CENTER UPDATE | FEBRUARY 2024
In this Issue:
- 2024 V-BID Summit – Register Now!
- $2K Medicare Part D Cap Could Reduce Out-of-Pocket Drug Costs for Over 1M Beneficiaries
- Decline in HDHP Enrollment, Concern Over Out-of-Pocket Costs
- Health Centers Can Make the Switch to Value-Based Payment But Need Assistance
- Why Affordability Is the Big Tent
- The Burden of Medical Debt in the United States
- Out-of-Pocket Costs are a Preoperative Concerns of Older U.S. Adults
Complimentary registration is open for the 2024 virtual V-BID Summit: Overcoming Financial Toxicity happening on Wednesday, March 13, 2024, from 12 pm to 4 pm ET.Â
Please join us!
$2K Medicare Part D Cap Could Reduce Out-of-Pocket Drug Costs for Over 1M Beneficiaries
Starting in 2025, Medicare beneficiaries will have a $2,000 cap on out-of-pocket expenses for prescription drugs under Part D, a result of the Inflation Reduction Act of 2022. This cap, indexed annually, aims to reduce patient costs and Medicare spending on drugs. The change would have benefited 1.5 million enrollees in 2021, with significant savings for those requiring high-cost medications. Over time, millions of beneficiaries are expected to benefit from this measure, although awareness of the change remains relatively low among older adults, according to KFF polling.
New Research Finds Decline in High-Deductible Plan Enrollment, Concern About Out-of-Pocket Expenses
The 2023 Consumer Engagement in Health Care Survey (CEHCS) found that overall satisfaction with health plan selection and services is high among privately insured adults. Notably, high-deductible health plan (HDHP) enrollment slightly declined, while satisfaction with various aspects of health care remained high. Important factors include network of providers, low out-of-pocket costs, prescription drug coverage in health plan selection, and potential of Health Savings Accounts (HSAs) for future health care expenses and tax savings.
Health Centers Can Make the Switch to Value-Based Payment But Need Assistance
A recent Commonwealth Fund blog notes how Federally Qualified Health Centers (FQHCs), serving over 31.5 million patients regardless of their ability to pay, face financial challenges due to low Medicaid reimbursements. Value-Based Payment (VBP) models could offer a solution by linking payment to quality, cost, and equity of care. Policymakers can help by taking the following into account when creating VBP models:
- Providing onramps to financial risk
- Accounting for patient complexity
- Offering initial financial support
- Offering tailored technical assistance and training support for FQHCs
Why Affordability Is the Big Tent
An analysis highlights the centrality of affordability in health care, as out-of-pocket costs eclipse other concerns. With 92% of the population covered, but many still struggling with medical bills, affordability resonates universally with voters across party lines. This focus has implications for policy discussions, polling methodologies, and the value movement in health care, underscoring the need for strategies that address individuals’ economic concerns and perceptions of cost and quality.
The Burden of Medical Debt in the United States
Medical debt affects over 20 million American adults in excess of $220 billion, despite high insurance coverage rates. A KFF analysis shows that individuals with health issues, disabilities, lower incomes, and no insurance are more likely to accumulate medical debt. Another study found that those with medical debt are much more likely to have other forms of financial distress than those without medical debt. Racial disparities persist, with Black Americans experiencing higher rates of medical debt.
Out-of-Pocket Costs are a Preoperative Concerns of Older U.S. Adults
A study surveyed older adults aged 50 to 80 considering elective surgery, finding common concerns such as pain, recovery difficulty, and out-of-pocket costs. Among those surveyed, 32% considered surgery, with major joint and eye surgeries being the most common. Concerns about costs, COVID-19 exposure, and time off work were associated with a decreased likelihood of undergoing surgery.
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