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How President Trump Is Delivering Results on Drug Prices

May 30, 2019By: Alex Azar, Secretary of the Department of Health and Human Services

Summary: Americans have heard politicians talk about high drug prices for years. It’s one of the main problems in health care that both President Donald Trump and I, as his health secretary, have talked about a great deal too.

This op-ed originally appeared in The Kansas City Star on May 30, 2019.

Americans have heard politicians talk about high drug prices for years. It’s one of the main problems in health care that both President Donald Trump and I, as his health secretary, have talked about a great deal too.

But the Trump administration isn’t offering up just talk — we’re delivering results. In December for the first time in 46 years, the official government measure of inflation in drug prices actually dropped for all of 2018. More than a dozen companies last year cut their prices, froze prices or rolled back price increases.

One year ago, the president and I stood in the White House Rose Garden to announce the American Patients First blueprint - PDF, a more ambitious to plan bring down drug prices than ever put forward by any administration. In the past year, we have delivered on that blueprint, producing more changes to drug pricing than any American president has ever taken.

One big change was just announced in May. Starting in July, drug companies will be required to include the list prices of their drugs in TV ads.

Now, when you see a prescription drug ad, it won’t just be drug companies telling you to consult your doctor about a drug, with no idea how much it might cost. Before you go pay for an appointment, you’ll know whether the price of the drug you heard about is $50, or $5,000 — and the company setting the $5,000 price will start to think twice about it.

Putting prices in TV ads is the most significant step any president has ever taken to back up this clear promise: You, as American patients, have a right to know the price of a drug or health care service before you receive it.

That is just one piece of our plan for bringing down drug prices. The president’s blueprint promised tougher negotiation, more competition, lower list prices and lower out-of-pocket costs. In just the last year, the president has delivered on all four goals.

We have approved record numbers of low-cost generic drugs, in part by cracking down on ways that drug companies cheat the system for approving generics. That included the first-ever approvals of a generic competitor to the EpiPen and a generic competitor for a common asthma inhaler.

We brought new negotiation tools to Medicare Advantage. Plans have already used these tools to choose lower-cost biosimilar options , cutting costs for patients while providing the same quality care.

The president signed legislation banning pharmacy gag clauses, which prohibited pharmacists from telling you the best deals for the medications you need. We’ve also required that every Medicare Part D plan offer a tool to allow your physician and you to find out your coverage options and out-of-pocket costs for drugs before they’re prescribed.

We have also proposed a plan to change the incentives that have driven drug prices higher and higher at the pharmacy counter by replacing a broken system of kickbacks with discounts delivered to patients.

These plans to keep bringing down drug prices are a contrast to legislative proposals for a total government takeover of health care. We will equip you with the knowledge you need to get your medications at a price that works for you — while preserving access to options. In socialist systems, the patient isn’t part of the picture. It’s government bureaucrats deciding which drugs patients have access to.

We believe the right way to bring down drug prices, and bring down health care costs overall, is to put patients in control. As Trump recently said, “no American mom or dad should lay awake at night worrying about the hidden fees or shocking unexpected medical bills.” We are working to deliver transparency in the pricing of hospital services, and have proposed a way for you to have seamless access to your health records at no cost. We’ve also laid down principles for how Congress should put an end to the abusive practice of surprise billing.

Under President Donald Trump, we’re finally moving from a system where patients are left in the dark to where patients are in the driver’s seat. That is the way Trump will deliver American patients the health care he’s promised them: with the affordability they need, the options and control they want and the quality they deserve.

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Ready for the Big Blue Button?

MyMedicare.gov's Blue Button makes it easy for you to download your personal health information to a file. The Blue Button is safe, secure, reliable, and easy to use. You can use the Blue Button to:

Download and save a file of your personal health information on your computer or other device

Print or email the information to share with others after you’ve saved the file

Import your saved file into other computer-based personal health management tools

What's Blue Button 2.0?

Medicare’s Blue Button 2.0 lets you connect your Medicare health information to other services you trust, like:

Applications (apps)

Computer-based programs

Research programs

Blue Button 2.0 gives you a wide range of options to manage and improve your health. Options might include things like:

Using an app to keep track of the regular tests and services you need based on your personal health information. The app can send you reminders when it’s time to schedule your next appointment.

Using an app or other computer program to track your health over long periods of time. This can help you and your doctor make better decisions about your health.

Using an app to organize your health information in an easy-to-read format, like charts and graphs. This can help you keep track of important information, like your medicines, allergies, or results of lab tests.

