Bipartisan Budget Act of 2018 and Medicare

The Bipartisan Budget Act of 2018 (BBA) passed on February 9, 2018. Included in this budget are some changes to Medicare, for both better and worse.

How these changes will impact Medicare beneficiaries is essential information for those enrolled in Medicare. As well as for those who are aging into the program over the next few years.

Planning for medical expenses above and beyond what Medicare covers is an important step in making sure healthcare is available as needed into our 70’s, 80’s and beyond.

Bipartisan Budget Act of 2018 and Medicare

The BBA extends funding for outreach programs for low-income Medicare recipients who may not have all the information they need to get the full benefits of Medicare and its supplemental programs.

This funding is allocated to State Health Insurance Assistance Programs (SHIPS), Area Agencies on Aging, Aging and Disability Resource Centers and the National Center for Benefits and Outreach Enrollment.

These organizations are excellent sources of information and can help seniors and their families to understand and utilize Medicare for their health care and other needs related to aging.

Rehabilitative Therapy

The law repeals the payment cap on outpatient physical, occupational, and speech therapies effective January 1, 2018.

The law also makes changes to the medical necessity review process for these services, which will make it easier to obtain therapy. Both of these changes are permanent.

Bipartisan Budget Act of 2018 will Impact the Donut Hole

Bipartisan Budget Act of 2018

How the Bipartisan Budget Act of 2018 will impact Medicare and the donut hole

The “donut hole,” which is the coverage gap in the Medicare Part D prescription drug plan, will decrease to 25% in 2019 instead of 2020.

This decrease occurs because Congress required some pharmaceutical companies to cover more of the expense for Medicare recipients who fall into the coverage gap.

The amount of brand-name drug manufacturers will pay increases from 50% to 70% under the BBA.

In-Home Care

Participants in the Independence at Home Demonstration Program increases from 10,000 to 15,000 people. This program keeps those who are homebound and unable to get to a doctor’s office for baseline care from relying on emergency room visits due to their limitations.

The Independence at Home Demonstration Program is especially helpful for medication management for those who are living alone.

Chronic Illness

The BBA expands the care for those with chronic illness on the Medicare Advantage program to cover not only health-related expenses but life-enhancing ones as well, allowing for those with chronic illnesses to live more comfortably and with better day-to-day function.

Speech Devices

The BBA ensures that speech devices, which are used by those unable to communicate verbally due to illness, are covered as durable equipment under Medicare. Speech devices are a lifeline for those who cannot talk.

Focus on Telehealth

Focus on Telehealth

Using technology for communication is a priority in the 2018 BBA Access to Telehealth services is improved, and the program extends by two years.

Under the changes, a Medicare recipient’s home or living space is an is considered an allowable origination site for Telehealth treatment.

Location limitations for Telehealth services go away under the new guidelines.

Downsides of the 2018 BBA and Medicare

Less Help with Enrollment Questions

The process of enrolling in Medicare, purchasing supplemental coverage and understanding how the sometimes- complicated Medicare system works can be difficult for even the most educated and informed consumer.

The BBA does not include the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, which modernizes and simplifies the Medicare Part B enrollment process.

Increase in Payments

The amount that those with high incomes ($500,000 individual, $750,000 couples) must pay for Medicare Part B and Part D premiums rises from 80% to 85%.

A Decrease in Prevention

The Prevention and Public Health Fund will see decreases in money of $1.35 billion over ten years beginning in 2024. The focus of this fund is on prevention of disease, falls and other medical problems that beset older Americans. It is also focused on the early detection of illnesses.

Follow the Money Funding

The Money Follows the Person (MFP) program has been instrumental in helping those on Medicare and Medicaid to transition out of institutional care and back to home-based living.

By redirecting assistance to community-based programs instead of institutional ones, seniors were given a chance to integrate back into the community instead of living in long-term-care facilities. The BBA does not extend the program.

Staying informed and up-to-date about programs, funding and available services through Medicare is essential to the health and safety of seniors.

Family members and caregivers should also be well informed. Information is available through and other community-based resources. Supplemental insurance plans are needed to bridge the gap between deductibles and benefits.

Let your congressional representative know what you think about the 2018 BBA and what you’d like to see changed in the future.

Seniors have a lot of power in their numbers and should use their voices to let the government know what matters to them regarding their healthcare.

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