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Although a Small Share of Medicare Part D Enrollees Take Specialty Drugs, A New Analysis Finds Those Who Do Can Face Thousands of Dollars in Out-of-Pocket Drug Costs Despite Plan Limits on Catastrophic Expenses

Some Medicare Part D enrollees can expect to pay thousands of dollars out-of-pocket for a single specialty drug in 2016, even though Part D plans provide substantial protection against catastrophic costs, according to a new analysis from the Kaiser Family Foundation. The findings illustrate how high prescription drug prices, one…

It Pays to Shop: Variation in Out-of-Pocket Costs for Medicare Part D Enrollees in 2016

This analysis focuses on out-of-pocket drug costs for Medicare Part D enrollees in 2016 for specialty, brand, and generic drugs. Part D drug plans differ considerably in the drugs they list on their formularies, their use of formulary tiers, and the level and structure of cost sharing applied to those tiers. Plan decisions affect different beneficiaries in different ways, depending on the drugs they use. The financial consequences for Part D plan enrollees can be substantial. In addition to examining costs for common drugs, we also examine profiles of multiple drugs for several hypothetical Part D enrollees.

Data Note: Are Nonprofits Requesting an Accommodation for Contraceptive Coverage?

The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services, including most contraceptives for women. This policy was at the center of a Supreme Court case brought forward by for-profit corporations (Hobby Lobby and Conestoga) that successfully claimed that the contraceptive coverage requirement violated their religious rights. Last month, the Supreme Court agreed to hear yet another challenge (Zubik v Burwell) to the contraceptive coverage requirement, this time brought by nonprofit corporations, claiming that the accommodation established by the federal government for religiously affiliated nonprofit employers with objections to contraception violates their religious rights.

Cost-Sharing Subsidies in Federal Marketplace Plans, 2016

This brief and the accompanying slides examine reduction of cost sharing – deductibles, copayments and coinsurance – in the Affordable Care Act’s (ACA) federally-facilitated marketplaces in 2016. The analysis shows how cost-sharing subsidies reduce the cost of deductibles, out-of-pocket limits, physician visits, emergency room visits and prescription drug costs in silver plans for low-income people (people whose income is 250 percent of the federal poverty level or below).

Patient Cost-Sharing in Marketplace Plans, 2016

This brief and accompanying slides examine cost sharing – deductibles, copayments and coinsurance – in 2016 insurance plans sold on the Affordable Care Act’s (ACA) federally-facilitated marketplaces. The analysis looks at out-of-pocket limits, as well as cost sharing for hospital stays, physician visits, emergency room visits, and prescription drugs, for plans across the metal levels (platinum, gold, silver and bronze).

What’s in Store for Medicare’s Part B Premiums and Deductible in 2016, and Why?

As a result of the recently-enacted Bipartisan Budget Act of 2015, the Medicare Part B monthly premium will be $121.80 in 2016 according to the Centers for Medicare and Medicaid Services, an increase of 16 percent over the 2015 amount for 30 percent of beneficiaries —far lower than the 52 percent increase initially projected by the Medicare actuaries. This Issue Brief reviews how Medicare Part B premiums and deductibles are affected by the recent budget deal (including the premium surcharge that covers the costs) and explains the connection between the Social Security cost-of-living adjustment (COLA), Medicare premiums, and the “hold harmless” provision that will keep premiums flat for 70 percent of beneficiaries in 2016.

Round 2 on the Legal Challenges to Contraceptive Coverage: Are Nonprofits “Substantially Burdened” by the “Accommodation”?

The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of the ACA contraceptive coverage requirement in 2012, over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. This brief explains the legal issues raised by the nonprofit litigation and discusses the impact of the Hobby Lobby decision on the current litigation.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.