Study: More Medicare Drug Plan Enrollees Hitting Out-of-Pocket Limit

May 10, 2018 - 02:24 PM
medicare-partd-coverage

The number of Medicare Part D beneficiaries who reach the catastrophic coverage phase of the prescription drug benefit rose by more than 50% between 2013 and 2016, according to an analysis released today by Avalere. The study looked at the 72% of Part D beneficiaries who do not receive low-income subsidies and found more than 800,000 entered the catastrophic coverage phase in 2016, up from about 515,000 in 2013. “Beneficiaries who reach the catastrophic coverage phase have spent thousands of dollars out-of-pocket on prescription drugs,” said Avalere President Dan Mendelson. “Because Part D has no out-of-pocket maximum, these patients will continue to face additional costs throughout the year.” Once in catastrophic coverage, beneficiaries pay up to 5% of their drug costs while the government pays 80% and the Part D plan 15%.

Related News Articles

Headline
KFF analysis highlights limited physician access in Medicare Advantage plans
A new report from KFF reveals that Medicare Advantage enrollees had access to just 48% of the physicians available to Traditional Medicare beneficiaries in…
Headline
AHA shares concerns, recommendations with CMS on WISeR model
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address…
Headline
CMS releases guide on prior authorization submissions, determinations under WISeR model  
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and…
Headline
OIG says MA, Medicaid managed care plans have limited, inaccurate behavioral health provider networks 
A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans…
Headline
Medicare open enrollment for 2026 begins
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
AHA encourages MedPAC to refine analysis of MA enrollment impacts on patients, providers
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…