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Medicare’s New $2,000 Cap on Out-of-Pocket Drug Costs Could Save Patients Thousands, AARP Says

Annika Kim Constantino

Jan. 16,2025

Key Points

  • Most Medicare patients who hit the new $2,000 cap on out-of-pocket spending for prescription drugs could see significant savings, according to a report from AARP. 
  • The findings suggest the spending maximum could be hugely beneficial for older adults in Medicare who struggle to afford high-cost drugs for cancer, rheumatoid arthritis and other serious conditions.
  • It is one of the most consequential provisions in President Joe Biden’s 2022 Inflation Reduction Act, designed to cut high drug costs.

Most Medicare patients who hit the new $2,000 cap on out-of-pocket spending for prescription drugs could see big savings, despite changes in premiums, according to a report today by AARP. 

The findings suggest the cap could be a huge benefit to older adults in Medicare who struggle to afford high-cost drugs for cancer, rheumatoid arthritis and other serious conditions. Those seniors and other U.S. patients pay two to three times more for prescription drugs than people in other developed nations.

The limit went into effect Jan. 1, 2025. It’s one of the most consequential provisions in the 2022 Inflation Reduction Act, designed to cut high drug costs – along with a $35 monthly cap on insulin and Medicare price negotiations with big pharma.

The report found that 94% of the more than 1 million enrollees in Medicare Part D expected to reach the new cap in 2025 will have lower out-of-pocket costs – including premiums and cost-sharing – and save an average of $2,474. That’s a 48% decrease on average in their total out-of-pocket costs, according to the report, which analyzed plan enrollment and premium data, among other information. 

That 1 million tally excludes Medicare beneficiaries who receive a low-income subsidy and those in employer waiver plans.

An estimated 62% of those 1 million enrollees will save an average of more than $1,000 in 2025, while 12% will save more than $5,000, the report said. The remaining 6% of Part D enrollees who are projected to reach the new cap are expected to have higher out-of-pocket costs, with an average of $268 in additional spending in 2025, the report said. 

Notably, the share of Part D enrollees expected to reach the cap and have lower total out-of-pocket costs in 2025 is estimated to be 95% or higher in 33 states and Washington, D.C.

“When you’re able to provide these types of savings, that frees up those funds for other really important things that maybe [patients] were having to make trade-offs for, paying for their food or paying for their rent,” Leigh Purvis, prescription drug policy principal at AARP, said in an interview. “It’s a really meaningful impact, especially for a population that’s on a fixed income.” She added that the median income of Medicare beneficiaries is around $36,000 a year. 

Those savings come despite changes to Part D premiums in 2025, AARP said. Purvis said the new prices for the first 10 medications selected for Medicare negotiations – and the lower costs expected from them – do not go into effect until 2026, so premiums have increased in some cases.

She said critics have been trying to blame the law for those premium increases and higher costs for Medicare enrollees overall. But the report said the lower out-of-pocket costs for most patients who reach the $2,000 cap will more than offset higher premiums.

The positive effect “will only grow larger” as new negotiated prices for the first round of drugs go into effect in 2026, according to the report. 

“The Medicare program is going to be saving a lot of money, so this is really a story that is much bigger than it appears, just because these savings go to a lot of different people in a lot of different ways,” Purvis said. 

A separate report from AARP found that 3.2 million Medicare recipients are expected to see savings from the out-of-pocket cap in 2025. By 2029, the number is expected to increase to 4.1 million enrollees.

Medicare covers about 66 million people in the U.S., and 50.5 million patients are enrolled in Part D plans, according to 2023 data from health policy research organization KFF.

The new price cap applies to all prescription drugs under Medicare Part D but doesn’t include drugs given to patients in the hospital or other health-care settings such as anesthesia and chemotherapy. 

Before the change, people on Medicare typically had to spend $7,000 or more out of pocket on prescription medications before they qualified for so-called “catastrophic coverage,” when insurance kicks in and covers most of the drug’s cost. Under this coverage, patients are charged a small co-payment or a percentage of a drug’s cost, usually 5%.

