The Bipartisan Budget Act of 2018 — What Does It Do For Medicare??

The Bipartisan Budget Act of 2018…
…contains several provisions related to healthcare, of which we are going to be most interested in those affecting Medicare. Here is a list of the most important provisions for Medicare beneficiaries::
  1. The “donut hole” will reduce to the final step-down percentage a year ahead of schedule, in 2019, instead of 2020. Part D originally had a 100% cost share responsibility for beneficiaries in the gap. Since 2011, we have seen a gradual reduction in the cost sharing amount a beneficiary has to pay for both generics and brand name drugs once they enter the coverage gap in Part D plans . In 2018, for someone getting into the gap, the share is 44% for generics, and 35% for name brands, with a manufacturer’s discount on certain brand name drugs of 50%. Starting on January 1, 2019, the cost share percentage for both categories of medications will be 25%.
  2. In addition, the Act dictates that the percentage of brand names drugs discounted by the manufacturer will rise from 50% to 70%.
  3. Means testing:: as I’ve explained in previous editions of my Medicare newsletters, the means testing tiers were compressed on January 1, 2018, with the next effect sweeping more people into paying higher premiums for both Parts A & D. This was due to legislation that was included in the MACRA act of 2015. Beginning in 2019, IRMAA (income-related monthly adjustment amount) will add another tier. For those with income of greater than $500,000 (individuals) or $750,000 (couples), with see even higher IRMAA amounts.
  4. A type of Medicare Advantage plan, called SNPs, or Special Needs Plans, were permanently authorized, along with an expansion for chronic illness SNPs.

Other provisions address continuation of value-based reimbursement models from 7 to 15 states; elimination of the exclusion of biosimilar drugs in the gap from the pharmaceutical company discount program; improvement and expansion of the competitive bidding process for durable medical equipment which should benefit testing supplies for diabetics;  and a variety of administrative updates.

There is nothing further about what will happen to the Part D payment schedule after 2019.

A bit of advice for 2019 planning:: in 2019, the means testing process will look back at the adjusted gross income from your 2017 tax returns. If you haven’t filed your taxes for 2017 yet, it may be prudent to do some tax planning to keep your income as low as possible anticipating the adjusted IRMAA tiers in 2019. For instance, were you planning to take some capital returns for the 2017 year that might push you above the present tiers, and you had the opportunity to redirect some of that income, it might allow you to avoid higher Parts B & D premiums in 2019. Consult your tax planning CPA or attorney for more planning options.

Tips & Notes!!

The Tax Law of 2017

News::  If you have access to a copy of the Wall Street Journal for 2/14/2018, look for a special section on the tax reform law passed by Congress late in 2017. The add-on details the various elements of the tax law are detailed. A very useful read! If you are a subscriber, they have also published an 80 page pamphlet on the tax law that you can either download or order a hard copy. Make sure you are looking at a version that is updated no earlier than 2/28/2018.

News::  Recently you may have seen a lot of commentary about funding issues for Medicare that are also within the Bipartisan Budget Act of 2018. As I am writing this newsletter, I noted a post from AARP decrying budget “cuts” included within the Act. I will note that similar “cuts” of several hundreds of millions of dollars were also passed under the previous administration (the Bipartisan Budget Act of 2015, for instance). This has to do with trying to control cost increases and not creating real cuts in spending.

Tip:: Last time I posted a table of dental coverage types. Did you get a chance to look it over? If you’d like it sent to you individually, drop me a line.

If you’d like to interact more personally, please subscribe on the home page. I am licensed in 16 states and should b able to help you and your friends in most places.