weekly blog--one for the ages
Here we go again. With Mueller gone, the political debate has shifted back to healthcare. "To Be or Not to Be" is the question of the day on Obamacare. For Medicare participants, the "To Be or Not to Be" resides in reining in escalating drug costs.
There are a number of proposals being floated on how to do so. But the gotcha in all of this is that unlike commercial plans that cap members’ out-of-pocket drug spending annually, traditional Medicare plans do not have a limit for prescription medications in its Part D drug benefit. And with the cost of specialty drugs increasing, some Medicare beneficiaries could owe thousands of dollars in out-of-pocket drug costs every year for a single drug.
In a standard Medicare drug plan, beneficiaries pay 25 percent of the price of their brand-name drugs until they reach $5,100 in out-of-pocket costs. Once patients reach that threshold, the catastrophic portion of their coverage kicks in, and their obligation drops to 5 percent.
And that never changes. The lack of a spending limit for the Medicare drug benefit sets it apart from other coverage. Under the Affordable Care Act, the maximum amount someone generally owes out-of-pocket for covered drugs and other medical care for this year is $7,900. Plans typically pay 100 percent of customers' costs after that.