Changes in Medicare Coverage and Treatments in 2016

The last few years have seen quite a bit of change in Medicare costs, due in part to Obamacare, as well as other economic factors. It's important and necessary to keep up on changes in Medicare, if you or a loved one is receiving benefits.

Whether these changes will benefit you or not, it's good to stay informed so that you can make the right decisions. You don't want to suddenly realize that you have to pay a lot more for your medication after the start of the new year.

New Therapy Cap Limits

Medicare Part B is what covers things like occupational therapy, speech therapy, and physical therapy, as long as they are deemed medically necessary. Most outpatient health care providers have limits on these services, which are referred to as "therapy caps" or "therapy cap limits".

The new therapy cap limits for 2015 are $1,940 for physical therapy and speech-language pathology combined. The 2016 cap for these services is $1,960. The numbers are the same for occupational therapy, as well.

If your doctor can prove it medically necessary that you continue to use these services, you can get an exception beyond these therapy caps. This means Medicare will continue to pay for your therapy the way they were before.

To get an exception, your doctor must come to the conclusion that it is medically necessary, and properly document this in your medical record. They'll also have to indicate this medical necessity on your Medicare claim.

There is another, higher limit to these services known as “thresholds”. The threshold amounts for 2015 and 2016 are $3,700 for physical and speech therapy combined, and the same for occupational therapy. If you require these services beyond the threshold, a Medicare contractor will review your medical records to make sure they meet the medical necessity standards.

Changes in Medicare Drug Plans

Changes were made to Medicare Part D drug policies, resulting in higher prescription costs for many seniors. If you were one of these seniors who found their prescription costs went up, you most likely decided to get enrolled in a more affordable drug plan.

Lower earning seniors haven't seen as high of a price jump, if at all, as this policy went into effect for higher earning seniors. If you don't enroll in a new Medicare drug plan, you will automatically go into the same plan when the new year starts. If you want to change drug plans, you can go to and use their “Plan Finder” to shop for a cheaper one.

In 2016, Part D beneficiaries will have 26 prescription drug plans to choose from. You will want to pay attention to these changes, as many premiums are projected to go up by at least $10 per month. Deductibles will also go up by at least $40, and at the most, $360.

Leave a Reply