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.
You have taken the first step. You created an estate plan. That is a great start.The problem? If your plan is sitting unsigned in your email inbox or lost in the back of a kitchen drawer, it is not doing your family any good.Even worse, if you used an online do-it-yourself form, your plan might not work when your loved ones need it the most. When it comes to protecting the people you love, a half-finished or one-size-fits-all plan just is not enough.The Risks of an Incomplete or Unsigned Estate PlanAn estate plan only works when it is complete and legally executed. That means it needs to be signed, witnessed, and stored properly. A plan sitting in your inbox is no better than no plan at all.If you pass away or become incapacitated and your documents are incomplete, your family may be forced to go through probate court or make difficult medical and financial decisions without guidance.Why Online Templates Rarely Work for Pennsylvania FamiliesOnline estate planning templates may seem convenient. However, these generic documents do not account for Pennsylvania laws, complex family situations, or unique asset structures. If you own a home, have children, or any significant savings, a one-size-fits-all plan can leave major gaps.For example, many online wills fail to address how assets will be distributed if a beneficiary passes away before you. Others do not include powers of attorney or healthcare directives. These are critical documents that protect you during your lifetime, not just after death.What Makes an Estate Plan ComprehensiveA complete estate plan includes more than just a will. It should reflect your values, your Familys needs, and your financial situation. Key components often include: A revocable living trust or will Durable financial power of attorney Healthcare power of attorney Advance healthcare directive or living will Guardianship nominations for minor children Clear instructions for asset distributionThis kind of planning ensures your wishes are honored, minimizes family conflict, and avoids unnecessary delays and costs in court. Real-Life Scenarios: When Things Go WrongImagine this: A mother leaves behind a will she created online but never signed. Her children are left scrambling in probate court, unsure of what she wanted and unprotected from legal fees and delays.Or consider a retired couple who thought they had everything covered, only to learn their do-it-yourself documents did not protect their home from Medicaid estate recovery. Now their children face losing the family house.These situations are real, and they are avoidable.How Entrusted Legacy Law Helps You Get It RightAt Entrusted Legacy Law, we believe estate planning should be simple, heart-centered, and tailored to your familys unique needs. We do not use scare tactics or wear suits. We work with you to create a plan that gives you peace of mind and protects your loved ones.We take the time to understand your story, explain your options, and walk you through every step. Our goal is to make sure your plan is more than just a document. We want it to actually work when your family needs it most.Your Family Deserves More Than a Half-Finished PlanYou only pass away once. Make sure your estate plan is signed, complete, and ready to Protect your loved ones when it counts.Your legacy deserves more than a forgotten file in a junk drawer.Schedule your free consultation today: https://book.entrustedlegacy.law/#/introcall
If you have a child with special needs, your estate plan must be more than just a basic will. Leaving money directly to your child through a will or having no will at all can create serious problems. It may unintentionally disqualify them from important government assistance programs such as Supplemental Security Income and Medicaid.Fortunately, there is a better way to plan for their future. A Supplemental Needs Trust allows your child to benefit from their inheritance without losing access to essential support services. It is a loving and responsible way to provide long-term care and financial protection.The Risk of Leaving Money Directly to a Special Needs ChildMany families believe that leaving assets directly to a child with special needs shows trust and love. However, doing so can disqualify the child from means-tested government programs. These programs often have strict income and asset limits. Inheriting money or property outright can push the child over those limits.Once benefits are lost, it can be difficult and time-consuming to requalify. Your good intentions could unintentionally cause more harm than good.What Is a Supplemental Needs TrustA Supplemental Needs Trust, sometimes called a Special Needs Trust, is a legal arrangement that holds and manages money for the benefit of a person with disabilities. The trust is designed so that the assets do not count against government benefit limits. The trust pays for things that government programs do not cover. This may include personal care attendants, out-of-pocket medical expenses, education, entertainment, or travel. It allows your child to maintain their quality of life while staying eligible for public assistance. Why a Will Alone Is Not EnoughA will simply directs how your assets should be distributed after your death. It does not offer protection if the beneficiary cannot manage the