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Flu Season in the US is the Most Intense it’s Been in at Least 15 Years

By Associated Press

February 11, 2025

U.S. health officials recommend that everyone 6 months and older get an annual flu vaccine. The U.S. winter virus season is in full force, and by one measure is the most intense in 15 years.

One indicator of flu activity is the percentage of doctor’s office visits driven by flu-like symptoms. Last week, that number was clearly higher than the peak of any winter flu season since 2009-2010, when a swine flu pandemic hit the nation, according to data posted Friday morning by the Centers for Disease Control and Prevention.

Of course, other viral infections can be mistaken for flu. But COVID-19 appears to be on the decline, according to hospital data and to CDC modeling projections. Available data also suggests another respiratory illness, RSV, has been fading nationally.

The flu has forced schools to shut down in some states. The Godley Independent School District, a 3,200-student system near Fort Worth, Texas, last week closed for three days after 650 students and 60 staff were out Tuesday.

Jeff Meador, a district spokesman, said most illnesses there have been flu, plus some strep throat. He called it the worst flu season he could remember.

So far this season, the CDC estimates, there have been at least 24 million flu illnesses, 310,000 hospitalizations and 13,000 deaths – including at least 57 children. Traditionally, flu season peaks around February.

Overall, 43 states reported high or very high flu activity last week. Flu was most intense in the South, Southwest and western states. In Rochester, New York, the flu season has been intense but not necessarily worse than at the peak of other years, said Dr. Elizabeth Murray, a pediatric emergency medicine doctor at the University of Rochester Medical Center. She said there’s a lot of flu, but there’s also still a lot of RSV and a surprising number of babies with COVID-19. “All of the respiratory illnesses are around, with a vengeance,” Murray added.

The CDC declined to let an Associated Press reporter speak to an agency flu expert about recent trends. The Trump administration ordered a temporary “pause” on health agency communications and has continued to refuse interview requests that were routinely granted in the past.

Late Friday afternoon, a CDC spokesperson acknowledged that the new data shows “the highest absolute value” of flu-like illness when compared with other seasons but added that the statistic is complicated: That value references a baseline estimate for doctor’s office visits, but the baseline is recalculated every year. In late January, the CDC was describing the season as “moderate” in severity.

About 44% of adults got flu shots this winter, the same as last winter. But coverage of children is way down, at about 45% this winter. It’s usually around 50%, according to CDC data.

About 23% of U.S. adults were up to date in their COVID-19 vaccinations as of late January, up from about 20% at the same point in time the year before. COVID-19 vaccination rates for kids were about the same, at around 12%.

The government has not yet reported its estimates of how well this season’s flu vaccine is working. Testing results from patients indicate that two strains of seasonal flu that are causing most illnesses – a Type A H1N1 and a Type A H3N2. Health officials are closely watching a third strain – a bird flu known as Type A H5N1 – that has sickened tens of millions of animals, but is known to have infected only 67 people in the U.S.

To avoid seasonal viruses, doctors say you should avoid touching your eyes, nose and mouth because germs can spread that way. You should also wash your hands with soap and water, clean frequently touched surfaces and avoid close contact with people who are sick.

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Research Shows More Than 150 Million Mental Diagnoses May be Linked to Lead in Gasoline

By Madeline Holcombe, CNN

December 4, 2024

Gas was a major exposure source of lead for those born before 1996.  A history of lead in gasoline may be behind tens of millions of mental health conditions in the United States, according to new research.

“We’ve shifted the curve in the population for mental health problems, so that everyone has a greater liability in the mental illness symptoms, and that some people who were already at risk are going to develop diagnosable disorders sooner, more often or more kinds,” said coauthor of the study Dr. Aaron Reuben, assistant professor of clinical neuropsychology at the University of Virginia.

The study published Wednesday in The Journal of Child Psychology and Psychiatry estimates that about 151 million mental disorder diagnoses in the US are attributable to lead. The exposure likely would not have happened had it not been in gasoline, Reuben added.

Cars ran on gasoline containing lead starting inthe 1920s, and the US did not start phasing out the substance until the 1980s, after substantial evidence of harm over the decades, according to the US Energy Information Administration. Leaded gasoline continues to fuel some planes, race cars, and farm and marine equipment.

