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How the Inflation Reduction Act Will Help All Americans Save on Healthcare

The weekend of August 6, Senate Democrats passed the Inflation Reduction Act of 2022. This legislation will help keep some of President Biden’s campaign promises, some of which are related to healthcare, like lowering the costs of prescription drugs. The revised bill is now set to be sent to the House, and if it passes as expected, it will be a massive win for Biden and the Democrats. Find out how the Inflation Reduction Act will affect you and your healthcare.

Passing the Inflation Reduction Act

The Inflation Reduction Act, which was negotiated as a result of Democratic Senator Joe Manchin’s opposition to the proposed Build Back Better Act, has finally been agreed to by all 50 Democratic senators. All 50 Republican senators opposed the bill, but Vice President Kamala Harris cast the tie-breaking vote, allowing the bill to pass in the Senate.

The bill will now be returned to the House, where the Democratic majority there is expected to approve it. It will then move on to President Biden for his signature. Biden himself lauded the compromise bill.

“Senate Democrats sided with American families over special interests, voting to lower the cost of prescription drugs, health insurance, and everyday energy costs and reduce the deficit while making the wealthiest corporations finally pay their fair share,” Biden said in a statement Sunday. “I ran for President promising to make government work for working families again, and that is what this bill does — period.”

Funding for the bill will come from raising taxes on some corporations that make over 1 billion dollars annually. There will be a 1% excise tax on the value of corporate stock buybacks, which Democrats are hoping will curtail some of these buybacks, since they produce capital gains but no immediate taxes. There has also been talk of giving more funding to the IRS to go after tax cheats.

What the Inflation Reduction Act Means for Medicare

In addition to fighting inflation, investing in domestic energy production, and fighting climate change, the bill also has provisions for helping make healthcare more affordable for Americans, especially seniors.

Medicare beneficiaries have been battling the cost of prescriptions for a long time, but this bill will allow Medicare to finally negotiate prices on prescription drugs. Once this bill passes, Medicare will be able to directly negotiate with drug companies, which will help lower the cost of medications and cap out-of-pocket drug costs for seniors.

For example:

Beginning next year, insulin copayments for Medicare recipients will be capped at $35 a month
Starting in 2024, those with costs high enough to qualify for the program’s “catastrophic coverage” benefit will no longer have to pick up 5% of the cost of every prescription
Starting in 2025, out-of-pocket costs for prescription medicines will be capped at $2,000 annually.

“This a huge policy change and one that has been a long time coming,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. “For people needing high-cost drugs, this will provide significant financial relief.”

What the Inflation Reduction Act Means for Healthcare

On March 11, 2021, President Biden signed the American Rescue Plan Act, which expanded healthcare coverage and lowered healthcare costs by boosting subsidies for Affordable Care Act (ACA) plans. It allowed those who earn over 400% of the federal poverty level to receive subsidies to purchase health insurance through the ACA Marketplace. It also required that Americans pay no more than 8.5% of their income on health insurance premiums, and provided a larger tax credit to people who already receive financial assistance.

person in a suit holding a white piggy bank — *You can save more money by working with an EZ agent to find an affordable plan for all of your needs.*

All of this was set to expire after 2 years, however, meaning by 2023 we would no longer be able to get the expanded subsidies and tax credits. But the Inflation Reduction Act will allow all Americans to continue to get subsidies for Affordable Care Act (ACA) premiums!

Looking For A Plan?

Whether you are a Medicare beneficiary looking to save money, or an individual looking for affordable health insurance, EZ can help. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free – our services come at no cost to you because we just want to help you save money so you can focus on your health. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207 for Medicare help, and 888-350-1890 for health insurance help.

How Does Medicare Handle ALS Coverage

Amyotrophic Lateral Sclerosis (ALS) affects as many as 30,000 Americans in any given year. The risk of ALS increases with age, most commonly developing in those between the ages of 40 and mid-60s. So, since an estimated 51% of people who have it are older than 70 years, it’s important to understand how Medicare covers this disease, in case it affects your life.

