Medicare

Addressing the cost of insulin continues to be at the forefront of policy discussions around prescription drugs. Overall, Medicare Part D enrollees spent nearly $1 billion out of pocket on insulin in 2019 — four times the amount enrollees spent in 2007.

While out-of-pocket spending quadrupled from 2007 to 2019, the number of enrollees using insulin doubled from 1.6 million to 3.2 million, which means the increase in out-of-pocket spending was not solely a function of more beneficiaries using insulin.

Skilled nursing facility spending for traditional Medicare beneficiaries with both Part A and Part B rose 4.4 percent in 2020 – even as the number of beneficiaries using such services declined, and at a time when spending on most other services fell.

The increase is explained by longer and more expensive SNF stays in 2020 compared to 2019, both of which increased more sharply for Medicare beneficiaries under 65 than for older Medicare SNF users. Overall, spending per day rose from $490 in 2019 to $534 in 2020, or 9.1 percent.

Rates of cost-related problems are higher among beneficiaries in Medicare Advantage than in traditional Medicare with supplemental coverage, but highest among beneficiaries in traditional Medicare without supplemental coverage. Among Black beneficiaries specifically, a larger share of those in Medicare Advantage reported cost-related problems than those in traditional Medicare (32% vs. 24%). The rate of cost-related problems was lower still among the subset of Black beneficiaries in traditional Medicare who had Medicaid or other sources of supplemental insurance (20%).