“The people who were exposed are not in the history books,” Reuben said. “Millions of Americans are walking around with an unknown, invisible history of lead exposure that has likely influenced for the worse how they think, feel and behave.”

Scientists have accumulated research over the last century showing that lead is harmful to almost every organ system, Reuben said. In a previous study, he and a team used data on childhood blood-lead levels, leaded gas use, and population statistics to estimate childhood lead exposure and found that half of the US population were exposed to adverse levels of lead early in life.

The number of people impacted might be unexpected to many people, said Dr. Bruce Lanphear, a population health scientist at Simon Fraser University in Canada with expertise in lead poisoning. He was not involved in the research.  “Given their caveats and limitations, I think they’ve done a thorough job of trying to estimate exposures,” he said.

One such limitation was that researchers did not measure all possible exposure sources, meaning that the results may actually underestimate the problem, Lanphear added. “We have not been able to fully understand how those exposures influenced health and disease across the century,” Reuben added.

Lead is a potent neurotoxin and can disrupt brain development in many ways that can impact most types of mental health problems, including anxiety, depression and ADHD, he said. But people were also likely impacted in ways that cannot be diagnosed.

“It also changed personalities. We believe that (lead exposure) makes people a little less conscientious – so less well organized, less detail-oriented, less likely to be able to pursue their goals in an organized way, and more neurotic,” Reuben added.

If lead exposure is a widespread problem and the possible health impacts are serious, what can be done? The first step Reuben recommends is to educate yourself on the sources of lead exposure. “We completely phased lead out of gasoline in ’96, we phased lead out of pipes in ’86, and we took it out of paint in ’78,” he said. “If you’re living in a home that was built before those years, you should be aware that there is likely a lead hazard in your soil or your home.”

It doesn’t mean it’s time to move out of your older home, just that you should check for lead when doing renovations or disturbing the soil, Reuben said. “The (Environmental Protection Agency) recently lowered its soil screening level, and it means that possibly one in four households in the US has soil lead that would now be deemed potentially hazardous,” he added.

You can test for lead exposure – Reuben requests tests for his kids at the pediatrician, he said. For those that have already been exposed, there isn’t a definitive answer on whetheryou can reduce your levels of lead, but Reuben recommends taking steps to identify the sources and reducing future exposure. You can also limit harm from the lead by doing other things that promote health like exercising, eating a nutritious diet and cutting out alcohol and cigarettes, he said.

But the most impactful step will be for institutions to invest in research and the elimination of lead from the environment, Lanphear said. “We really need regulatory agencies like the FDA to make sure there is no lead in the baby food,” he said. “Finding ways to deal with the 20 million homes that still contain lead hazards, getting rid of leaded aviation fuel, these are not things that people can do. This is what the government and regulatory agencies need to do.”

“We’ve got to stop putting this burden on people and families,” Lanphear added.

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Eating More Plant Protein May Lower the Risk of Heart Disease as Much as 27%

MedicalNewsToday – Sophia Hsin/Stocksy

  • A recent study examined the potential effects that consuming different forms of protein may have on heart health.
  • The researchers were interested in the ratio of plant vs. animal-based protein people consumed and their long-term health outcomes.
  • The researchers learned that consuming a higher ratio of plant to animal protein could lead to a reduction of both coronary heart disease (CHD) and cardiovascular disease (CVD).

A new study links consuming more plant-based protein to a lower risk of heart disease. With deaths attributed to heart disease holding the top spot in the U.S., researchers wonder how to cut that number. While medications and technological interventions help, diet remains a focus point for those looking to prevent heart disease or improve their health after being diagnosed with it.

Researchers at the Harvard T.H. Chan School of Public Health recently released the results of a 30-year study that analyzed the effect consuming more plant-based protein than animal-based protein has on heart health.

While the research did not yield a specific ratio of plant to animal protein to incorporate into dietary guidelines, the researchers did learn that people who consume more plant-based protein generally have lower ratios of both CHD and CVD.

People with the highest ratio of plant to animal protein had a 19% lower risk of CVD and a 27% lower risk of CHD.

The study was published in the American Journal of Clinical Nutrition.