Connecting your data to research projects. Researchers can use your data to expand their knowledge about a range of health issues.

How do I download & share my health information?

Log into MyMedicare.gov. Look for the Blue Button as you search claims, and view your "On the Go Report".

Select the Blue Button to create a downloadable file with your MyMedicare.gov information.

Select the information you want to download, and select "Submit".

Save the file to your computer as either a PDF or a TXT file.

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The Penalty for Not Having Health Insurance Ends October 2 (Not for Everyone – Just Most People)

The Penalty for Not Having Health Insurance Ends October 2 (Not for Everyone – Just Most People)

By Jeff Smedsrud

Officially, the Obama-era penalty for not having health insurance ends on December 31, 2018. The penalty is 2.5% of your household taxable income. For someone with $100,000 of taxable income, that would equal $2,500.

But under the Affordable Care Act, an individual can go three months without having coverage and not pay the penalty. That means that those who are covered under an ACA plan could drop their plan on October 2, and not pay a penalty for the remainder of the year.

And — by the way — the Trump administration just announced that starting October 2 you can buy a short term medical (STM) plan for up to 364 days of coverage, and be renewed for up to 36 months. Just a coincidence? Let the political pundits argue that one.

How Short Term Health Insurance Can Save Money

But what does this mean for consumers (and to advisors and brokers who serve them)?

For some individuals, they are money ahead by dropping their ACA (Obamacare) plan. However, short term health insurance plans are only for those in relatively good health, pre-existing conditions may apply, and coverage is “good” but not “great.” It is not as comprehensive as ACA plans.

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Where do I find my 1095 tax form?

Q: What are the tax forms associated with health insurance, and where do I get them? A: There are three different forms that are used by exchanges, employers, and health insurance companies, to report health insurance coverage to the IRS.

It’s tax time, this is a pretty helpful link...

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Short Term Medical Enrollments

STM Enrollment Reminder: As a reminder, effective April 1, short-term medical policies can only be written for a period of time less than 3 months. This is consistent with regulations finalized by the Federal government in June 2016. Customers purchasing short-term medical plans may not repurchase the same plan from the same company when their current short-term medical plan ends. The regulations do not prohibit consumers from purchasing a different short-term medical plan from the same company or one from another company. Customers who have a qualifying life event may be eligible to enroll for coverage under the Affordable Care Act as part of a special enrollment period.

If you have questions as always give us a call at 765-746-6459 ​

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Has the ACA helped?

Gallup released the current numbers for uninsured Americans, unfortunately the numbers don’t lie, and President has to acknowledge at some point the ACA is not securing more people with health insurance than before its implementation in 2013. The availability of affordable short term health care plans are providing Americans with more affordable options, even with paying the fine for not having “creditable coverage”. Most Republican plans suggest that allowing private insurance companies to offer competitive plans with an “a la carte” approach to benefit selections. This would allow people to spend their money on the befits that are most important to them and allow the market and competition for business keep the cost down for consumers. 

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IRS Wraps Up the "Dirty Dozen" List of Tax Scams for 2016

As we come into the last of the tax season here are the TOP 12 scams according to the IRS...

IR-2016-29, Feb. 19, 2016

WASHINGTON — The Internal Revenue Service today wrapped up its annual "Dirty Dozen" list of tax scams with identity theft topping this year's list but with phone scams and phishing schemes also deserving special mention. Taxpayers need to guard against any ploys to steal their personal information, scam them out of money or talk them into engaging in questionable behavior with their taxes.

During the past year, as part of the Security Summit initiative, the IRS partnered with states and the tax industry to enhance coordination and create a more secure system for taxpayers. Participants now regularly share details of fraudulent schemes detected so both industry and government can provide increased protection. Many enhancements are invisible to taxpayers.

"We are working hard to protect taxpayers from identity theft and other scams this filing season," said IRS Commissioner John Koskinen. "Taxpayers have rights and should not be frightened into providing personal information or money to someone over the phone or in an email. We urge taxpayers to help protect themselves from scams — old and new."

This is the second year the IRS has highlighted its Dirty Dozen list in separate releases over 12 business days. Taxpayers are encouraged to review the list in a special section on IRS.gov and be on the lookout for these scams. Many of these con games peak during filing season as people prepare their tax returns or hire someone to do so.

