Plano health insurance recipients will soon experience indefinite coverage for various therapy and drug prescription treatment included in their Medicare coverage.
Due to a recent revision in federal law, Plano health insurance recipients of Medicare will no longer have annual caps on physical, occupational and speech therapy. Included in the federal budget that was passed and signed by President Trump in February, the provision has the potential to alleviate health and financial burdens for millions of Americans.
Medicare, the federal health insurance program for older and disabled adults, typically had placed annual limits on the amount Medicare would pay out for various drug and therapy treatment. For example, after reaching approximately $3,750, a patient’s out-of-pocket cost for prescription drugs would dramatically increase to 35%. Under the new law, the yearly expense cap has been raised to $5,000 and patients only pay 5% thereafter.
With therapy treatments, the positive news is that Medicare health insurance in Plano would allow patients to have indefinite coverage. As long as the physician (or in some cases a physician assistant) approves the continued therapy, the patient will be able to have Medicare pay for the treatment. This modification applies to people in traditional Medicare as well as those with private Medicare Advantage policies.
“This is certainly something that most health insurance professionals have been asking for and welcome. Elderly patients will be able to continue to receive critical therapy treatment and not have to worry about how they will pay for it,” states Rick Thornton, a Plano health insurance agent. The gap between Medicare reimbursement and self-pay is commonly referred as the “donut hole”. The modifications to the law has stipulated that coverage gap will be reduced to 25 percent by 2019.
In addition, due to a 2013 settlement patients with chronic diseases such as Amyotrophic lateral sclerosis (ALS) cannot lose therapy coverage provided by private Medicare plans. By 2020, certain benefits, which may include equipment and various therapies would allow recipients to remain in their homes instead of entering nursing homes or utilizing costly emergency room visits. As a result, quality of care is expected to increase while simultaneously reducing overall costs. Premiums may also fall given the drug plans would not need to cover as much under the previous requirements. The changes will only cover beneficiaries in private plans, approximately one-third of the Medicare population.
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