For more information about the author, click to view their website: National Council on Aging
Key Takeaways:
An increasing number of older Americans can’t afford the prescriptions they need to stay healthy. In a recent study, roughly 1 in 5 people age 65+ took shortcuts—such as skipping doses or delaying refills—due to financial worries.1 Said President Biden in a statement: “For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear.”
That could soon change as a result of the Medicare Drug Price Negotiation Program. If you have Medicare, keep reading to find out how (and when) this program may affect you or an older adult you care for.
What is the Medicare
Drug Price Negotiation Program?
The Medicare Drug Price Negotiation
Program is part of the Inflation Reduction Act (IRA) of 2022, which includes several
provisions to help lower prescription drug costs for people with Medicare. This
provision will allow Medicare—for the first time ever—to negotiate drug prices
directly with pharmaceutical companies. The goal is to improve the affordability
of some of the most expensive drugs covered under Medicare Part B and Part D.
Part B covers drugs administered by a physician.
Reduced prices from drug negotiations for the first 10 drugs will take effect
starting in January 2026.
Going forward, the Centers for
Medicare & Medicaid Services (CMS) will then select:
·
Up to 15 additional drugs to negotiate for 2027
·
Up to 15 additional drugs (including those under Part B) for 2028
·
Up to 20 additional drugs for 2029 and subsequent years
“Today’s announcement is a game
changer for the millions of older adults who rely on these medications every
day," said Ramsey Alwin, NCOA President and CEO, in a statement on the start of drug price negotiations. "Our
research shows that the cost of chronic conditions falls heaviest on women and
people of color, who have the fewest resources. Lower prices are a matter of
equity."
A recent KFF survey showed strong bipartisan support (83%)
for allowing the federal government to negotiate drug prices.
Which prescription
drugs will be negotiated?
The drugs that qualify for Medicare
price negotiation are from a list of high-cost, brand-name, single-source drugs
that have no generic competition on the market. In 2022, Medicare
enrollees paid a total of $3.4 billion in out-of-pocket costs for
these medications.
The 10 drugs selected for the first
round of Medicare negotiation:
·
Eliquis: For preventing strokes and blood
clots
·
Jardiance: For type 2 diabetes and heart failure
·
Xarelto: For preventing strokes and blood clots
·
Januvia: For type 2 diabetes
·
Farxiga: For chronic kidney disease
·
Entresto: For heart failure
·
Enbrel: For arthritis and other
autoimmune conditions
·
Imbruvica: For blood cancers
·
Stelara: For Crohn’s disease
·
Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog
FlexPen; NovoLog PenFill: Insulin products for diabetes
How will these
changes affect me?
Once fully implemented, the Medicare
Drug Price Negotiation Program is expected to drop prices on negotiated drugs
for up to 9 million older adults, who now pay as much as $6,497 out of pocket each year for these
medications. People with Medicare will have better access to prescription drugs
that help them manage chronic and life-threatening conditions. More older
adults will be able to start medications, take them appropriately, and stay on
them without making potentially dangerous trade-offs.
Experts
predict the program will also save taxpayers $160 billion by lowering Medicare
costs.
Other Medicare
prescription drug provisions
In addition to drug price negotiation,
there are several other important provisions in
the Inflation Reduction Act designed to lower healthcare costs for people with
Medicare.
Several provisions have already taken
effect:
·
Medicare will cover a greater portion of the cost for high-quality
biosimilars (drugs made from a natural source) for a period of
five years, which began October 1, 2022.
·
Monthly out-of-pocket cost sharing for insulin is capped at $35.
·
Vaccines recommended by the Advisory Committee on Immunization Practices
(ACIP) are 100% free.
·
Drug manufacturers that raise their prices at a faster rate than
inflation will face a financial penalty.
Starting in 2024:
·
The 5% coinsurance for catastrophic drug costs will be eliminated.
·
Eligibility for the full Medicare Part D Low-Income Subsidy (LIS, also called “Extra Help”) will
be expanded to beneficiaries with incomes up to 150% of the federal poverty
level. LIS lowers premiums and out-of-pocket costs for prescription drug
coverage.