ALS Explained

ALS, also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. Around 5 to 10% of all ALS cases are familial, meaning they have been inherited from a parent. The familial form usually only requires one parent to be a carrier of the disease, which is caused by mutations in more than a dozen genes.

ALS will often start in the hands, feet, or limbs, and then spread to other parts of the body, and will usually begin with muscle twitching, weakness, or slurred speech. As it advances, nerve cells are destroyed, creating weaker muscles that will eventually affect chewing, swallowing, speaking, and breathing. Unfortunately, there is no cure for ALS.

Risk Factors

Family members with the disease- 5-10% of people with ALS inherited it from a parent.
Age– Risk increases with age; diagnosis is most common between the ages of 40 and mid-60s.
Sex- More men under the age of 65 develop ALS than women in the same age group, but after age 70, the difference between the sexes disappears.
Genetics– Some studies examining the entire human genome have found many similarities in the genetic variations of people with familial ALS and some people with non-inherited ALS
Smoking

ALS & Medicare

If you are diagnosed with ALS, no matter if you’re 65 or not, you can enroll in Medicare once you are also receiving Social Security disability benefits. In the past, if you were younger than 65 and were diagnosed with ALS, you were required to undergo a 5-month waiting period to get your Medicare and SSDI benefits. As of July 23, 2020, though, people with ALS no longer have to wait five months, and are eligible for automatic enrollment into Medicare Parts A and B the first month they receive SSDI.

Extra Coverage Options

If you’re a Medicare enrollee with ALS, you can choose a Medicare Part D Plan when you become eligible for Medicare, which will help with the cost of prescription drugs. But, you also have the option of purchasing a Medicare Supplement Plan, which can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Medicare Patients With Blood Cancer Face High Costs That May Impact Treatment

September is Blood Cancer Awareness Month. We wanted to talk about this important topic this month especially because, according to a new report from the Leukemia and Lymphoma Society, while survival rates for older patients with blood cancers have been improving, rising healthcare costs have meant that less than half of newly diagnosed patients are receiving treatment for their cancer. And as with any cancer, early treatment is crucial to beating the disease. Find out how Medicare helps those who are dealing with blood cancer, and what patients can do to make the cost of treatment less of a barrier to receiving care.

What the Study Shows

The study mentioned above analyzed costs that are incurred by Medicare beneficiaries who have been newly diagnosed with acute leukemia, chronic leukemia, lymphoma, multiple myeloma, and bone marrow disorders, and found that older patients are at a disadvantage when it comes to the cost of care.

“Along with the substantial healthcare costs associated with the treatment of patients with blood cancer comes substantial OOP [out-of-pocket] costs for patients,” the researchers wrote in the report. “In particular, because of the Medicare Part A, B, and D benefit design, the OOP burden can be greater for Medicare beneficiaries compared to commercially insured patients.”

In fact, when expenses were the highest (generally in the month patients were diagnosed), the average amount spent by patients, depending on the type of blood cancer, was anywhere from almost $18,000 to $178,000.

These greater costs mean older adults aren’t getting the care they need. Of Medicare beneficiaries who are newly diagnosed with blood cancer, only 43.7% of them receive therapy within 90 days of receiving their diagnosis.

“In addition to the emotional impact of dealing with a blood cancer, patients and families often face extraordinary costs in the first year after diagnosis and beyond,” Louis J. DeGennaro, Ph.D., LLS president, and chief executive officer, said in a statement. “The Leukemia & Lymphoma Society hopes that the findings from this new study will prompt payers, providers, patient advocates, and policymakers to work together to address the financial burdens for patients.”

Medicare Coverage

Medicare helps pay for many of the expenses incurred when diagnosing and treating blood cancers, such as leukemia. But Medicare Part B, which covers the costs of cancer prevention and treatments, only covers 80% of these costs. This will leave you with the remaining 20% to pay out-of-pocket, but there is help. You can enroll in a Medicare Supplement Plan to help cover these costs. A Medicare Supplement Plan can help you pay the medical expenses that aren’t covered by Medicare Part B, helping you save hundreds, or maybe even thousands of dollars each year.