The IRS this week also renewed a consumer alert for e-mail schemes after seeing an approximate 400 percent surge in phishing and malware incidents so far this tax season. (IR-2016-28)

Perpetrators of illegal scams can face significant penalties and interest and possible criminal prosecution. IRS Criminal Investigation works closely with the Department of Justice to shut down scams and prosecute the criminals behind them. Taxpayers should remember that they are legally responsible for what is on their tax return even if it is prepared by someone else. Be sure the preparer is up to the task. For more see the Choosing a Tax Professional page.

Here is a recap of this year's "Dirty Dozen" scams:

Identity Theft: Taxpayers need to watch out for identity theft especially around tax time. The IRS continues to aggressively pursue the criminals that file fraudulent returns using someone else’s Social Security number. Though the agency is making progress on this front, taxpayers still need to be extremely careful and do everything they can to avoid being victimized. (IR-2016-12)

Phone Scams: Phone calls from criminals impersonating IRS agents remain an ongoing threat to taxpayers. The IRS has seen a surge of these phone scams in recent years as scam artists threaten taxpayers with police arrest, deportation and license revocation, among other things. (IR-2016-14)

Phishing: Taxpayers need to be on guard against fake emails or websites looking to steal personal information. The IRS will never send taxpayers an email about a bill or refund out of the blue. Don’t click on one claiming to be from the IRS.Be wary of strange emails and websites that may be nothing more than scams to steal personal information. (IR-2016-15)

Return Preparer Fraud: Be on the lookout for unscrupulous return preparers. The vast majority of tax professionals provide honest high-quality service. But there are some dishonest preparers who set up shop each filing season to perpetrate refund fraud, identity theft and other scams that hurt taxpayers. Legitimate tax professionals are a vital part of the U.S. tax system. (IR-2016-16)

Offshore Tax Avoidance: The recent string of successful enforcement actions against offshore tax cheats and the financial organizations that help them shows that it’s a bad bet to hide money and income offshore. Taxpayers are best served by coming in voluntarily and getting caught up on their tax-filing responsibilities. The IRS offers the Offshore Voluntary Disclosure Program (OVDP) to enable people catch up on their filing and tax obligations. (IR-2016-17)

Inflated Refund Claims: Taxpayers need to be on the lookout for anyone promising inflated refunds. Be wary of anyone who asks taxpayers to sign a blank return, promises a big refund before looking at their records, or charges fees based on a percentage of the refund. Scam artists use flyers, advertisements, phony store fronts and word of mouth via community groups where trust is high to find victims. (IR-2016-18)

Fake Charities: Be on guard against groups masquerading as charitable organizations to attract donations from unsuspecting contributors. Be wary of charities with names similar to familiar or nationally-known organizations. Contributors should take a few extra minutes to ensure their hard-earned money goes to legitimate and currently eligible charities. IRS.gov has the tools taxpayers need to check out the status of charitable organizations. (IR-2016-20)

Falsely Padding Deductions on Returns: Taxpayers should avoid the temptation of falsely inflating deductions or expenses on their returns to under pay what they owe or  possibly receive larger refunds. Think twice before overstating deductions such as charitable contributions and business expenses or improperly claiming such credits as the Earned Income Tax Credit or Child Tax Credit. (IR-2016-21)

Excessive Claims for Business Credits: Avoid improperly claiming the fuel tax credit, a tax benefit generally not available to most taxpayers. The credit is generally limited to off-highway business use, including use in farming. Taxpayers should also avoid misuse of the research credit. Improper claims generally involve failures to participate in or substantiate qualified research activities and/or satisfy the requirements related to qualified research expenses. (IR-2016-22)

Falsifying Income to Claim Credits: Don’t  invent income to erroneously qualify for tax credits, such as the Earned Income Tax Credit. Taxpayers are sometimes talked into doing this by scam artists. Taxpayers are best served by filing the most-accurate return possible because they are legally responsible for what is on their return. This scam can lead to taxpayers facing big bills to pay back taxes, interest and penalties. In some cases, they may even face criminal prosecution. (IR-2016-23)

Abusive Tax Shelters: Don’t use abusive tax structures to avoid paying taxes. The IRS is committed to stopping complex tax avoidance schemes and the people who create and sell them. The vast majority of taxpayers pay their fair share, and everyone should be on the lookout for people peddling tax shelters that sound too good to be true. When in doubt, taxpayers should seek an independent opinion regarding complex products they are offered. (IR-2016-25)

Frivolous Tax Arguments: Don’t use frivolous tax arguments in an effort to avoid paying tax. Promoters of frivolous schemes encourage taxpayers to make unreasonable and outlandish claims Even though they are wrong and have been repeatedly thrown out of court. While taxpayers have the right to contest their tax liabilities in court, no one has the right to disobey the law or disregard their responsibility to pay taxes. The penalty for filing a frivolous tax return is $5,000. (IR-2016-27)

Additional information about tax scams is available on IRS social media sites, including YouTubehttp://www.youtube.com/irsvideos and Tumblr http://internalrevenueservice.tumblr.com, where people can search “scam” to find all the scam-related posts.

