Bipartisan PACE Part D Choice Act Would Reduce Part D Costs and Increase Access for Medicare Beneficiaries to Innovative Programs of All Inclusive Care for the Elderly

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Nov 16, 2022, 12:19 ET

WASHINGTON, Nov. 16, 2022 /PRNewswire/ -- Earlier today, U.S. Senators Tom Carper (D-DE) and Bill Cassidy, MD (R-LA) introduced The PACE Part D Choice Act, which would eliminate a significant financial disincentive for Medicare-only beneficiaries to enroll in Programs of All-Inclusive Care for the Elderly or PACE. While a notable cost disparity already existed for PACE Part D coverage for Medicare-only beneficiaries, the passage of the Inflation Reduction Act and the $2,000 out-of-pocket cap for Part D has significantly exacerbated the situation. The policy solution in the legislation has been cited by non-partisan think tanks, including in a recent Bipartisan Policy Center report, as a solution to the crisis of being able to provide care outside of nursing homes for the country's fast-growing elderly population.

Although many PACE participants are eligible for Medicare and Medicaid, for those who do not qualify for Medicaid, their average monthly Part D plan premium costs of $1,015 in 2022 are considerably higher—more than 20 times higher, than the $43 average monthly cost of a marketplace plan. The PACE Part D Choice Act would increase access to PACE for Medicare-only beneficiaries by enabling them to choose between the PACE Part D plan or a marketplace Part D plan, which is likely to have fewer total costs with a lower premium and related deductible and coinsurance amounts.

NPA applauds the ongoing and stalwart leadership displayed by Senators Carper and Cassidy to make PACE more affordable and accessible.

"PACE participants in Delaware and across our nation are dealing with rising prescription drug costs every time they need a refill for their live-saving medications. It makes no sense that these older Americans cannot choose which Medicare Part D plan makes the most financial sense for them," said Carper. "I'm glad to introduce this bipartisan legislation that would give these individuals a choice, lowering monthly costs and, thanks to the Inflation Reduction Act, ensuring PACE participants won't pay a dime over $2,000 a year for their medications. I urge my colleagues to join me in supporting this overdue legislation, and hope to see it reach the President's desk by years-end."

"This bill ensures patients in the PACE program have the same access to lower premiums and affordable prescription drugs that lead to better health outcomes as those in other Medicare programs," said Dr. Cassidy.

"PACE is a proven model of care for the elderly, and it has continued to demonstrate its benefits even more profoundly during the pandemic," said Shawn Bloom, President and CEO of the National PACE Association. "But widespread enrollment in PACE for the millions of Medicare-only beneficiaries who could benefit faces a significant financial obstacle --the high Part D premium cost. NPA urges Congress to pass this bill quickly so that many more older adults and their families can be served by PACE and receive the care they need in their homes and communities."

The House companion, H.R. 4941, was introduced last year by U.S. Reps. Earl Blumenauer (D-OR4), Jackie Walorski (R-IN2), Debbie Dingell (D-MI12) and Christopher Smith (R-NJ4).

PACE is widely seen as the "Underdog of Senior Care," as cited by the New York Times, and as an innovation in long-term care services and support (LTSS) by many organizations, including AARP.

Currently, 148 PACE programs operate at least 309 PACE centers in 32 states, serving more than 62,000 participants. However, if barriers to joining PACE, such as high prescription costs that were recently capped for other Medicare beneficiaries, many millions more eligible seniors could be taking advantage of the benefits that PACE offers.

As the AARP report points out, "evidence of PACE's impact on Medicare and Medicaid costs is unequivocal. A 2021 study of PACE beneficiaries who were eligible for both Medicare and Medicaid found that they were less likely to be hospitalized, less likely to visit the emergency department, and much less likely to be institutionalized than their similar, dually eligible peers enrolled in Medicare Advantage Plans…PACE improves the LTSS system by reducing institutionalizations, improving outcomes, decreasing costs, and empowering older adults to live at home," the report continued.

"Making PACE more affordable for older adults eligible only for Medicare is common sense. Expanding access to PACE is a bipartisan, cost-effective solution to the nation's senior care crisis. It increases quality of life, reduces dependency on nursing home care, and above all treats our seniors with the respect they deserve." said Bloom.

PACE programs use an interdisciplinary team approach to keep older adults with long-term care needs healthy and cared for around the clock while living independently in their own homes. PACE enrollees receive care at home, are transported to their local PACE center and other appointments, and visit the PACE center to socialize, receive therapy and other services, and see a physician.

The National PACE Association (NPA) works to advance the efforts of PACE programs, which coordinate and provide preventive, primary, acute and long-term care services so older individuals can continue living in the community. The PACE model of care is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. For more information, visit www.npaonline.org and follow @TweetNPA.

SOURCE National PACE Association