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Medicare Beneficiaries Might Have to Pay Thousands More for Therapy

1/27/2018

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AARP calls on Congress to repeal limits on physical, speech, occupational treatmentsby Dena Bunis, AARP, January 24, 2018

Millions of Medicare beneficiaries who need physical, speech or occupational therapy to help them recover from strokes or deal with chronic illnesses will have to pay thousands of dollars more for that care unless Congress acts soon.
For two decades, Medicare has capped how much it will pay for physical, speech and occupational therapy. But ever since the limits were imposed, Congress has passed an automatic exception that allows Medicare to pay for care beyond the caps when the treatments are deemed medically necessary.
The latest exception expired Dec. 31, which means the caps of $2,010 for physical and speech language therapy and $2,010 for occupational therapy are now being enforced. These services fall under Medicare Part B, which covers doctor visits and other outpatient services. When the exceptions were in place, Medicare beneficiaries paid only the 20 percent coinsurance that Part B requires.
Without the exceptions, Medicare beneficiaries must pay the entire therapy bill once they exceed the threshold. According to AARP, some beneficiaries with high-cost conditions could reach the annual caps in the coming weeks.
AARP is part of a coalition of provider, consumer and advocacy organizations urging Congress to repeal the therapy caps. “The caps prevent beneficiaries from receiving the rehabilitation care they need from therapists in a timely fashion,” Joyce Rogers, AARP senior vice president for government affairs, wrote in a December letter to Senate Finance Committee leaders. “Delaying or reducing care can diminish an individual’s independence in his or her home and community.” 
The caps apply to the therapy that Medicare covers whether delivered in a provider’s office, a patient’s home or an outpatient therapy center. It’s very common for someone who has had a stroke or a hip or other fracture to need intensive therapy to learn how to speak and walk again or feed themselves. Patients who suffer from conditions such as arthritis, Parkinson’s disease or multiple sclerosis also often need therapy to manage the tasks of everyday living.
According to a recent analysis commissioned by the American Occupational Therapy Association, nearly 6 million Medicare beneficiaries accessed outpatient therapy services in 2015. Of those, nearly 1 million required care that exceeded the combined cap on physical and speech therapy, while nearly 250,000 surpassed the occupational therapy threshold. 
Without rehabilitation care, more older Americans won’t be able to maintain their independence, making them more likely to move into a nursing home or face frequent and costly hospitalizations.
“The level of anxiety among patients, their families, caregivers and providers is definitely rising,” says Justin Elliott, vice president of government affairs for the American Physical Therapy Association. “Every day the caps are in place they’re going to potentially reach it and not get the care they need.” 

Click her for AARP Article

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Talking Points for Addressing the Tax Bill and the Individual Mandate

1/2/2018

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a Larkin

Senate Republicans recently approved the repeal of Obamacare’s individual shared responsibility penalty as part of the 2017 reconciliation act. While the tax cut does not repeal the individual mandate itself, it zeros out both the dollar amount and percentage of income penalties imposed by the mandate.
The details of the repeal may be confusing for your clients, so we have put together a resource of talking points to simplify the repeal and what it means, sourced from a recent article from Health Affairs:
  • Both houses of Congress have now voted to repeal the Affordable Care Act’s (ACA) individual shared responsibility penalty, effective for 2019, as part of the 2017 tax reconciliation act.
  • Individuals remain responsible for having insurance or paying the penalty for the 2017 filing season and for 2018.
  • The IRS announced it will reject electronic filings of 2017 tax returns that do not claim coverage or an exemption or include payment of the penalty.
  • Important:  the individual mandate was not repealed.  Section 5000A of the individual mandate provides the legal requirement for individuals to purchase minimum essential coverage even though the penalty for not doing so has been repealed.
  • Employers providing “minimum essential coverage” must still report info to the IRS for the covered individuals and provide evidence of coverage to the individual or be subject to penalties if they fail to report.
  • Provisions for individuals to apply for exemptions from the mandate (to exchanges or the IRS) are still in place but it’s unlikely that individuals will apply for exemptions after the penalty is repealed in 2019.
  • There are two employer mandate penalties that remain in place:
    • a penalty imposed on employers who fail to offer minimum essential coverage to full-time employees if any employee receives premium tax credits to enroll in coverage through an exchange, calculated on a per-employee basis for all full-time employees; and
    • a larger penalty imposed on employers who offer minimum essential coverage but fail to offer “minimum value” coverage, which applies to each full-time employee who in fact receives premium tax credits for exchange coverage.
  • Premium tax credits will continue to keep coverage affordable for consumers with incomes below 400 percent of the poverty level.
  • Coverage will continue to be available to all consumers regardless of preexisting conditions.
  • Premiums will not depend on health status, and a risk adjustment system will penalize insurers who attract primarily healthy enrollees.
  • The remaining eight titles of the ACA remain operative, including provisions closing the Medicare donut hole.
http://www.crnstone.com/news/talking-points-for-addressing-the-tax-bill-and-the-individual-mandate/
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    Benefits Specialist, emphasis on Healthcare and  Long Term Care Insurance

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