Part D: More Retirees Face High Drug Costs

Pharmacist selling prescriptions Several million retirees have spent so much on their prescriptions in recent years that they crossed over into the “catastrophic” phase of their Medicare drug plans.

Once catastrophic coverage kicks in, Part D drug plans require retirees to pay only 5 percent of their medication costs out of their own pockets. But there’s a catch: there is no cap on total annual spending, which can quickly rise to thousands of dollars if they need chemotherapy or a brand-name designer drug for a rare medical condition.

Juliette Cubanski, deputy director of the Kaiser Family Foundation’s Medicare policy program, said that could change, because proposals to place a cap on total out-of-pocket spending in Part D plans have a bipartisan tailwind behind them. Democrats in the House recently reintroduced a bill that would limit spending to $2,000. Last year, the Republican-controlled Senate Finance Committee approved a $3,100 cap, which is currently part of a Republican prescription drug bill.

Now, President Biden says he wants to limit retirees’ spending in their Part D plans. However, the bills circulating on Capitol Hill could also become tangled up in a more complex debate about a related issue: the best way to control drug prices.

A flat dollar cap – if it passes – would be simpler than the current system for determining out-of-pocket drug costs, though it would mainly help people with extraordinarily high spending. Cubanski said most people on Medicare spend less than $2,000 out-of-pocket annually.

But in a given year, she said, “that could be anybody.” And as baby boomers stampede into retirement, more people will be pushed into catastrophic coverage at a time of continually rising drug prices. …Learn More

Not Everyone Can Delay their Retirement

Retirement experts encourage baby boomers to hang on to their jobs as long as possible to boost their monthly Social Security checks and add to their retirement savings. If they can delay retirement to age 70, they have good odds of maintaining their standard of living.

That isn’t always possible, however, for the baby boomers confronting disabling physical impairments or health problems. Add to that the generally declining health of the older population over the past 20 years.

Working to 67But a new study has revealed a deep socioeconomic divide. More-educated older workers are actually able to work longer than they did 15 years ago, while less-educated older workers – and Black men in particular – are mostly losing ground.

To estimate the changes in working life expectancy for various groups of older workers, Laura Quinby and Gal Wettstein at the Center for Retirement Research considered three factors: life expectancy overall, how long the workers can expect to remain free of a disability, and the rates of institutionalization in prisons and long-term care facilities. The incarceration rate is relevant, because the young adult men who received the longer prison sentences that started being imposed a couple of decades ago are now in their 50s and 60s.

Between 2006 and 2018, working life expectancy increased by about one year for older Black and white workers in the top half of the educational ranking. This makes sense because more educated people tend to be healthier and have seen stronger gains in their longevity.

But working life expectancy declined in the bottom half of the educational ranking for Black men and for white men and women. The exception is less-educated Black women – they have seen a small increase in working life expectancy, along with a more substantial increase in longevity.

The researchers also estimated the share of each group who, at age 62, could feasibly work until age 67, which would lock in their full retirement age benefit every month from Social Security, and until 70, which would provide them with their maximum monthly benefit.

A comparison of two extremes – more-educated white men and less-educated Black men – dramatizes the divide. …Learn More

Older Americans Felt Lonely in Pandemic

Last year, millions of older Americans went into hiding to protect themselves from the ravages of COVID-19.

Did the isolation take a psychological toll? How did they respond to infrequent contact with friends and family? Researchers in a recent webinar tried to understand the unique phenomenon of loneliness in a modern pandemic.

Over 50 and lonelyWhat we know from the National Poll on Healthy Aging in the early months of the pandemic is that more than half of older workers and retirees between 50 and 80 said they “felt isolated from others” – twice the levels seen in 2018.

In a different survey conducted every two months for most of last year, loneliness was “common and it was incredibly persistent during the first six months of the pandemic,” said Lindsay Kobayashi, a University of Michigan epidemiologist involved in the COVID-19 Coping Study, a survey of adults over age 55.

Two groups in particular suffered rates of loneliness that were twice as high as their peers: older people who live alone and residents of senior communities and nursing homes, where staff often separated the residents or confined them to their rooms in an attempt to protect their health.

A larger share of Black Americans also expressed feelings of loneliness than whites and Hispanics, and women were generally more lonely than men. “I’m very afraid that we are going to get so used to being alone, on our own, by ourselves that we won’t reconnect the way we need to,” a 76-year-old woman told the Coping Study researchers last fall.

But the news isn’t all bad. Feelings of loneliness, especially among the oldest retirees, had subsided a bit as early as November as news reports emerged that the vaccines were effective. Older people also found ways to cope with their isolation, and some even felt the pandemic gave them a renewed sense of purpose, according to a pair of studies in The Gerontologist. …Learn More

Marriage Plays a Part in Income Inequality

In the madcap 1960 movie, “Where the Boys Are,” a college student named Tuggle (played by Paula Prentiss) is forthright about why she’s going to Ft. Lauderdale for spring break: to find a husband.

Women have come a long way, and two out of three married women today choose to work, rather than go Tuggle’s presumed route and become a full-time housewife. Yet there’s a 21st century corollary to Tuggle’s experience. College is important in determining who people marry.

We tend to marry others who are like us, and education has become central to this. College graduates gravitate to other college graduates. People who complete their formal education at high school graduation tend to marry other high school grads. Further, this trend of marrying someone with a similar education is growing over time.

“People are increasingly marrying other individuals with the same level of education,” says Boston College economist Geoffrey Sanzenbacher. Sanzenbacher and other economists say the growing trend of college graduates pairing off with other graduates has increased income inequality.

