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PART D OUT OF POCKET SPENDING

No Limit: Medicare Part D Enrollees Exposed to High Out-of-Pocket Drug Costs Without a Hard Cap on Spending

Since 2006, the Medicare Part D prescription drug benefit has helped improve the affordability of medications for people with Medicare. Yet even with Part D, enrollees can face relatively high out-of-pocket costs because there is no hard cap on out-of-pocket spending under Part D. Enrollees are required to pay up to 5 percent of their drug costs above the catastrophic coverage threshold, unless they receive low-income subsidies that help pay Part D premiums and cost sharing. For high-priced medications, this relatively small coinsurance rate can translate into significant out-of-pocket costs. This analysis examines out-of-pocket prescription drug spending among Medicare Part D enrollees with costs above the catastrophic coverage threshold.

 

INFORMATION PROVIDED BY THE HENRY J. KAISER fAMILY fOUNDATION