Shifting the focus to plant-based protein sources

According to the Centers for Disease Control and Prevention Trusted Source, heart disease is the leading cause of death for both adult men and women. In 2022, around 1 out of 5 deaths were attributed to heart disease.

There are many reasons someone can develop heart disease, such as genetics, poor dietary choices, and habits such as smoking tobacco products and drinking alcohol. People concerned about their heart disease risk can lower it by exercising and making better food choices. For example, choosing lean meats vs. fatty red meats can reduce heart disease risk.

While protein is a staple in a diet, and focusing on lean proteins is more beneficial for the heart, some researchers wonder if people should focus more on consuming proteins derived from a non-animal source.

Diets that focus on plant-based proteins have increased in recent years as vegetarianism and veganism rise. Quinoa, edamame, and chickpeas are examples of the plant-based proteins Trusted Source people use.

With the benefits of consuming non-animal sources of protein in mind, researchers in the current project accessed data compiled in a 30-year study to develop a better understanding of how higher ratios of plant-based protein impact the heart. The study involved more than 200,000 participants. People who signed up to participate who already had CVD or cancer were excluded.

The participants provided information about their health every two to four years and completed food frequency questionnaires (FFQ) every four years. With the FFQ, the participants reported how often they consumed specific foods over the past year, which the researchers used to determine their daily ratio of plant to animal protein intake.

Throughout the study, if a participant reported having a major illness that would potentially cause them to make changes to their diets, the researchers stopped tracking their FFQs. Once the study concluded, the researchers analyzed dietary intake and CVD and CHD outcomes.

A higher ratio of plant-based protein yield heart benefits 

By the end of the 30-year study, 16,118 participants reported developing CVD, and 10,187 participants reported developing CHD. Additionally, 6,137 participants reported having strokes. The researchers compared this data to the plant-animal protein ratio to see if they could find any connections between the ratio and CVD/CHD risk.

Participants with higher plant-to-animal protein ratios showed a significantly reduced risk of CVD compared to those who had the lowest plant-to-animal protein ratio – they had a 19% lower risk. The reduced risk for CHD was even more impressive at a 27% lower risk.

The researchers said that a plant-to-animal protein ratio should be 1:2 to lower the risk of CVD and 1:1.3 for CHD. The scientists noted that over the 30-year study, participants with a higher plant-to-animal protein ratio had lower BMIs, were less likely to be smokers, and were more active.

While the researchers found positive benefits for a higher plant-to-animal protein ratio for reducing the risk of CVD and CHD, they did not find such benefits associated with stroke. The study authors pointed out that despite these findings, they have not identified an optimal plant-to-animal protein ratio and said more research is needed.

Nutrition tips for consuming more plant protein

John Higgins, MD, a cardiologist at UTHealth Houston, who was not involved in the study, spoke with Medical News Today about the study. Higgins said the findings are “consistent with prior studies that recommend plant-protein-based diets or Mediterranean diets Trusted Source as the best diets to prevent CVD as well as reduce further events.” The Mediterranean diet focuses on eating plant-based foods, healthy fats, and whole grains.

Since the authors noted different optimal ratios for preventing CVD and CHD, Higgins offered an explanation for this.

“A higher ratio for prevention of coronary heart disease might further improve blood lipids, blood pressure, and inflammatory markers – because of the fact that plant proteins are accompanied by high amounts of fiber, antioxidant vitamins, minerals, and healthy fats,” he noted.

Higgins suggested that people interested in improving their plant-to-animal protein ratio should cut back on red meat and focus on eating more healthy nuts. “Eat more healthy nuts daily as a source of protein. Nuts are a good source of protein, fat, and fiber, have a low glycemic index, reduce CVD and some cancers, and improve cognitive functioning too,” he added.

Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at Memorial Care Saddleback Medical Center in Laguna Hills, California, who was not involved in the study, also spoke with MNT.

Chen said the study findings were “entirely consistent with many previous studies which found that eating more plant-based protein instead of red meat reduces the risk of many cardiometabolic conditions including heart disease, stroke, hypertension, high cholesterol, diabetes, and obesity.”

When asked whether adjusting the plant-to-animal protein ratio would be difficult for most people, he said it should be doable.