The importance of college goes much deeper. Among graduates, the specific college one attends is more important in determining who one marries than one’s field of interest or personal attributes like SAT scores or a parent’s income.

For example, graduates of a specific college are very likely to marry someone who went to that same institution – even if they are in different fields, according to a new research study that connected the data in Norway’s centralized college admissions system with marriage data. Or consider two graduates of the same law school. They have a good chance of getting married – not because they are both lawyers but because they attended the same school. …Learn More

Disability Discrimination and Aging Workers

Older workerA unique situation faces older workers with a disability: apply for federal disability insurance now or try to hold on and keep working to retirement age.

Of course, people who leave the labor force and apply for disability are taking a risk: they might be denied the benefits. But another possible factor in how these situations play out are state anti-discrimination laws to protect people with disabilities, including older workers, from employment discrimination. If these laws can reduce discrimination, could they increase employment and eliminate the need for some older workers to apply for disability?

A new study suggests that state anti-discrimination laws have prevented some disability applications – if the laws are broad enough to provide better protection to workers with disabilities.

The state laws deemed to be broader set a lower burden for proving that the individual has a disability than the standard in the federal Americans with Disabilities Act (ADA). Under the ADA, individuals must prove that their condition “substantially” impacts their ability to function. Under this high burden of proof, many individuals with disabilities were not considered disabled under the ADA and did not receive the federal legal protections from discrimination.

The researchers analyzed whether the broader state laws limited the growth in disability applications between 1992 and 2013 by making it easier for workers at or near retirement age to remain employed.

Disability applications increased during that period for a range of reasons, from the Great Recession to a long-term deterioration in older workers’ health. But the basis for this new study was an increase in disability applications tied to a 1983 reform to Social Security. The reform reduced retirement benefits by raising the program’s full retirement age. Disability checks, which were not reduced, became more attractive to older workers relative to their retirement benefits.

But the researchers found that disability applications did not increase as much – and sometimes not at all – in the states with the broadest disability discrimination laws. The laws were especially effective in reducing applications by people getting close to retirement age. …Learn More

Healthcare Deductibles: the Burden Grows

At $140 billion, the nation’s unpaid medical bills are the single largest form of past due debt. One thing driving this is no doubt rising deductibles for health insurance.

Health Insurance CartoonA third of insured Americans said in a survey that it is difficult to pay the deductibles in their employer health insurance plans and in the policies sold on the Affordable Care Act (ACA) marketplaces.

Among employer-sponsored insurance plans, policies with high deductibles are becoming more pervasive, even in large corporations. Employers are choosing high-deductible plans in part to keep their workers’ monthly premiums at a reasonable level – a tradeoff that is inherent in health insurance.

But the sky-high cost of medical care can quickly run-up out-of-pocket spending in years when someone in the family becomes very ill or needs surgery. Average deductibles exceed $3,000 for a single worker’s policy in half of the U.S. companies with less than 200 workers. The family plan deductibles exceed $6,000 in more than 40 percent of small companies.

ACA plan deductibles are rising in almost every state and have surpassed $4,000 per year, on average, in 11 states from Arizona and Michigan to Oregon. A variety of plans are available on the exchanges, including plans with lower deductibles for people willing to pay higher premiums. But ACA premiums have also been rising, though the federal government has temporarily increased the premium subsidies as part of COVID-19 relief.

New research appearing in the July issue of the Journal of the American Medical Association (JAMA) estimates that medical bills made up more than half of all the consumer debt in collections last year. And the data are through June 2020 and don’t even reflect the full cost of caring for COVID patients. …Learn More

Be prepared

Onus of Retirement Planning is on Us

Many workers are poorly prepared for retirement. Inadequate savings is a primary culprit.

But the question of why workers don’t save enough was debated by our readers in comments posted to a recent article. The article pertained to a new study showing that life gets in the way of saving, which is derailed by major disruptions such as unemployment or a large, unexpected medical bill.

“This confirms my thinking that the major reason for not saving is spotty employment and a lack of money,” Chuck Miller wrote in his comment posted to “Here’s Why People Don’t Save.” Debi Street agreed: “It is also the quotidian reality of too many people in low-wage, precarious jobs with no surplus to save.”

The research study also tested an alternative explanation for insufficient savings: procrastination. The procrastination theory was not supported by the analysis.

Readers, however, would not let people off the hook so easily. “What’s that old saying? ‘Failing to plan is planning to fail,’ ” said Brian Jarvis. “That planning is certainly impacted by procrastination, which then leads to being … unprepared for life’s disruptions.”

A reader who calls herself Retirement Coffee Shop knows “more than a few people who just disregard the notion of saving for the future. They have lived their lives like there is no tomorrow and spend money on any and everything they want.”

On another matter central to retirement planning – Social Security – readers didn’t criticize. They just offered practical advice.

The article, “Workers Overestimate their Social Security,” described research showing that workers of all ages have a poor grasp of how much they’ll receive in their monthly Social Security checks when they retire.

Specifically, the workers’ estimates were higher than the more precise benefit projections made by the researchers, based on each individual’s earnings history. Not surprisingly, young adults, who have more pressing matters on their minds than retirement, were farthest off the mark.

Several readers made the same suggestion: get the facts. “Go online and look at your SSA statement,” said Lynn. “It lists your FRA [monthly benefit] amount” – at the full retirement age – “as well as estimated amounts at 62 and 70.” …Learn More