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Some Important Changes 2009-2010
- In late 2009, the Centers for Medicare and Medicaid Services (CMS) began implementing new rules for Prescription Drug Plans in connection with sales and marketing. In the past, aggressive and sometimes misleading marketing has worsened an already confusing selection process. The new rules may help. Some new rules may also reduce out of pocket expenses for some participants.
- Cuts in physician payments that were to be implemented in 2009 were avoided, and replaced with a very small increase.
- Effective in 2010, the value of an applicant's insurance and of in-kind support and maintenance from third parties will not be included as resources in calculating resource limits for eligibility for the Low Income Subsidy (Prescription Drug Plans)
- Effective in 2010, the method of calculating covered mental health treatment will have the effect of reducing the patient's 50% copayment by 6.25%. The reduction process will continue for annually so that effectively, copayments for mental health services will be in parity with those of other medical treatments by 2014 (copayments for other types of services and treatments are 20%).
- As of 2010, Medicare is to identify categories of drugs and require that all drugs in those categories that are Part D drugs be included in the formularies (lists of drugs covered) of all plans. Such classes will be expected to meet certain criteria. The six "protected classes" (drugs most often prescribed for seniors) should meet those criteria. Any exceptions must also meet certain criteria.
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