatient therapy cap. Before the passage of the Bipartisan Budget Act, Medicare coverage for various forms of outpatient therapy – including physical therapy and speech therapy – was arbitrarily capped at ,500 per year. For years, lawmakers sought to repeal this cap since it limited the care older Americans could receive under Medicare. TSCL advocated tirelessly for Congressman Erik Paulsen's (MN-3) bipartisan Medicare Access to Rehabilitation Services Act (H.R. 807), and we were thrilled that a similar provision was included in this year's bipartisan budget agreement, repealing the therapy cap once and for all. … Continued
-
Video Out Of Cola
Other Legislation Also Targets Scams and Fraud Against Seniors .TSCL would like to thank the following for taking time out of their busy schedules to discuss the issues that matter most to our members and supporters: Rep. Paul Cook (CA-8), Rep. John Lewis (GA-5), Justin Lawson (Legislative Assistant for Rep. Gloria Negrete McLeod (CA-35)), Claire Cozad (Legislative Assistant for Rep. Paul Cook (CA-8)), Kalina Bakalov (Legislative Assistant for Rep. Tammy Duckworth (IL-8)), and Thomas Dorney (Legislative Assistant for Rep. John Lewis (GA-5)). .The Social Security Notch is the unexpectedly steep drop in benefits that affects people born from 1917 through 192This generation of seniors receives lower benefits than other seniors who had nearly identical work and earnings histories. … Continued
Representative Peter DeFazio (OR-4) introduced H.R. 1170 on February 13, 201It has since been referred to the Committee on Ways and Means. .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. .Call your local State Health Insurance Assistance Program (SHIP) and ask for free counseling from a Medicare counselor. You can find local contact info here: https://www.shiptacenter.org. Many of these programs operate through local agencies on aging or senior services departments. Counselors can help you over the phone from home. .For information about town hall meetings near you in the days ahead, call the local offices of your elected officials. You can find contact information for your Members of Congress right here. .Congress and President Obama are battling over the federal budget, but supporters in Congress aren& 8217;t about to forget Notch Babies. The Notch Fairness Act bills (H.R. 155) and (S.90) were introduced by Representative Mike McIntrye (NC-7) and Senator David Vitter (LA). They were among the first bills to be re-introduced in. TSCL Continues Working For Notch Reform TSCL has not given up our goal of Notch reform. In recent months we have been working with long-term Notch reform allies in Congress to ensure that Notch Babies& 8217;, needs are protected from deficit reduction plans that would affect people who are currently retired. .I would like to know how, at this point, you project a Social Security COLA at 6.1%. Inflation would have to continue on an upward path through September for that to happen. — R.Q., NJ . Check to see if Eliquis is covered by your drug plan and the cost sharing for the tier in which it is listed. Many drug plans have five tiers covering preferred generics, generics, preferred brands, non-preferred brands and specialty drugs. Check to see where Eliquis fits in on these tiers (probably preferred or non-preferred brand). It's not uncommon for insurers to move a drug from preferred brand to non-preferred brand status, causing you to pay more out-of-pocket. For example, your plan in 2019 may have charged a co-pay of for preferred brands, but if Eliquis was moved into a non-preferred tier in 2020 you might have to pay 50% co-insurance or about 5.00. .Every day approximately ten thousand people reach their retirement age. Many have spent a lifetime working to care for their families and save for retirement all while paying federal taxes. The taxes paid into Social Security and Medicare have helped make these programs successful for past generations of retirees. .One of TSCL's goals this year was to end "surprise billing" – the situation that happens when some types of medical providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your health insurer even though they provide services at a hospital or facility that is in your health plan's provider network. So, in addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and the amount the provider billed for their services.
