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High cost of enrolling in mandated PACE Medicare Part D plan prevents older adults with complex care needs from accessing high-quality, coordinated, community-based care

Including the bipartisan "PACE Part D Choice Act" in a year-end spending bill will end the PACE Part D penalty, enabling older adults enrolled in PACE to have access to affordable prescription drug coverage like all other Medicare beneficiaries

ALEXANDRIA, Va., Sept. 23, 2024 /PRNewswire/ -- The National PACE Association (NPA) is calling on Congress to end the costly financial penalty incurred by the Program of All-Inclusive Care for the Elderly (PACE) participants eligible for Medicare who must enroll in the PACE Medicare Part D drug benefit. Every other original Medicare enrollee may 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—than other people enrolled in Medicare Part D who may select from numerous Part D plans available in their county.

The PACE Part D penalty, which can total $11,000 annually, prevents people enrolled in Medicare with complex care needs from participating in the PACE program, 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 enrolled in Medicare with complex care needs 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 Senators Tom Carper (D-Del.) and Bill Cassidy (R-La.) and U.S. Representatives Brad Wenstrup (R-Ohio) and Earl Blumenauer (D-Ore.). It would end the PACE Part D penalty by supporting greater access to the PACE program 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 PACE's Medicare enrollees are ineligible for the $2,000 out-of-pocket cap on Medicare Part D spending that takes effect in January 2025.

"The COVID experience taught us that many older adults want to, or would be better off, aging in place," 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's 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 PACE's high degree of coordination among payer and community-based providers leads to good outcomes for older adults with complex care needs. Evidence shows that PACE program membership limits hospitalizations and emergency department visits, addresses social isolation and depression, and improves quality of life for participants.

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

About National Pace Association
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.

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SOURCE National PACE Association