Greg Hansch

Greg Hansch

Texas seniors and those with disabilities face rising out-of-pocket drug costs.

Whether you’re a senior, a caregiver or family member, you likely recognize the strain that increasing out-of-pocket costs for health care have on Texas’ most vulnerable patients, including seniors and those with disabilities. That’s why the National Alliance on Mental Illness of Texas (NAMI Texas) is calling on Congress to cap Medicare Part D out-of-pocket costs.

As an organization that serves people with mental illness, we see every day the adverse impact that unexpected health care costs have on our populations. When someone is in pain and reaching out for help, the undue burden of crushing financial debt can only exacerbate their health condition.

Thanks to a loophole in the Medicare Part D benefit, Texans are on the hook for thousands of dollars on top of the extra price they’re paying for a plan that’s supposed to cover their prescription drug needs. It’s an ailment in need of treatment, and that’s why we say it’s time to close the Medicare Part D loophole.

Introduced in 2006, the Medicare prescription drug benefit was supposed to help those with disabilities and seniors, and in many cases, it has. In fact, 72% of all Medicare beneficiaries nationwide, are enrolled in Part D plans. That’s great news and certainly helps put health care within reach for many Texans. However, unlike commercial insurance plans which cap out-of-pocket costs for patients, Medicare Part D has no such limit.

Through the Affordable Care Act, people with insurance have a maximum limit on their out-of-pocket drug and medical costs. Once that’s reached, plans usually cover 100%. But this is not true under Medicare Part D, and voters say that needs to change. Polling data released in March found that 76% of voters support legislation that would cap or limit out-of-pocket prescription drugs costs for Medicare Part D recipients.

In 2016, more than five million Medicare beneficiaries who paid extra for Part D plans still ended up having to reach into their pockets significantly for the cost of their care – anywhere from hundreds to an average of nearly $1,600. This loophole continues to place an enormous financial burden on Medicare beneficiaries.

This year, the annual out-of-pocket spending threshold—the amount beneficiaries must spend before the coverage gap ends and catastrophic coverage begins—is projected to increase by an additional $1,250, according to an analysis by the Kaiser Family Foundation.

And people who need specialty drugs (think patients with cancer, among many others), could end up paying significantly more than that—anywhere from $2,600 to $16,500 in out-of-pocket expenses.

For people living with a disability like a mental health diagnosis, or chronic illnesses, like cancer, multiple sclerosis, debilitating arthritis and many others, medicines help them manage their diseases so that they can life productive and full lives. Often these medicines are expensive. Having to pay thousands of dollars out-of-pocket even after you’ve bought an extra insurance coverage plan is simply unfair.

We feel strongly that this can and should be an issue that receives bipartisan support and immediate action. It’s time to write the “prescription” to fix this problem. Congress should close the Medicare Part D loophole now.

Greg Hansch is the Interim Executive Director of NAMI Texas and serves as the organization’s Public Policy Director. Online at

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