The rising cost of health care is a major concern and a growing burden to accessing care across North Carolina, especially for seniors living on a fixed income. However, Congress is running out of time in 2019 to pass legislation to help lower health-care costs. Congress must enact a straightforward, common-sense fix to help North Carolina seniors afford the care they need.
It’s no surprise that many seniors rely on Medicare, which provides health coverage for nearly 2 million North Carolinians. Nationwide, about three-quarters of those beneficiaries also enroll in prescription drug coverage, known as Medicare Part D.
While Medicare Part D is often seen as a success for patients, given its popularity among seniors, the current system has one glaring loophole: the high out-of-pocket cost for many seniors, especially those with chronic and complex conditions. Right now, Part D beneficiaries have no cap or maximum on the cost they could be expected to pay out of their own pockets, unlike anyone with commercial insurance.
Unless they qualify for low-income subsidies, even beneficiaries who reach a certain maximum cost of care set by Medicare (known as the “catastrophic coverage threshold”) are still required to pay up to 5 percent of the cost of the medication they rely on to get through the day.
While that number may seem low, many rare and chronic conditions are incredibly expensive; hemophilia, for example, can cost tens or even hundreds of thousands of dollars a month to treat. Even a small percentage of that care adds up to a huge bill for North Carolina families. The number of people who reach this maximum is on the rise, and recently passed 1 million Americans, according to the Kaiser Family Foundation; up from slightly over 400,000 beneficiaries just ten years ago.
North Carolinians simply cannot afford the rising cost of care. The average Medicare beneficiary pays about $2,750 out-of-pocket, an untenable amount when this same group has a median income of only $26,000. For patients who rely on specialty drugs, from cancer and rheumatoid arthritis to hemophilia and multiple sclerosis, that cost is often significantly higher.
When out-of-pocket costs get too high, studies have shown that many patients simply stop taking their medications, or try to ration them to make them last longer. In either case, the health impact can be dire — less disease control, more hospital visits, more pain and suffering for patients.
Our seniors need more from Congress. They deserve legislation that lowers health-care costs and helps seniors access care. As Congress considers multiple proposals to address health-care costs, we urge North Carolina’s congressional delegation to immediately pass affordable Medicare Part D out-of-pocket caps, and ensure the most vulnerable patients do not have to decide between paying rent, heating their home or staying healthy.