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Obama proposal to revamp Part B faces more opposition

Recently STAT reported the Obama administrations plan to revamp  the Part B reimbursement for drug coverage administered in a doctor’s offices or hospitals.

Their plan was to reimburse doctors the average sales price for drugs administered, 2.5 % percent of the sales price, and a flat fee of $16.80. Currently, doctors are receiving the average sales price plus 6%. The new arrangement is supposed to take away the incentive for doctors to prescribe the higher cost drugs, but the reality is it will prevent them from prescribing drugs that might be more effective in order to avoid loosing money. 

Once again when politicians involve themselves in health care the consumer looses. 

The Insurance Lady

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Social Security...changing the rules again.

Married couples will have fewer claiming options.

By Friday, April 29, 2016—about six months after the bill’s signing—people who have not yet filed for Social Security benefits will no longer be able to use the program’s “file and suspend” rule. This claiming strategy has permitted one member of a married couple to file for Social Security, thereby enabling a husband or wife to file for a spousal benefit. (Or other family members to file for ancillary benefits.) The spouse, meanwhile, could suspend his or her own retirement benefit, which then could grow due to delayed retirement credits by 8% a year. The changes also will end the ability of anyone born in 1954 or later to file what’s called a restricted application and collect only a spousal benefit while letting their own retirement benefits rise by 8% a year for up to four years, until age 70. Instead, filing for spousal benefits will be deemed by Social Security to also trigger a person’s own retirement benefit. The agency will pay only an amount that is roughly equal to the greater of the two benefits. Right now, deeming only applies to benefits claimed before age 66, but the new law will eventually extend it to older filers as well.

Find out more options here:

http://time.com/money/4105571/new-social-security-claiming-rules/

TheInsuranceLady

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2016 Parts A & B Premiums and Deductibles Announced...

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.

for the full story and the rest of the 2016 numbers visit here :

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-11-10.html

The Insurance Lady

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Obamacare the penalty?

Time and time again I have heard folks say, “i’ll just pay the penalty” but each year that penalty has increased. This year the penalty is $695 per adult and $347.50 per child or 2.5% of your income which ever is higher. 

Many are already getting “sticker shock” from higher than expected tax bills with one going viral as they posted online their IRS bill for $2344. 

http://dailysignal.com/2015/10/16/indiana-man-says-irs-fined-him-2344-for-violating-obamacares-individual-mandate/

Be sure to weight your options and know what YOUR fine may be this year by seeing an actual licensed insurance agent in your state with knowledge and experience. 

The Insurance Lady

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Medicare Part B increase not as big as forecast…

Maybe it’s just because it’s an election year or maybe we just got lucky, but we dodged one yesterday when the House voted on and passed the new budget agreement. Both democrats and republicans say they each got “something” but both aren’t thrilled about the deal, which is possibly a good sign. The potential 52% increase in part b premiums was reduced to 14% instead, but also includes a $3 surcharge on top of the 14%. The new rate will be $120.70 + $3 for 2016, although those that are paying more for part B for income reasons will still can see significant increase to $168 to $384, the official numbers for them have yet to be released. 

The Insurance Lady

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Social Security Tip: Claim and suspend

How it works: Normally, you have to be collecting Social Security payments before your spouse can claim spousal benefits. But if you have reached FRA (age 66), you can file for your benefits and then suspend them until a later date. Then, your spouse can start receiving spousal Social Security checks based on your work history, as long as he or she 62 years of age, and the value of your future benefits keeps rising.

Whom it may benefit: This strategy works best for couples with very different earnings histories, where the higher-earning spouse would like to keep working, and the lower-earning spouse wants to retire and would be better off with the spousal benefit than his or her own.

Example: Suppose Brooks (in the chart at right) has reached his FRA of 66 and is eligible to receive $2,000 a month. His wife Helen is 62 and will collect $750 a month when she reaches her FRA of age 66. If Helen retires at age 62, because she will be claiming benefits early, she will get only $563 a month based on her own work history. But if she claims spousal benefits based on Brooks’ earnings, she'll get $700 a month.

