Celebrate, Protect Your Benefits

(This article first appeared in the July-August 2018 issue of The American Postal Worker magazine) 

By Retirees Director Nancy Olumekor

Every year we recognize and celebrate the Social Security Act, enacted on Aug. 14, 1935, 83 years ago, and Medicare, enacted on July 30, 1965, 53 years ago. These two important laws were established to benefit workers in their old age, as retirees.

Our celebration this year during July and August includes continuing the fight to protect these earned benefits. All APWU members, along with their families, friends and neighbors, can participate in an action of recognition by supporting APWU legislative priorities for fair benefits for American seniors.

For Civil Service Retirement System (CSRS) annuitants, the Social Security benefit is drastically reduced by the Windfall Elimination Provisions (WEP), enacted in 1983, and Government Pension Offset (GPO), enacted in 1977. The WEP/GPO are penalties imposed on CSRS annuitants who worked two jobs and paid into CSRS as well as Social Security.

Reach out to your members of Congress and Senators by telephone, email, mail or in person to tell your story, and ask them to support legislation to repeal the WEP/GPO. The “Social Security Fairness Act of 2017,” H.R. 1205 and S. 915, are two bills which would repeal the GPO and WEP. These bills have bipartisan cosponsors – 25 in the Senate and 181 in the House of Representatives.

Also, ask your representatives to support “Medicare For All” legislation (H.R. 676 in the House and S. 1804 in the Senate). These bills ensure universal access to highquality, affordable health care for all Americans, regardless of employment, income or health care status.

Good News! Congress eliminated the annual therapy caps on how much Medicare pays for therapy, and streamlined the medical review process for therapy. An edited version of the CMS revised May 2018 Beneficiary
Fact Sheet on Medicare Limits of Therapy Services is provided below.

Medicare Coverage of Therapy Services:
Important: This information only applies if you have Original Medicare. If you have a Medicare Advantage Plan (like an HMO or PPO), check with your plan for information about your plan’s coverage rules on
therapy services.

In 2018, Congress eliminated the limits on how much Medicare pays for therapy services in one calendar year (also called “therapy caps” or “therapy cap limits”). However, for Medicare to pay for your services, the law requires your therapist or therapy provider to confirm that your therapy services are medically reasonable and necessary when they reach certain amounts each calendar year.

Your therapist or therapy provider will need to add information to your therapy claims and your medical record if your therapy services amounts in 2018 reach $2,010 for physical therapy (PT) and speech-language pathology (SLP) services combined or $2,010 for occupational therapy (OT) services. By adding this notation, the therapist confirms that your therapy services are reasonable and necessary and your medical record will include an explanation of why the services are medically required.

In addition, a Medicare contractor may review your medical records to be sure your therapy services were medically necessary when your therapy services amount in 2018 reach $3,000 for PT and SLP services combined or $3,000 for OT services.

Medicare doesn’t pay for therapy services that aren’t reasonable and necessary, therefore your therapy provider must give you a written notice before providing services that aren’t medically necessary. This notice is called an “Advance Beneficiary Notice of Noncoverage” (ABN). The ABN lets you choose whether or not you want the therapy services and you will pay for them.

Call your State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. To get the phone number for your state, visit shiptacenter.org, or call 1-800-MEDICARE (1-800-633- 4227). TTY users can call 1-877-486-2048.