News
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Benefit Bulletin September 2012
In addition, one new cosponsor signed on to the Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act (H.R. 2305). The new cosponsor is Rep. Tim Walberg (MI-7), and the total now sits at sixty-six. If signed into law, the PRIME Act would take a number of steps to comprehensively prevent fraud, waste, and abuse within the two programs – a problem that TSCL believes must be addressed in order to ensure that scarce program dollars are being spent properly. .In 2016 your Part B premium would be 1.80 per month if your family income is under 0,000. (If income is higher beneficiaries pay higher Medicare Part B and Part D premiums.) In addition you will need to decide whether to purchase a Medigap supplement and enroll in a Part D plan for drug coverage, or to enroll in a Medicare Advantage plan that includes Part D coverage. .Medicare Advantage plans have somewhat different costs. If the stay is considered observation care, however, that is covered under Medicare Part B, which means you will have a copayment for each individual outpatient hospital service. In addition, Part B doesn't cover most prescription drugs that are received in an outpatient setting. Perhaps even more importantly, the lack of inpatient status also disqualifies you from receiving Medicare-covered care in a skilled nursing facility or nursing home. … Continued
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Legislative Update For Week Ending September 11 2015
WWII Vets Break Through Shutdown Barriers .There is no simple, direct mechanism for regulators or legislators to control pricing. Our laws, in fact, favor business: Medicare is not allowed to engage in price negotiations for medicines covered by its Part D drug plan. The Food and Drug Administration, which will have to approve the manufacturer's vaccine for use as "safe and effective," is not allowed to consider proposed cost. The panels that recommend approval of new drugs generally have no idea how they will be priced. .TSCL looks forward to working with these veteran lawmakers, along with new Representatives and Senators, on the following issues in the 114th Congress: … Continued
TSCL has been working with Rep. Larson the past few years to expand Social Security benefits, strengthen the Social Security Trust Fund and correct the flaw in the way annual COLAs are determined. We look forward to his reintroduction of the Social Security COVID-19 Correction and Equity Act. .The Medicare Prescription Drug Price Negotiation Act (H.R. 275), which was introduced by Congressmen Peter Welch (VT) and Francis Rooney (FL-19), would require the federal government to negotiate lower Medicare Part D prices on behalf of Medicare beneficiaries. .Mail order can also help you save if your drug plan is increasing co-pays or drug costs, dropping coverage or making similar changes for 201Orders placed by December 31, 2011 will be filled by your 2011 drug plan mail order pharmacy, and covered at the costs when you place your order your prescription in December. .Before the Affordable Care Act, seniors could deduct out-of-pocket medical costs that exceeded 7.5 percent of their Adjusted Gross Income (AGI). Starting in 2017, however, the law increases this threshold to 10% of a person's AGI – effectively lowering how much can be deducted at the end of the year and increasing how much seniors will pay in taxes. .TSCL Calls On Congress To Close The Loop Hole .Although immigration law forbids work without authorization, immigrants do find jobs, and the majority of employers report their earnings to SSA. Each year SSA receives hundreds of millions of W-2s. When the name and Social Security number (SSN) do not match SSA's records, the W-2 is held in the Earnings Suspense File (ESF). Recent data indicates that in recent years the ESF is growing at an unprecedented pace and the cumulative wages represented is now 5 billion. These wages can later be reinstated to valid Social Security numbers when immigrants gain work authorization. Because earnings are used to determine both the number of quarters of coverage worked for insured status, and the initial retirement benefit, this poses a substantial liability to the Social Security Trust Fund and would worsen its solvency. .And no matter what critics may say about the dire finances of the Social Security, the government can find the money for Notch Reform simply by cutting waste, fraud and abuse. The General Accountability Office reported earlier this year that government agencies made over billion in improper payments in fiscal year 200Forty-five billion would more than pay for a Notch settlement. TSCL estimates the cost of the Notch Fairness Act to be around billion. .CMS said in a press release that this change is to provide patients and their doctors more options and to lower costs by promoting more competition among hospitals and independent surgical centers. But while these surgeries will be removed from the inpatient-only list, the government did not approve any of them to be performed anywhere else. Patients will still have to get care at hospitals but, because these services have been reclassified, they will be billed under Medicare Part B as outpatient services, instead of Medicare Part A for hospital services. Medicare beneficiaries pay a bigger share of the costs under Part B, than under Part A for an inpatient stay, and those costs would also drive up Medicare Part B premiums in the future. .Normally it would seem logical that a bi-partisan bill would have a very good chance of passing in the Senate, but these are not normal times. In fact, four of the five Republican Senators whose offices we visited this week, and who are on the Finance Committee, voted against their own chairman's bill. The five Senate offices we met with were Scott (SC), Thune (SD), Toomey (PA), Alexander (TN), and Burr (NC). We picked these Senators because all are members of at least one of the committees that any bill to lower drug costs would have to go through.
