I See Trouble Ahead for Medicare Part D

Each year, Healthcare Leadership Council’s Medicare Today sends a survey to a cross section of seniors to ask them how they feel about Medicare’s Prescription Drug program, Part D. Click here to read more about the 2025 survey. We average a response of over 1,000 seniors who give us their feedback to the basic questions we always ask about how the program is working, and also to some current relevant questions about how the implemented changes have, or the proposed changes will, impact(ed) Part D. For the past five years I’ve reported on the survey’s results and for most of those years we’ve also done a Facebook live event to discuss those results. We will continue that tradition by holding a Facebook live event on Tuesday, November 4th at 1:00 PM ET. You can click here to take part in this event.

Our basic satisfaction questions haven’t changed since the initial survey was sent out in 2007, when Part D was first implemented. Over the years America’s seniors’ general satisfaction with Part D has remained in the high 80s or low 90s percentage wise, which is an amazing statement when you’re talking about any government program, especially one that’s dealing with your health. When lawmakers were debating how Part D should work back when the legislation was evolving, there were those who wanted it to be a complete government run program. They warned that if Part D became a public/private partnership where private plans would compete for business, with oversight from the government, there wouldn’t be enough plans to compete for business in rural areas, that seniors would not be able to wade through all the information to choose the best program for them and, finally, that the premiums would rise without much control. As you know, the public/private partnership barely won out and none of the dire predictions came true. Rural areas, historically, have between 15 to 21 plans to choose from - Billings, Montana, for instance, has 16 plans available. Seniors have proven that they are very capable of choosing for themselves or accessing the help they need to pick the correct plan for themselves. Premiums have stayed consistently low, 40% lower than predicted when Part D was approved. For 19 years Part D has been a success, but I fear there are storm clouds on the horizon.

For the first time in its history there has been a reduction in the number of plans to choose from and there are strong indications that there will be a substantial increase in premiums. I’ve always been amazed how low premiums have stayed over the years but that might not be the case in 2026. I think the cap on out-of-pocket costs has had a very positive impact on the survey this year, the 93% satisfaction rate is one of the highest we’ve had, but I’m not so sure about next year. Seniors will find fewer plans to choose from and I fear that many plans will have fewer drugs offered on their formularies or will require higher co-pays on some drugs. The projected higher premiums are sure to impact seniors as they calculate their prescription drug costs for 2026. I think there are other things that also trouble older Americans.

The continued uncertainty in how the recent changes to Part D will impact each senior is deeply concerning. Tariffs continue to be in the news with many theories on how that will impact the availability and cost of drugs. The survey showed that the continued government program to fix the price of certain drugs worries seniors due to its chilling impact on investment in discovering and manufacturing new life-saving and life-altering medicines. Lately, the Administration has turned its focus back to Most Favored Nation (MFN) pricing as a way to dictate the price of drugs, furthering the government’s intrusion into our healthcare, adding another area of uncertainty. Under MFN pricing, we adopt the pricing algorithms and policies of foreign countries which includes one of their major tools, Quality-Adjusted Life Years (QALY). This approach is used to determine which treatments provide the most value for the money and helps governments prioritize healthcare spending. I believe it discriminates against older people and those with chronic health problems. From my point of view, it is only a way to ignore the patient and use equations to ration care. It dehumanizes the process of caring for the sick, it removes the human element. I don’t know why we would want to pattern our healthcare after any country that uses QALY. All of this adds even more concern to the future health of Medicare Part D.

There was another interesting question on the survey concerning the Medicare Prescription Payment Plan (MPPP). I wrote about this plan in a recent blog. The survey asked some questions about this program - and the lack of knowledge about MPPP and what it does was eye opening. Very few people knew about the program and only 10% of the people who spent $2,000 or more - the very people that this plan would benefit the most - have used it. It smooths the payments over the full year rather than requiring big payments in the first few months. Somehow, we need to get the word out on this great program.

Seniors know a good program when they see it and use it, but they also can see the trouble on the horizon. We need to do everything we can to preserve the parts of Medicare Part D that made it successful – competition, access, and choice. Take the time to tune into the Facebook live event next Tuesday at 1:00 PM ET as we discuss the survey and the future of Part D. Click here to get the link to this event.

One more thing, Tuesday, November 4th is election day in many states. Find out who is running for positions in your state, county, and city and get out and vote! Let your voice be heard.

Best, Thair