Carmen: Out-of-pocket costs hurt seniors

By Chuck Carmen | Herald-Tribune

When seniors, especially those on a fixed budget, lack access to needed medications — simply because they cannot afford them — they often end up in the hospital, increasing the burden on society.

In the end, it makes life harder on everyone: the individual, his or her family, and the taxpayer. This problem needs to be, and can be, solved.

Recently there has been progress in Washington toward passing a bill capping out-of-pocket Medicare Part D costs that would help seniors afford their medications, but there is still a long way to go to get it passed. Elected officials in Washington have created a few proposals that may contain workable solutions and they need to be considered and looked at seriously.

The Medicare prescription drug benefit has helped many seniors. However, one loophole — the out-of-pocket costs — continues to bring financial burden on many of them. Until real change is made, many seniors will forgo their medication in order to afford life’s necessities. They face the decision of whether to pay for their medication or their basic needs.

With a looming increase in the patient’s share of Medicare Part D medication costs, and unless action is taken soon to cap those out-of-pocket costs, millions of Floridians who rely on Medicare Part D coverage will face the terrible choice between whether to pay for their medicine or for their groceries.

Out-of-pocket costs can prevent Medicare patients, age 65 and older who suffer from chronic diseases, from being able to pay for their needed medication.

Patients already pay extra for the Medicare Part D plans they need to cover prescription drug costs. These added costs do not hurt just them. The negative impacts are far-reaching.

At the Epilepsy Association of Central Florida, we constantly hear of the problems associated with these out-of-pocket costs and not being able to afford needed medication.

It is essential that steps be taken now, as the threshold for out-of-pocket expenditures is projected to see a $1,250 increase before any catastrophic coverage kicks in.

Beneficiaries could end up paying even more if they have a chronic medical condition like epilepsy, multiple sclerosis, rheumatoid arthritis, cancer or other diseases that call for often-expensive specialty drugs. Their out-of-pocket costs could total anywhere from $2,600 to $16,500.

A cap on these out-of-pocket expenses can, in the end, save money by allowing many seniors to be able to afford their medications. It would also eliminate needless doctor visits, emergency room visits and hospitalizations. More important, it will help Medicare beneficiaries get their prescriptions filled and receive the care they deserve.

If the Affordable Care Act places a maximum out-of-pocket costs on medication and medical expenses for those insured under it, then why not allow a maximum cost for our seniors who are on Medicare?

When the limit is reached under an ACA plan, the insurers typically cover 100% of additional payments. Medicare Part D does not limit out-of-pocket costs for its beneficiaries.

For the sake of our seniors, I call on our elected Washington officials to take a hard look at the proposals for Medicare Part D that would either not raise these costs or would eliminate them all together.

Chuck Carmen is the Executive Director of the Epilepsy Association of Central Florida.