Medicare Supplement Plans can cover your Part A deductible and coinsurance costs, as well as your Medicare Part B copayment, coinsurance, and deductible. There are 10 different plans to choose from, and depending on which plan you choose, you could get anywhere from 75% coverage of your medical expenses up to 100%. Each plan offers a range of coverage at different price points; if you are battling cancer, your best option is to get the plan with the most coverage possible, so you will only have to worry about paying your Medicare Supplement Plan monthly premiums.

Medicare Supplement Plans can help save you money and keep you from stressing over medical bills for your cancer treatments, leaving you with more time and energy to focus on your health. EZ can compare all 10 Medicare Supplement Plans and find the one that will meet your financial and medical needs. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free – our services come at no cost to you because we just want to help you save money so you can focus on your health. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.

What Isn’t Covered in Medicare’s Annual Wellness Visit

If you’re new to Medicare, you might be a little confused about what is covered by Medicare and what isn’t. But it’s very important to understand your coverage, because assuming a visit or treatment is covered when it isn’t could mean receiving a surprisingly large bill in the mail. For example, as a Medicare beneficiary, you can see your doctor every year for an annual wellness visit, but some things are not covered during this visit. Find out what isn’t covered so you can avoid an unexpected bill.

What Can You Expect at an Annual Wellness Visit?

If you’ve had Medicare Part B for longer than 12 months, you can get an annual wellness visit. This wellness visit isn’t a physical exam; it’s meant to help you create or update a personalized health plan for preventing disease and disability, based on your current health and risk factors.

During your annual wellness visit, your doctor will ask you to fill out a questionnaire called a “Health Risk Assessment,” so they can develop a more personalized prevention plan for you. They will also:

Review your medical and family history.
Review your current providers and prescriptions.
Check your height, weight, blood pressure, and other routine measurements.
Offer personalized health advice.
Provide a list of risk factors and treatment options for you.
Create a screening schedule (like a checklist) for appropriate preventive services, and give you details about coverage for screenings, shots, and other preventive services.
Provide advance care planning

Your doctor will discuss your health and any changes in your household, and work together to create a personal health plan for the year ahead.

What Is Not Covered?

Sick visits– If your time with your doctor involves a discussion of an illness or symptoms, and your doctor recommends care or a treatment plan, you will be charged a copay and/or have to meet your deductible.
Chronic illnesses– Your visit will not cover any discussion, treatment, or prescription of medications for chronic illnesses or conditions, such as high blood pressure, high cholesterol, or diabetes. If it does, you will be charged a copay and/or a deductible.

Extra Coverage

gold piggy bank — *If you want to save more money, then consider looking into a Medicare Supplement Plan, which can save you thousands each year.*

So, while your Medicare annual wellness visit is an excellent tool for keeping you healthy, there are important things that it doesn’t cover. Not only that, but in general, Medicare Part B will only cover the cost of any services or treatments you receive at 80%, leaving you to pay the other 20% out-of-pocket. This can get quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

CMS Proposes New Medicare Payment Adjustment for Home Healthcare

The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a permanent payment adjustment to the home healthcare 30-day period payment rate. The change would decrease Medicare payments to home health agencies by $810 million next year. Home healthcare providers have concerns that this will put the stability of home healthcare at risk, and are pushing a new bill to hold off any payment reductions until 2026. Because these pay cuts would mean home healthcare providers would lose a lot of their funding, home healthcare agencies would lose staff and more, which would ultimately affect Medicare beneficiaries’ care.

The New Proposal

CMS is proposing a new Medicare payment adjustment under the Home Health Prospective Payment System. The adjustment would decrease payment rates to home healthcare providers and facilities by 4.2%, or $810 million, compared to 2022 rates.