inheritance or if the gift may interfere with their government support.A Supplemental Needs Trust works alongside your estate plan to manage the funds responsibly. It ensures that money is used in the best interests of your child without disrupting their access to programs that provide medical care, housing, or food assistance. Key Benefits of Supplemental Needs Trust Protects eligibility for Supplemental Security Income, Medicaid, and other services Provides funds for extra care, enrichment, and quality of life Appoints a trusted person as the trustee to manage the money Offers peace of mind that your child will be supported long-term The Importance of Planning AheadIt is never too early to put a plan in place for your childs future. Even if they are young or you believe they may become more independent later, a trust can offer flexibility and protection as circumstances change.Having a plan in place now ensures that decisions will not be left to chance. It also prevents court involvement or family conflict during difficult times.Let Us Help You Protect What Matters MostYour childs future deserves thoughtful and informed planning. At Entrusted Legacy Law, we help families create personalized estate plans that support their children without risking essential services.We understand how emotional and complex this planning can be. Our heart-centered approach means you will never feel rushed or confused. We are here to educate, support, and walk with you every step of the way.Schedule Your Free ConsultationYou do not need to navigate this alone. Schedule your free consultation with our caring legal team today and take the first step toward protecting your child and your legacy.https://book.entrustedlegacy.law/#/introcall
When it comes to protecting your home from nursing home costs, many Pennsylvania families do not realize that being cared for by your adult child at home could be the key.Thanks to the Caregiver Child Exemption, you may be able to transfer your house to your caregiving child without it being counted as a gift under Medicaid rules. This can allow you to qualify for long-term care benefits while preserving your home for your family.Let us break down how this works, who qualifies, and why working with an elder law attorney is essential.What Is the Caregiver Child Exemption Pennsylvania?The Caregiver Child Exemption is a special rule under Medicaid law in Pennsylvania that allows a parent to transfer their home to an adult child without a penalty. This applies when the adult child: Lived in the parents home for at least two years before the parent moved into a nursing home Provided care during that time that helped the parent avoid the need for nursing home care If these conditions are met, the home can be transferred to the child without it being considered a gift for Medicaid purposes.Why This Matters for Your FamilyNursing home care in Pennsylvania can cost more than twelve thousand dollars per month. If your assets are not properly protected, your home may be considered available to pay for care. That means your home could be lost to Medicaid estate recovery later.The Caregiver Child Exemption provides a way to transfer your home legally while preserving Medicaid eligibility. This can save families hundreds of thousands of dollars and give peace of mind that a loved one will still have a place to live.Who Qualifies for the Caregiver Exemption?Not every situation will meet the requirements. To qualify, the following must usually be proven: The adult child lived in the home full-time for two years before nursing home admission The child provided direct care that delayed the need for institutional care There is documentation showing how the childs care helped keep the parent safe at home Medical records, personal statements, caregiver logs, and testimony can all be used to support the exemption. It is important to have an elder law attorney guide the process and ensure all requirements are met. Timing and documentation are critical.Real-Life ExampleLinda is a single mother living in Erie, Pennsylvania. Her adult daughter, Maria, moved in with her after Lindas health began to decline. For more than two years, Maria helped with medications, meals, doctor visits, and daily living.When Linda eventually needed skilled nursing care, they were able to transfer the home to Maria under the Caregiver Child Exemption. The home was protected and did not count against Lindas Medicaid eligibility.Now, Maria continues to live in the home she helped maintain, and Linda is receiving the care she needs without losing everything.Why Early Planning MattersMedicaid laws can be complicated, and small mistakes can lead to large penalties. The Caregiver Child Exemption can only be used if it is properly applied and documented.If you wait too long or miss a step, your family might lose the chance to protect your home.Working with an experienced elder law attorney helps ensure you understand all your options and plan the right way.Protect Your Legacy with ConfidenceIf your adult child is helping you stay in your home, the Caregiver Child Exemption might be the right strategy for your family. Estate and Medicaid planning are not just about money. Schedule a free consultation with Entrusted Legacy Law to learn how we can help protect your home and your legacy. https://book.entrustedlegacy.law/#/introcall