·
From 2024-2029, annual Part D premium increases will be capped at 6%.
Starting in 2025:
·
There will be a $2,000 annual cap on drug out-of-pocket costs. This
could save beneficiaries $400 each year on prescription drug
costs. Enrollees with the highest out-of-pocket drug costs could save $2,500
per year. In addition, the Medicare Prescription Payment Plan provision will allow
enrollees to pay their out-of-pocket prescription costs in the form of fixed
monthly payments over the course of the plan year (instead of all at once).
“These key provisions will help
promote equitable aging by making vital medications affordable
for more older Americans,” says Josh Hodges,
NCOA’s Chief Customer Officer. “Reducing drug costs will serve to improve the
Medicare program now and ensure it remains strong and solvent for future
enrollees.”
The Inflation Reduction Act also
extends premium subsidies for the Affordable Care Act (ACA) Marketplace into
2025. As a result, an estimated 10 million people will save about $700 annually
on their healthcare premiums.
Source
1. Stacie B. Dusetzina, PhD et al. JAMA Network. Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022. May 18, 2023. Found on the internet at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805012
This article was written by the National Council on Aging, September 14, 2023.
As the senior population grows, planning for future healthcare needs becomes increasingly important. One of the most critical tools in ensuring financial security and peace of mind during retirement is long term care insurance. In Pittsburgh, Pennsylvania, seniors and their families are recognizing the value of preparing for potential long-term care needs early. This blog explores everything you need to know about long term care insurance in Pittsburgh and how to find the right resources to support your planning journey.What is Long Term Care Insurance?Long term care insurance is designed to cover services that are not typically covered by traditional health insurance, Medicare, or Medicaid. This includes assistance with daily activities such as bathing, dressing, and eating, either at home, in an assisted living facility, or in a nursing home.Having long term care insurance helps protect your savings, maintain your independence, and ease the financial and emotional burden on your loved ones. In a city like Pittsburgh, where healthcare costs continue to rise, securing long term care coverage is a smart move for safeguarding your future.Why Long Term Care Insurance is Important in PittsburghPittsburgh boasts some of the nation's best healthcare facilities and senior services. However, the cost of long-term care remains substantial. According to recent studies, the average cost of a private room in a nursing home in Pennsylvania exceeds $120,000 per year. Without long term care insurance, these expenses can quickly deplete a lifetime of savings.In addition to managing costs, long term care insurance gives Pittsburgh seniors more options. It allows individuals to choose high-quality care providers and facilities without being limited strictly by financial considerations.Key Features to Look for in a Long Term Care Insurance PolicyWhen considering long term care insurance in Pittsburgh, its important to understand what to look for in a policy. Here are a few critical features:Daily/Monthly Benefit Amount: Determine how much the policy will pay per day or month toward care costs.Benefit Period: Know how long the policy will pay benefits (e.g., two years, five years, or unlimited).Elimination Period: Understand the waiting period before benefits begin after qualifying for care.Inflation Protection: As the cost of care rises over time, this feature increases your benefits accordingly.Types of Care Covered: Ensure the policy covers a wide range of services, from in-home care to assisted living and nursing home care.Pittsburgh residents should also assess if their policy offers coverage for specialized services, such as memory care for Alzheimers or Parkinsons disease, both of which are growing needs in the area.When to Buy Long Term Care InsuranceThe ideal time to purchase long term care insurance is before its needed. Most experts recommend buying a policy in your mid-50s to early 60s, while you are still in good health and eligible for better rates. In Pittsburgh, where the population of seniors continues to expand, preparing early can ensure access to the best care options in the future.Local Resources for Long Term Care Planning in PittsburghFinding the right long term care insurance policy can be a complex process. Fortunately, Pittsburgh offers a range of resources to help seniors and families make informed decisions.Explore a full list of senior-focused services in Pittsburgh here: Senior Resources Directory for PittsburghFor services specifically related to insurance and financial planning for seniors, visit: Insurance and Financial Resources in PittsburghThese resources can connect you with trusted advisors, educational workshops, and support organizations that specialize in long term care planning.Planning for Peace of MindWhile no one likes to think about needing long-term care, being prepared can make a significant difference in your quality of life and financial stability. Long term care insurance empowers Pittsburgh seniors to maintain their dignity, independence, and control over their future healthcare decisions.Taking the time to explore your options today can lead to greater peace of mind for you and your loved ones tomorrow.Conclusion Long term care insurance is a vital component of a comprehensive retirement plan, especially for those living in Pittsburgh, Pennsylvania. By securing the right coverage, you can protect your assets, ensure access to quality care, and ease the burden on your family. To begin your search for the right resources and support, visit SeniorsBlueBook.com today and take the first step toward a more secure future.
