Created in 2003, Medicare Part D enables seniors to buy into insurance coverage for prescription drugs. Today this option is extremely popular and works well for people who do not have a chronic condition for which medications are very expensive. Medicare Part D is the only health insurance in the United States in which there is no maximum out of pocket costs, and this can be financially devastating for patients with high-cost drugs.
In Medicare Part D, patients pay a $415 deductible and a 25% co-insurance. Once the patient’s portion of costs reaches $5,100 this year (increasing to $6,350 in 2020), it has reached the “True Out of Pocket” threshold (called TrOOP). At this point the co-insurance drops to 5% but there is no maximum.
Now 5% may not sound like much until you consider that the costs beyond TrOOP were $17.7 billion with patients paying almost $850 million out of pocket. When you consider that the average annual income of a Medicare beneficiary is $26,000 and some out of pocket costs can be upwards of $8,000, it is clear the lack of a maximum cap on co-insurance can be devastating for patients with chronic conditions.
Fortunately, leaders in Congress are considering creating a maximum limit on out of pocket expenses called a MOOP Cap. The Senate is considering a $3,100 maximum and the House is looking at a $2,000 cap; either would improve the current situation of no limit to what costs a patient may be responsible to pay.
As time is short before the end of this Congressional session, the Colorectal Cancer Alliance urges you to call or email your representative and both senators to say you support having a limit on how much a patient with a catastrophic condition should have to pay out of pocket under Medicare Part D. Older Americans value Medicare and see the Part D option as the way to address the high costs of prescription drugs; they should not be faced with unlimited out of pocket costs because of a catastrophic condition.
Colorectal Cancer Alliance's Speak Up Speak Out program made possible due to educational funding provided by Genentech.