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Do You Know About These Threats to Medicare?

As seniors, we know just how important Medicare programs are to our health and wellbeing. Unfortunately, there are currently some government proposals that would affect Medicare’s ability to provide accessible, affordable care for seniors. We have outlined some of the major threats below, because the first step in making a difference is being informed!

First, there have been various proposals to repeal the non-interference (NI) clause of the Medicare Part D program. This clause prohibits the government from interfering in negotiations between manufacturers and insurers that result in rebates and discounts. The proposals seek to repeal that clause and allow the government to negotiate medicine prices under Medicare Part D, but studies have shown the only way the government could negotiated lower prices is if they severely restricted access to medicines. As seniors, it is vital that we support protecting Part D’s private marketplace structure that is in place to keep medications accessible and affordable. You can find an informative video about this issue here.

Another recent proposal that could threaten Medicare Part D relates to coverage of medicines within the six protected classes. Currently, Medicare Part D plans are required to cover “all or substantially all” medicines within these six classes—which include medicines that help those suffering with mental illnesses, HIV, cancer, and organ transplant rejection. The Centers for Medicare and Medicaid Services (CMS) has proposed making changes to these protections, which could harm some of America’s most vulnerable patients. Ensuring that seniors are able to receive the specific medications our doctors prescribe us is very important, and this proposal could threaten that ability.

Finally, another threat to Part D is the upcoming out-of-pocket cliff. This explainer video provides more information about this issue, as does this informative graphic from Medicare Today. If not addressed, the dollar value necessary to reach catastrophic coverage, which helps cover prescription medications for seniors once they have already spent a substantial amount out of pocket, is set to increase in 2020. It is vital that we advocate for seniors’ health by urging Congress to address this impending out-of-pocket cliff, and ultimately help patients save more money at the pharmacy counter.

In addition to Part D threats, the Administration has recently proposed some changes to Medicare Part B, the program within Medicare that covers outpatient physician-administered medicines, as well as outpatient services like doctor visits and ambulance services. The Department of Health and Human Services’ (HHS) International Pricing Index proposal could harm seniors and patients with chronic conditions by inserting middlemen into the doctor-patient relationship, which will create new administrative barriers that could hinder a doctor’s ability to provide care. The proposal would also open U.S. borders to price controls from socialized health care systems and could severely limit access to existing and new treatment options.

The American health care landscape is always changing, so it is critical that we keep informed about current proposals and challenges facing Medicare—a program that provides us with so many benefits and reliable, affordable access to care. The more we know as seniors, the better we can advocate for our friends, our families, and ourselves.