Navigating Medicare can feel overwhelming, especially with so many choices and deadlines to manage. If you or a loved one are approaching the age of 65 in Pittsburgh, Pennsylvania, having a solid Medicare planning strategy is critical. Whether you are preparing for your initial enrollment or considering additional coverage options, understanding how Medicare works can help you make informed decisions about your healthcare and financial future.Why Medicare Planning MattersMedicare is not a one-size-fits-all program. There are multiple parts, each covering different services, and various plan options that can impact your out-of-pocket costs, access to providers, and coverage for prescriptions. Medicare planning ensures that you select the best coverage for your health needs and financial situation, minimizing unexpected expenses and maximizing your benefits.Proper Medicare planning also helps you avoid common pitfalls such as late enrollment penalties, gaps in coverage, and underinsurance.Key Components of MedicareWhen planning for Medicare in Pittsburgh, it is important to understand the basic components:Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.Medicare Part B (Medical Insurance): Covers outpatient care, doctor services, preventive services, and some home health services.Medicare Part C (Medicare Advantage Plans): Offered by private companies approved by Medicare, these plans combine Part A and Part B coverage and often include Part D (prescription drug coverage) and additional benefits.Medicare Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.Additionally, many individuals choose to purchase Medicare Supplement Insurance (Medigap) to help pay for some of the healthcare costs that Original Medicare doesnt cover, such as copayments, coinsurance, and deductibles.Medicare Planning Tips for Pittsburgh ResidentsIf you live in Pittsburgh, planning ahead for Medicare can significantly ease the transition and help you secure the best possible coverage. Here are some important tips:1. Start EarlyBegin researching your options at least six months before you turn 65. Early planning allows you to compare plans, check for additional programs specific to Pennsylvania, and ensure that you meet all deadlines without stress.2. Consider Your Healthcare NeedsThink about your current doctors, medications, and any expected health needs. Some Medicare Advantage plans in Pittsburgh may have network restrictions, so its important to ensure that your preferred providers are covered.3. Evaluate Costs Beyond PremiumsWhen comparing plans, look beyond just the monthly premiums. Consider deductibles, copayments, coinsurance rates, and out-of-pocket maximums to fully understand your potential healthcare costs.4. Look for Local ResourcesPittsburgh offers a variety of local resources to help with Medicare planning. From community education seminars to independent advisors and nonprofit support groups, taking advantage of local expertise can make the process smoother.For a comprehensive list of senior resources available in Pittsburgh, including assistance with Medicare planning, visit: Senior Resources Directory for Pittsburgh.You can also find Medicare-focused resources and services directly through: Medicare and Insurance Resources in Pittsburgh.5. Be Aware of Special Enrollment PeriodsIf you delay enrolling in Medicare because you are still working and have employer coverage, you may qualify for a Special Enrollment Period (SEP) later. Understanding how these periods work can prevent penalties and gaps in coverage.Local Insights: Medicare Planning in PittsburghPittsburghs healthcare environment is unique, with access to nationally ranked hospital systems like UPMC and Allegheny Health Network. This makes it important to choose a Medicare plan that includes your preferred providers and facilities.Furthermore, Pennsylvania offers programs like PACE and PACENET that assist eligible seniors with prescription drug costs. Exploring state-specific assistance programs can provide additional savings for Pittsburgh seniors during the Medicare planning process.Conclusion Medicare planning in Pittsburgh, Pennsylvania, is an essential part of securing your healthcare future. With the right knowledge and resources, you can make confident decisions that protect your health and financial well-being. Starting early, understanding your options, and taking advantage of local support will help ensure a smooth transition into Medicare coverage.