Providers Not Happy

Home healthcare providers are arguing that the proposal does not take into account multiple factors, such as increased home healthcare labor costs and the high inflation rate.

“We are very disappointed in the CMS proposed rule issued today,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), wrote in a comment shared with Home Health Care News. “The stability of home health care is at risk as a consequence of CMS proposing the application of a fatally flawed methodology for assessing whether the PDGM payment model [Patient-Driven Groupings Model, which uses 30-day periods as a basis for payments] led to budget neutral spending in 2020. That has been made clear to CMS in the 2021 rulemaking and in multiple discussions since.”

blue boxing gloves — *A new bill that would prevent CMS from reducing home health payments until 2026 was introduced in the Senate.*

“With significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of the proposed rate cut,” Dombi said. “Reliable analyses prove that PDGM underpaid home health agencies. We will be taking all steps to protect the home health benefit as this proposed rule advances and have fully prepared for congressional action and more.“

Fighting Back

With pay cuts like this, home health agencies will be underpaid, which could result in fewer workers to help care for Medicare beneficiaries who need home healthcare. But a new bill that would prevent CMS from reducing home health payments this year – and until 2026 – was introduced in the Senate on July 25.

“The bill is set up so that CMS is blocked from reducing payment rates until 2026,” Dombi told Home Health Care News. “And the purpose of that, essentially, is to create what we hope is an opportunity to correct where CMS is at in terms of their methodology. And to deal with even some of the questions around transparency relative to the data that we’ve asked for.”

Are Plastic Surgeries Covered by Medicare?

When you think of plastic surgery, the Kardashians or a Real Housewife of some random city probably come to mind, but what they’ve actually had is cosmetic surgery. There is a difference between the 2 and if you have Medicare, the good news is one of them may be covered.

Plastic Surgery vs. Cosmetic Surgery

bare back — Medicare will cover breast reconstruction after breast cancer surgery.

Plastic surgery is a procedure performed because it’s medically necessary. That means you need it for medical reasons to improve the health or function of your body. Plastic surgery is sometimes referred to as reconstructive surgery. You may need plastic surgery for medical reasons after an accident, infection, tumor, malformation of a body party or other disease, such as breast cancer. Some examples of medically necessary plastic surgery covered by Medicare include treatment for severe burns, facial reconstruction following a car accident, or a breast reconstruction after a partial or full mastectomy. Cosmetic surgery is a type of plastic surgery used to enhance the natural features of the body. Surgeons generally perform cosmetic surgery to reshape normal structures of the body to improve your appearance or enhance your self-esteem. These are generally not covered by Medicare. If you’re looking to get a breast lift, facelift, neck lift, or chemical peels covered, you’re out of luck because those are considered cosmetic and are not medically necessary.

Cosmetic Surgery for Medical Reasons

Medicare may pay for a cosmetic surgery if you need it for medical reasons but you must obtain prior authorization. This means your doctor must send a prior authorization request to Medicare for approval before performing the procedure. If Medicare approves the request, you’ll pay your Medicare Part A and/or B deductible and coinsurance costs, depending on the setting of your plastic surgery, such as inpatient or outpatient. Some examples of cosmetic surgeries that may be considered medically necessary are botox to treat muscle disorders or a nose job to correct structural nose defects that affect your breathing. An eyelid surgery to remove excess tissue around your eye that may be impairing your peripheral vision would probably qualify as medically necessary as well. Only your doctor can determine whether your procedure is medically necessary so be sure to have a thorough conversation with them before going through with a procedure.

Find a Medicare Supplement Plan

eye surgery — Medicare Supplement Plans may help cover costs of certain types of plastic surgeries.

There are many reasons why you might need or want plastic surgery. Luckily Medicare Parts A and B may cover plastic surgery if you need it for medical reasons. If your plastic surgery is covered by Medicare, you may be able to find a Medicare Supplement Insurance plan that helps pay for some of your Medicare copays, deductibles and more and EZ can help. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.

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