Bill Overview
Title: PACE Part D Choice Act of 2022
Description: 2022 This bill allows Medicare-only beneficiaries who are enrolled in Programs of All-Inclusive Care for the Elderly (PACE) to choose prescription drug plans that are not operated by PACE. (PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care.) Specifically, the bill allows PACE enrollees who are Medicare (but not Medicaid) beneficiaries to choose a prescription drug plan that is not a Medicare Advantage plan or operated by PACE and for which annual out-of-pocket costs and federal subsidies are equal to or less than that under the applicable PACE prescription drug plan. The bill also allows for disenrollment from a chosen plan upon a change in medication or demonstration of an unexpected increase in out-of-pocket costs. PACE programs must conduct outreach, monitor data, and coordinate benefits with respect to such options.
Sponsors: Sen. Carper, Thomas R. [D-DE]
Target Audience
Population: Medicare-only beneficiaries enrolled in the Programs of All-Inclusive Care for the Elderly
Estimated Size: 55000
- The PACE program serves older adults who require nursing-home-level care but prefer to remain in their own homes.
- PACE is available in various states across the U.S., providing integrated care to the elderly population.
- The bill specifically affects Medicare-only beneficiaries within PACE, not those who are dual eligible for both Medicare and Medicaid.
- Approximately 55 million people are enrolled in Medicare in the U.S., but only a subset of this group is enrolled in PACE.
- PACE serves a smaller population specifically needing nursing-home-level care in their homes, with National PACE Association reporting around 55,000 individuals enrolled nationwide.
- PACE enrollees who are Medicare-only (not dual eligible) will have new choices in prescription drug plans, affecting their healthcare and financial decisions.
Reasoning
- The population targeted by the PACE Part D Choice Act is relatively small compared to the overall Medicare population, focusing on older adults needing nursing-home-level care but living at home.
- The policy impacts financial decisions around prescription drugs, allowing more flexibility in selecting plans, potentially reducing costs for individuals involved.
- This policy is more likely to impact wellbeing in terms of financial security and access to necessary medications for this specific group.
- Given a limited budget for rollout, initial impacts may be most notable among enrollees living in states with greater availability of PACE programs.
Simulated Interviews
Retired teacher (New York, NY)
Age: 78 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 3/20
Statement of Opinion:
- I worry about how much I spend on my prescriptions each month.
- It's good to know there could be options to spend less.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Retired accountant (Miami, FL)
Age: 85 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- I've been uneasy about changes to my medication costs.
- If this policy helps manage my expenses better, I'm all for it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired librarian (San Francisco, CA)
Age: 72 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 3/20
Statement of Opinion:
- I prefer knowing exactly how much my medication will cost every month.
- More plan choices could complicate things but also bring relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 5 |
Retired engineer (Cleveland, OH)
Age: 80 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 3/20
Statement of Opinion:
- My medication costs are manageable but could be better optimized.
- Trial periods for new plans without extra cost impact would be reassuring.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired nurse (Austin, TX)
Age: 77 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- It's hard managing both of our healthcare costs.
- This policy could give me breathing room with my prescriptions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
Retired baker (Portland, OR)
Age: 79 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 3/20
Statement of Opinion:
- I need the assurance that switching plans won't mean higher expenses unexpectedly.
- This seems like a safety net for medication changes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Retired journalist (Chicago, IL)
Age: 81 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 3/20
Statement of Opinion:
- Lower costs are important but so is medication reliability.
- I'd like to see what the new options truly offer.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Retired musician (Seattle, WA)
Age: 84 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- It's hard to balance my medical and living expenses.
- I hope this policy might offer some financial relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
Retired construction worker (Phoenix, AZ)
Age: 75 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 4.0 years
Commonness: 4/20
Statement of Opinion:
- I feel positive about potentially lessening my expenses for medication.
- Flexibility in what I pay per month is crucial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 3 |
Retired social worker (Boston, MA)
Age: 82 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 6.0 years
Commonness: 3/20
Statement of Opinion:
- I'm concerned about keeping my medication budget stable.
- This policy could be beneficial if it truly avoids higher costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
Cost Estimates
Year 1: $15000000 (Low: $10000000, High: $20000000)
Year 2: $16000000 (Low: $11000000, High: $21000000)
Year 3: $16500000 (Low: $11500000, High: $21500000)
Year 5: $17000000 (Low: $12000000, High: $22000000)
Year 10: $18000000 (Low: $13000000, High: $23000000)
Year 100: $30000000 (Low: $20000000, High: $40000000)
Key Considerations
- Size of the affected population (around 55,000 Medicare-only PACE beneficiaries).
- Relative wide variety of choices in prescription drug plans could lead to more optimal selections.
- Administrative overhaul demands significant investment initially,