Planning for the future is one of the most important gifts you can give to yourself and your loved ones. Estate planning ensures that your wishes are honored, your assets are protected, and your family is supported. If you live in Pittsburgh, Pennsylvania, understanding the basics of estate planning and utilizing the many available local resources can help you navigate this essential process with confidence.In this article, well explore the importance of estate planning, the essential documents you should consider, and how Pittsburgh residents can access local support to secure their legacy.Why Estate Planning MattersEstate planning is not just for the wealthy. It is a crucial step for anyone who wants to have control over their health decisions, finances, and property, particularly later in life. A thoughtful estate plan can:Ensure your assets are distributed according to your wishes.Minimize taxes and legal complications for your heirs.Protect your healthcare and financial decisions if you become unable to manage them yourself.Provide clarity and peace of mind to your loved ones during difficult times.Without an estate plan, Pennsylvanias default probate laws will determine how your assets are divided, which may not align with your personal wishes.Key Components of an Effective Estate PlanA complete estate plan typically includes several important documents. Pittsburgh residents should consider working with qualified professionals to ensure these documents reflect current Pennsylvania laws and personal preferences:1. Last Will and TestamentA will outlines how you want your property distributed after your death and allows you to name guardians for minor children. In Pittsburgh, having a valid will can help your family avoid complicated and costly probate proceedings.2. Durable Power of AttorneyThis document appoints someone to make financial decisions on your behalf if you become incapacitated. Having a trusted individual designated can prevent court-appointed guardianship proceedings.3. Healthcare Power of Attorney and Living WillHealthcare directives ensure your medical care preferences are followed if you are unable to communicate. These documents guide your loved ones and healthcare providers in making critical decisions.4. TrustsTrusts can be used to manage assets during your lifetime and distribute them after your death while potentially avoiding probate. Pittsburgh seniors often use revocable living trusts to maintain control over assets while simplifying estate administration.5. Beneficiary DesignationsRegularly updating beneficiary designations on accounts such as retirement plans and life insurance policies ensures that these assets are passed directly to your chosen heirs.Estate Planning Resources in PittsburghPittsburgh offers a variety of resources to assist seniors and families with estate planning. Local organizations, legal aid services, and educational workshops are available to help residents understand their options and complete their documents.For a full listing of estate planning resources and related services in Pittsburgh, visit: Senior Resources Directory for PittsburghYou can also find estate planning-specific services and legal support here: Estate Planning Resources in PittsburghUsing trusted local resources ensures that your estate plan complies with Pennsylvania laws and is tailored to your unique circumstances.Common Estate Planning Mistakes to AvoidWhile creating an estate plan, it is important to avoid common mistakes that can lead to unintended consequences:Failing to Update Documents: Life changes such as marriage, divorce, births, or deaths should trigger updates to your estate plan.Not Considering Long-Term Care: Planning for potential future healthcare needs, including nursing home care, protects your assets and ensures you receive the care you want.Leaving Out Digital Assets: In todays world, managing digital assets such as social media accounts, online banking, and email accounts is essential.Assuming a Will Covers Everything: Some assets, like jointly owned property or retirement accounts, are not controlled by your will but by ownership laws or beneficiary designations.Working with knowledgeable professionals and reviewing your estate plan regularly can help you avoid these pitfalls.Estate Planning and Peace of MindEstate planning provides peace of mind, knowing that your wishes will be honored and your loved ones will be supported during difficult times. Whether you are just starting the process or need to update an existing plan, Pittsburgh offers a wealth of resources to help you at every step.By taking action now, you can protect what matters most and leave a lasting legacy for the next generation.ConclusionEstate planning is an essential step for Pittsburgh seniors and families looking to protect their futures. With thoughtful preparation and the right support, you can ensure that your assets are managed according to your wishes, minimize burdens on your loved ones, and achieve peace of mind. For additional resources and to explore estate planning services available in Pittsburgh, visit the Seniors Blue Book Senior Resources Directory today.