Brooks claims benefits now, but suspends taking them for himself until he is age 70 so his wife can draw spousal payments right away. If he then lives to age 86 and she lives to age 88 (average expectancies, given their current ages), this strategy in our hypothetical example will add more than $26,000 to Helen’s lifetime benefits, increasing the total value of her payments by about 12%.

Get the entire story here : https://www.fidelity.com/viewpoints/retirement/social-security-tips-for-couples

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The Insurance Lady

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Legislation Introduced to Avert Medicare Premium Spike

This week, leadership in both the House and Senate sounded alarms about the potential spike for Medicare premiums next year. On Wednesday, Senate Finance Committee Ranking Member Ron Wyden (D-OR) introduced S. 2148 and in the House Representative Dina Titus (D-NV-1) introduced H.R. 3696, legislation to avoid the projected 52% increase in Medicare Part B premiums that would impact 15 million beneficiaries (roughly 30% of Medicare beneficiaries) in 2016. Premiums and deductibles are expected to spike due to a projected 0% cost of living adjustment (COLA) and the affected beneficiaries will face increased costs from being excluded from a rarely-used “hold-harmless” policy. The legislation would hold 2016 premiums constant for the excluded group at the 2015 level of $104.90 (instead of an increase to $159.30) and maintain the deductible for all beneficiaries at the 2015 threshold of $147 (instead of the increase to $223).

Medicare’s “hold-harmless” provision is designed to ensure that beneficiaries will not have a reduction in their monthly Social Security benefit, by ensuring that the dollar increase in the Part B Medicare premium cannot be more than the dollar increase of a beneficiary’s monthly Social Security benefit. Certain beneficiaries are statutorily excluded from the “hold-harmless” provision, particularly those eligible for both Medicare and Medicaid (“dual-eligibles”) who make up two-thirds of the excluded group, as well as new beneficiaries, high-income beneficiaries, and Medicare beneficiaries who do not receive Social Security. This could be especially harmful for Medicare-eligible individuals who delay Social Security until a later age and could be hit with this increase.

This issue also came up in 2010 with a smaller projected increase for those excluded from the hold-harmless group. Similarly, legislation was introduced in both chambers, and while the House overwhelmingly passed their bill by a vote of 406 to 18, the Senate never took up the legislation and the premium and deductible increases went into effect in 2011.

Wish us LUCK!

The Insurance Lady

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We live and breath this....

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Find and compare Medicare Health Plans, Prescription Drug Plans and Medigap Policies in your area.

You REALLY do need to check every year that all of your current drugs will still be covered by your current drug card next year. As some drugs become eligible to be generic, or more affordable drugs for your condition become available, some companies will pull a more expensive drug from it’s formulary. You may find out the hard way come January 1st that your drug is no longer covered. To find out what card is best for you in 2016 call, email, or follow the link above to check 2016′s drug card options!

The Insurnace Lady

https://rleeinsurancesolutions.com 

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Medicare, Part B Premiums, and the “Hold Harmless Provision”

Something you should consider in the coming days when figuring your health insurance budget for 2016. On April 16th, 2015 the President signed into law H.R. 2, the “Medicare Access and Chip Reauthorization Act of 2015″. 

It provides for extended funding for several gov’t. programs but the biggest change it provides for is the permanent funding of the “Doctor Fix”. Doctors had been facing an accumulated annual rate reduction in Medicare reimbursements that threaten to reduce their reimbursement for services from Medicare by nearly 30%. This came with no small price tag and, to offset the $210 billion dollar price tag, Medicare was seeking an across the board rate increase for part B premiums. 

Enter Section 1395r(f) of the Medicare code, which simply put denies Medicare the right to raise Part B premiums to folks that do not get a COLA raise that same year. The rub here is it only protects those that have their Part B premiums deducted from the SSI check directly each month, about 70% of Medicare folks fall into this category. 

Who could see a rate increase in Part B premiums? New enrollies into Medicare as of Jan.1st, individuals that already pay more because of higher incomes, Medicare/Medicaid dual eligible folks, and folks that do not pay their Part B premiums directly from their SSI check each month. 

How much more? the CMS has not determined 2016′s new rate for part B premiums they are projecting a “possible” rate increase from the current $104.90 to as much as $159.30, unless congress steps in to ease the blow on an election year this could be a huge increase over recent years. Until we get the official number stay tuned!

The Insurance Lady

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