NPA to Congress: End the Part D Penalty Before This Session Ends

Posted on: September 23, 2024
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Including the Bipartisan PACE Part D Choice Act in a Year-End Spending Bill Would Give Older Adults Enrolled in PACE Access to Affordable Prescription Drug Coverage

ALEXANDRIA, VA – Sept. 23, 2024 – The National PACE Association (NPA) is calling on Congress to end the costly financial penalty incurred by participants in the Program of All-Inclusive Care for the Elderly (PACE) who are eligible for Medicare and must enroll in the PACE Medicare Part D drug benefit. Other original Medicare enrollees are able to comparison shop for an affordable Part D plan from among numerous options in their county. Medicare-enrolled PACE program participants face exponentially higher premiums for prescription drugs – 22 times higher, on average.

The PACE Part D penalty, which can total $11,000 annually, prevents people with complex care needs who are enrolled in Medicare from participating in PACE, which provides affordable, high-quality, highly coordinated services to people directly in their homes and communities.

“As millions of baby boomers retire and decide how they want to age, people with complex care needs who are enrolled in Medicare should have the option of receiving high-quality, long-term care in their home and community,” said Shawn Bloom, president and CEO of NPA. “Congress must end the PACE Part D penalty before the legislative session finishes so more older adults in need can benefit from the proven care and support the PACE program provides.”

The PACE Part D Choice Act (S.1703/H.R. 3549) is a bipartisan solution sponsored by Sens. Tom Carper (D-DE) and Bill Cassidy (R-LA) and U.S. Reps. Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR). The legislation would end the PACE Part D penalty by supporting greater access to PACE for people enrolled in Medicare by allowing them to purchase an affordable Part D plan from the marketplace.

The PACE Part D Choice Act is expected to save older adults nearly $1,000 a month on prescription drug premiums, according to estimates. That would help level the Part D playing field, as Medicare enrollees in PACE are ineligible for the $2,000 out-of-pocket cap on Medicare Part D spending that will take effect in January 2025.

“The COVID experience taught us that many older adults want to age in place or would be better off doing so,” continued Bloom. “PACE is a program whose time has come. More older adults need to be able to take advantage of the coordinated home- and community-based care that is at the heart of PACE. But that’s only possible if Congress ends the PACE Part D penalty, which will encourage more people in Medicare to sign up for the program.”

Experts say the high degree of coordination among payer and community-based providers in PACE leads to good outcomes for older adults with complex care needs. Participating in PACE limits hospitalizations and emergency department visits, addresses social isolation and depression, and improves quality of life for participants, research shows.

Nearly 95 percent of adults age 60 and over have at least one chronic condition, and more than three-fourths (77 percent) of adults age 40 and over prefer to receive long-term care services in their home, according to one survey. Millions of older adults will soon develop multiple chronic conditions requiring high-quality, coordinated complex care. The Medicare-eligible population is expected to increase to nearly 70 million by 2030. 

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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 their 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.