News

  • Legislative Update Week Ending April 21 2017

    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. .Even though Medicare recipients getting these services may stay in the hospital overnight or longer, getting the same nursing care, lab tests and drugs as they would if inpatients, their bill will be calculated very differently. Patients admitted for in-patient stays usually are responsible for the Medicare hospital deductible of ,484 for a stay of up to 60 days. They may also pay 20% of doctor charges. Many people have Medigap or Medicare Advantage plans that cover much or even all of this expense. Outpatient services, on the other hand, are charged differently, with the patient paying 20% of the Medicare approved amount for each service. In addition, the new billing changes would hit patients with "facility fees" that can run up to several thousand dollars to cover hospital overhead charges. And since, prescription drug plans don't cover medication for hospital patients, beneficiaries would be charged 100% of the full retail cost of drugs they need, even those they normally routinely take at home. .We could, alternatively, allow Medicare to negotiate drug prices — a proposal that has been raised by politicians and beaten back by industry again and again. We would then need to restrict markup for a COVID-19 vaccine for the private market. Otherwise, we would get the kinds of results emerging from the COVID testing industry, where Medicare pays 0 for the test but some labs charge insurers over ,000. … Continued

  • Seniors Need Better Benefit Boost

    (Washington, DC) – Older Americans are not to blame for an exploding federal budget deficit warns The Senior Citizens League. "Congress can't cut taxes by an estimated .7 trillion and then turn around and blame rising deficits on ‘entitlements' and aging," says Mary Johnson, a Social Security and Medicare policy analyst for The Senior Citizens League. .While the cost of the prescription is affordable, the drug causes a number of serious side effects. Susan needs to see her doctor more frequently for monitoring and blood tests. Her biggest prescription cost surprise was learning that her prescription vitamin, folic acid, which she needs to fight the side effects, was not covered under Medicare. Her Part D plan wanted 0.00 for a one-month supply. Susan instead orders an over-the-counter supply of 400 pills for .99 on Amazon, taking 7 pills every day to get to the required dosage, which is still not as effective as the prescription version of folic acid. Now her doctor is considering a different medication. .TSCL believes that these two provisions unfairly reduce the earned benefits of millions of seniors each year. We were pleased to see support grow for the Social Security Fairness Act this week. … Continued

Two Social Security Reforms That Seniors Strongly Support .So far, many accomplishments have made the first session of the 113th Congress a memorable one for TSCL. To read more about our latest efforts, check out our Legislative Updates. .Only twice in the history of Medicare was the therapy cap actually implemented. In 2003, the cap was set at ,500 until the cap was once again halted from being implemented that same year. Then earlier this year the cap briefly went into effect again. Congressman Erik Paulsen (MN-3) introduced the Medicare Access to Rehabilitation Services Act of 2017, a bill that would repeal the therapy cap permanently. This bill gained the bipartisan support of 240 cosponsors in the House of Representatives and TSCL was proud to endorse and build support for this piece of legislation. .Services must be those that have earned an "A" or "B" recommendations by the U.S. Preventive Services Task Force. They include: annual wellness visit, blood tests for heart disease, bone mass measurements, diabetes screening, colon cancer screening, diabetes screening, flu shot, hepatitis B vaccine, medical nutrition therapy, pap smears, pelvic exams and clinical breast exams, pneumonia vaccine, prostate cancer screening (PSA test), and screening mammograms. .When a Senate vote is tied, the Vice President, who the Constitution designates as the President of the Senate, can cast the tie-breaking vote, which is exactly what happened. .Those receiving work authorization become vested for benefits with as little as ten years of earnings. The oldest of those who are eligible for the deferred action could potentially have worked illegally long enough to be "vested," or nearly so, for Social Security already — including disability benefits. Once illegal workers gain a work-authorized Social Security number, individuals who have evidence of earnings, even for jobs worked under invalid Social Security numbers, may claim and reinstate those earnings under their own number. The earnings are then later used to determine Social Security benefits. .In yet a third judicial ruling, The U.S. District Court of Appeals for the District of Columbia upheld a rule by the Trump Administration that hospitals will have to publicly disclose the prices they negotiate with insurance companies. ."Reducing the cost of prescription drugs is essential for both Medicare beneficiaries and Medicare's finances," says Mary Johnson, a Medicare policy analyst for The Senior Citizens League (TSCL). The average monthly Social Security retiree benefit is just ,552, while spending on prescription drugs is the fastest growing cost that most retirees face in retirement," she says. Over time, drug costs take a growing portion of Social Security income, because prices are rising several times faster than annual cost of living adjustments (COLAs). .As we foresaw last week, Congress was not able to finish its work by the end of the day last Friday and had to pass two continuing resolutions (CR) in order to give themselves more time. The current CR runs through next Monday, the 28th.