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Information from Norm Sherman, Florida CSARC SE Florida Liaison & Outreach Coordinator, Council of School Supervisors and Administrators (1/15)


1. Prescription Costs - As we enter the New Year, your drug costs may change since you start again in Tier 1. For example, if you ended the year in the donut hole, you were paying 60% of the cost for drugs. Now you will pay only 25% until your TOTAL DRUG COST (what you pay plus what your plan pays) REACHES $2,250. After that you are back in the donut hole. Had you ended the year in the Catastrophic Tier III, you were paying only 5% of the cost for drugs. Again, you start again in Tier 1, paying 25% of the cost for drugs. Those who stayed in Tier 1 remain there, experiencing no change in drug costs unless the price of the drug increases.


2. High Option Rider - When I mention to some members they pay a premium for Medicare Part D, they look at me quizzically. "I don't see any deduction for drugs coming off my pension check," they say. "Look again," I say. All of a sudden they see a deduction coded GHI-CBP/EMPE for $105. That my friends is your Part D premium paid as part of the high option rider benefit. Of course, if you have been subject to an IRMAA assessment on Medicare Part B then you also pay an IRMAA assessment for Part D. This amount is deducted from your Social Security check and is in addition to your premium of $105 that is deducted from your pension check. In 2015, the premium remains the same as does the IRMAA assessment (eligibility for the assessment also remains the same).


3.  Medicare Limits On Outpatient Therapy Services – Medicare will continue in 2015 to pay for outpatient therapy services, although there are cap limits in the calendar year. For example, the cap limit for physical therapy (PT) and speech therapy combined is $1,940(up from $1,920) while the limit occupational therapy is $1,940 (also up from $1,920). Most of us use the cap limit to take physical therapy, and is equivalent to about 20 sessions. However, under certain conditions you can receive an exception to the limit. For that to happen, your therapist must:


Ø Document your need for additional therapy in your medical record.

Ø Indicate the need on the Medicare claim stating that the additional therapy is medically reasonable and necessary.


With proper documentation from your doctor or therapist, Medicare may cover additional therapy.


4. March of Dimes – March for Babies – As you know, CSA’s charity project this year is the March of Dimes – March for Babies. Information regarding this project is available at

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