The Kaiser Family Foundation just released a report documenting the high out-of-pocket costs for many people with the Medicare Part D drug benefit. Without an out-of-pocket cap, the Medicare drug benefit leaves people with costly prescription drug needs choosing between paying thousands of dollars for their medicines or foregoing treatment.
In 2017, before Part D drug coverage kicks in, people pay a $400 deductible. After they meet their deductible, they must pay 25 percent coinsurance, up to a coverage limit of $3,700 in total drug costs. They then fall into a coverage gap (donut hole) where they must pay a bigger portion of their drug costs until these costs total $4,950, the catastrophic coverage limit. After they reach the catastrophic coverage limit, if they still need drugs, they are responsible for 5 percent of their drug costs. People with low incomes may receive subsidies that help cover the Part D premiums and cost sharing, bringing down their out-of-pocket costs.
More than 3 million people had drug costs above the catastrophic coverage limit. Of those, one million did not qualify for subsidies. All in, with the Part D drug benefit, these people spent an average of more than $3,000 out of pocket on their medications.
The Kaiser report reveals that about half the people enrolled in Medicare Part D spent over $2,924 on their medicines in 2015. About one in ten spent $5,200 or more out of pocket for their prescription drugs. People with HIV/AIDS, multiple sclerosis, viral hepatitis, leukemia/lymphoma, and schizophrenia incurred the highest out-of-pocket drug costs.
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Here’s more from Just Care:
- Will CMS reduce people’s Part D drug costs?
- Six tips for keeping your drug costs down if you have Medicare
- Medicare Open Enrollment: It’s time to revisit your Medicare options, including Part D
- If you want easy access to care and good quality care, you probably want traditional Medicare
- No projected 2018 increase in standard Medicare premium, but most people will likely see their premiums rise