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The Proposed Out of Pocket Cuts for Medicare Patients
Posted: Feb 12, 2024
The Proposed Out of Pocket Cuts for Medicare Patients image

There are a lot of changes on the immediate horizon for Medicare patients, including the reduction in out-of-pocket spending on drug costs.

Next year, these changes will go into place, and millions of Medicare Part D beneficiaries will be positively impacted. These changes include the new $2000 max cap on prescription drug cost that is part of the Inflation Reduction Act passed in the legislature last year.

This means that if you use a very expensive drug, you will meet that $2000 maximum cap rather quickly. This change comes on the heels of the elimination of the 5% payee requirement this year after reaching a threshold for beneficiaries of Part D plans.

This is good news for many patients who are burdened with expensive drugs, many of whom may not have generics as an alternative for treatment.

However, if you depend on financial assistance from any of the nonprofit organizations to help you pay for your medications, changes have already started. Patients who have previously qualified to receive grants from the LLS (Leukemia and Lymphoma Society) have received up to $12,000 per year for copay assistance and insurance premium reimbursement. That amount has now been reduced significantly from $12,000 of assistance to $5,000.

Why the change? Last year, the LLS (as well as other nonprofits that provide financial assistance to eligible patients) found their funds dried up early in the year. Consequently, fewer patients were able to participate in the grants program. Perhaps anticipating the changes in the max out of pockets, the reduction in grants can allow LLS to provide grants to more patients.

So far, this year this is the only organization that has published a reduction in grant amounts online. That reduction doesn’t guarantee they will stay open all year. If you need to renew your grant from last year, I would encourage you not to wait. 

Don’t forget, you can qualify for more than one grant. Consider using one for co-pays while perhaps using another for premium reimbursements if the grant allows.  

Also, remember that there are time limits for submitting reimbursements. If you don’t use the funds according to the guidelines of the grantor, you risk losing the grant and they may not have funds for your next enrollment period.

If you find that you’re unable to procure financial assistance from any non-profit organization, reach out to the pharmaceutical company for help. Most do offer assistance to those who are un or underinsured. You do need to be aware of other criteria surrounding qualification.

Keep an eye on the organizations you’re receiving grants from. They may also follow LLS’ lead. Your saving grace is having the strongest and best insurance coverage to mitigate some of the huge out-of-pocket expenses. If you need direction, please contact one of our financial coaches to guide you. 

Financial Resources 

For a list of financial resources for myeloma patients and their loved ones, click here: Myeloma Financial Resources 

Join our Myeloma Coach program today and connect 1:1 for free with a financial coach: Myeloma Coach Program

Watch past Financial Webinars here: Myeloma Financial Webinars 

The author Diahanna Vallentine

about the author
Diahanna Vallentine

Diahanna is the Financial Program Manager for the HealthTree Foundation,  specializing in financial help for multiple myeloma  and AML patients. As a professional financial consultant and former caregiver of her husband who was diagnosed with multiple myeloma, Diahanna perfectly understands the financial issues facing myeloma patients.

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