12 Worst States for Out-of-Pocket Medicare Drug Costs

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One of the little thieves nibbling away at your retired clients’ income is the bills not paid by their health insurance.

Designers of Medicare programs, including the Medicare Part D prescription drug program, are big believers that giving patients “skin in the game,” or a share of the bill, helps hold total spending down.

In 2022, the average Medicare Part D coverage holder who had too much income to qualify for extra government subsidies spent $464 out of pocket on prescription drugs, according to a new analysis from the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services.

For a look at the 12 states where non-poor Medicare drug plan enrollees spent the most out of pocket on drugs, see the gallery above.

What It Means

The government has provided free, public domain data you can use to help clients budget for out-of-pocket health care costs.

The History

HHS is the federal department that oversees the Centers for Medicare and Medicaid Services.

HHS is now implementing federal Inflation Reduction Act drug market provisions, such as provisions that will let Medicare program managers bargain with drugmakers for better prices.

HHS prepared the out-of-pocket drug spending report to show how the act provisions might affect Medicare enrollees’ costs in each state.

The Data

The new HHS Part D report includes extensive data on Part D coverage users and benefits.

A Part D plan has four phases of coverage. One, the catastrophic benefits phase, is for enrollees with especially high prescription drug bills.

A Part D plan covers all bills at that point, but the enrollee must pay 5% of the total.

In 2022, 1.5 million of the 38 million non-poor Part D enrollees reached the catastrophic benefits phase, and they spent an average of $3,093 on drugs out of pocket, according to HHS analysts.

Credit: Adobe Stock

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