“A 1:2 plant-to-animal protein ratio means that 33% of protein intake comes from plant sources. As the average American currently gets [just over a quarter] of their protein from plant-based sources (1:3 ratio), we are talking about replacing only a relatively small amount of animal protein with plant protein in order to get significant benefits to heart health,” Chen pointed out.

How to eat more plant protein

“Some strategies would be to reduce the amount of meat in a dish, and replace it with ingredients such as beans, tofu, and nuts. One could strive to eat more protein-rich vegetables and grains such as quinoa, spinach, tomatoes, and mushrooms.”
— Cheng-Han Chen, MD

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Assisted Living vs Nursing Home Care: How They Differ

Are you attempting to weigh assisted living versus nursing home care as an option for yourself or a family member? Many Americans just like you are doing exactly that. They’re looking for clear answers about senior living possibilities and the differences between them. Thankfully, this article can help to find some of those answers.

With help from this article, you can start making informed decisions that result in a comfortable, connected, and care-focused quality of life for you or your loved one. After all, a lot of today’s nursing homes and assisted living facilities are warm, homelike communities where older adults enjoy kindness and respect, make new friends, entertain visitors, and pursue satisfying leisure activities.

As you’ll discover, there isn’t just one main difference between assisted living and nursing home care. Rather, each type of senior care community has several special and defining characteristics. In this article, you’ll learn more about those differences as they relate to the following aspects:

Terminology

The “assisted living vs. nursing home” topic is best understood when you know what each term means. It also helps to know the other terms that are frequently used for the same types of senior care options. To that end, here are basic definitions that begin to clarify the difference between nursing home and assisted living options.

An assisted living facility (ALF) is a place where seniors or adults with disabilities live semi-independently and receive limited help with certain day-to-day activities. Assisted living communities tend to provide various hospitality and personal care services, 24-hour emergency response protocols, and regular opportunities for recreation and social interaction. The exact levels of care and types of services that are offered vary from facility to facility and often depend on state regulations. Other terms that are sometimes used when referring to assisted living include:

  • Assisted care
  • Residential care
  • Supportive housing
  • Supported living
  • Adult foster care (in facilities with no more than four residents)

A nursing home is a place where residents who cannot live independently receive extensive and ongoing care due to old age, disabling medical issues, or other kinds of physical or mental conditions that require continuous monitoring or supervision. Nursing homes tend to provide more frequent and comprehensive personal care services than what you will find in assisted living facilities. They also provide easier access to skilled nurses. In some cases, people use the following terms when describing nursing home care:

  • Long-term care
  • Extended care
  • Rest home
  • Care home
  • Intermediate care home

A skilled nursing facility (SNF) is a specific type of nursing home (or a special unit within a nursing home) that focuses on providing services that can only be carried out by registered nurses (RNs) or licensed practical or vocational nurses (LPNs or LVNs). Skilled nursing facilities are mostly intended for people who need short-term medical care or rehabilitative services outside of a hospital following surgery or other serious medical treatments. Examples of skilled nursing care procedures include:

  • Giving injections
  • Inserting catheters
  • Using aspiration devices
  • Inserting IV feeding lines
  • Treating widespread skin diseases
  • Applying dressings to infected wounds
  • Assessing and educating patients
  • Planning, managing, and evaluating patient care

Personal care (also known as custodial care) is assistance that doesn’t require the skills of a registered or licensed nurse. That’s why personal care is a stronger focus within facilities that provide assisted living (vs. skilled nursing facilities, which have a stronger focus on skilled care for medical conditions). Examples of personal care services include:

  • Helping residents eat, bathe, get dressed, or go to the bathroom
  • Administering routine oral medications, ointments, or eye drops
  • Applying creams for minor skin problems
  • Repositioning residents in their beds
  • Changing dressings for non-infected wounds
  • Helping residents walk, get around in wheelchairs, or stay mobile through other means
  • Assisting with routine maintenance of bladder catheters or colostomy bags
  • Supervising residents who have dementia

Common Types of Residents

When it comes to weighing nursing home versus assisted living options, it’s essential to understand who is best served by each type of facility. That way, you can feel more confident in your decision-making while potentially avoiding a costly or unnecessary move later on.

Assisted living is usually suitable for people who:

  • Are open to the idea of getting assistance
  • Can benefit from a more socially engaging living environment
  • Are able to walk or use mobility devices on their own
  • Need a limited amount of supervision or personal care assistance
  • Are lucid or have only mild cognitive problems
  • Want or need to be free of the responsibilities of home ownership

Nursing home care is often necessary for people who:

  • Need daily medical care and/or a lot of personal care assistance
  • Aren’t able to walk or get around in other ways without help
  • Are too sick or frail for home care
  • Need round-the-clock supervision or monitoring
  • Have severe problems with incontinence
  • Are likely to need frequent visits to the hospital
  • Have moderate to severe cognitive problems
  • Have complicated medical, emotional, or mental conditions
  • Resist when being given assistance
  • Display problematic behaviors

Many assisted living facilities welcome residents who have early to middle-stage dementia, including people with Alzheimer’s disease. When those residents require 24-hour supervision (for their own safety and the safety of others), they often need to move into nursing homes that have special memory care units.

Typical Living Spaces

Everyone wants a comfortable living environment. That’s why most assisted living facilities and nursing homes strive to create warm, homelike atmospheres where residents can socialize and accommodate visitors. However, beyond that shared goal, these two types of senior living options tend to have some very recognizable differences when it comes to the actual living spaces they offer.

Assisted living facilities:

  • Tend to feature private or shared apartment-style units or studios
  • Often feature units with small kitchens
  • Generally give residents a lot of freedom in decorating their spaces
  • Provide communal dining rooms
  • Provide a lot of shared recreational space
  • Serve about 28 residents each day, on average, according to CDC

Nursing homes:

  • Mostly offer shared or private hospital-style rooms
  • Sometimes provide a little less freedom when it comes to decorating
  • Provide communal dining and living areas
  • Tend to offer less recreational space
  • Serve about 88 residents each day, on average, according to CDC

Cost and Payment Methods

According to Genworth, in 2023, the national median cost was $7,944 per month for a shared room in a nursing home (vs. assisted living costs of $5,628 per month). For a private room in a nursing home, the cost was $8,898 per month. So, although costs vary from facility to facility, assisted living usually costs quite a bit less than nursing home care.

But looking at cost alone doesn’t provide the full picture. That’s because how you pay for services may play a larger role in determining your options. For example, many seniors rely on Medicare and Medicaid, but those government programs don’t always provide the necessary coverage.

When it comes to assisted living:

  • Most residents (or families) pay out of their own pockets.
  • Some people are covered through private long-term care insurance.
  • Many former military members (and/or their spouses) are able to pay using veterans’ benefits.
  • Some states provide Medicaid coverage if you meet certain eligibility criteria.

When it comes to nursing home care:

  • Most residents, if they are eligible, pay for it with Medicaid.
  • Some people pay for it out of pocket or with private long-term care insurance.
  • Under certain conditions, some patients receive temporary coverage through Medicare.

Medicare Part A, which is a federal government program, will temporarily cover the costs of care in a skilled nursing facility (SNF) under specific conditions. Medicare.gov says that, in order to qualify, a patient must have spent at least three days in the hospital prior to his or her stay in an SNF. Medicare will then fully cover the costs of care for the first 20 days in the SNF. After that, Medicare will continue to pay a portion of the costs for up to a total of 100 days. (During that time, a patient will need to pay a copay of over $214 per day.) When Medicare coverage runs out, the patient must cover all costs of care in the SNF.

In contrast, Medicaid is often used to pay for extended stays in nursing homes (and, less commonly, in assisted living facilities). Medicaid is a joint program of the federal government and individual state governments. Each state gets to set its own eligibility criteria for Medicaid benefits. As a result, the rules about long-term care coverage vary from state to state.

In general, however, a long-term care resident can often qualify for Medicaid coverage if he or she meets a few basic conditions. First, the long-term care facility must be licensed by the state and accept Medicaid payments. Second, the resident must have proof from his or her doctor that the long-term care is medically necessary. Finally, the resident may have to prove that his or her income and financial assets fall below a specific state-mandated threshold.