Not all prescription costs will be capped for people enrolled in Medicare, expert says

AUSTIN, Texas - While Medicare customers can look forward to out of pocket caps on some prescription drugs, it doesn't apply to all medication.

Sylvia Gordon, also known as the Medicare Mama, joined FOX 7 Austin's Rebecca Thomas to answer questions about Medicare, Social Security and retirement in general for almost a million followers across social media.

MORE: Prescription costs for people enrolled in Medicare will soon be capped

REBECCA: Sylvia. Last week we discussed that $2,000 cap on Medicare drugs. How does that relate to drugs that are either on Medicare Part D and part B? 

SYLVIA: While most people think that Medicare Part D, the prescription drug program, covers all drugs, they're not aware that some drugs and some of the most expensive drugs are actually covered under Medicare Part B. So, for example, there's a new drug for Alzheimer's. It's a breakthrough drug, one of the first drugs that has proven to slow the progression of Alzheimer's that we've had in years. But it's very expensive, and it's not covered under Medicare Part D. It's covered under part D.

REBECCA: What would you expect? Or what could someone expect to pay for this new Alzheimer's drug?

SYLVIA: So what you pay for any drug on Medicare will be dependent on what type of insurance you have. So if you only have government, Medicare A and B, which I normally do not recommend, but there's over 6 million people that's all they have. If they got prescribed liquid B, which is going to be infused in a doctor's office, they would pay 20% of the retail cost of liquid T, the retail cost is $26,500 a year, so they would pay $5,300 a year. Now, if you have a Medicare supplement plan, let's say you have a plan G. That's the most popular plan in America. The deductible this year is only $240. So if you had a Medicare supplement plan, and you've already met your deductible, you wouldn't pay anything for this drug. That's a big difference between $5,300 and 0. If you have Medicare Advantage, Medicare Advantage can be all over the board. All the plans vary. But most plans would also charge you 20%. So, for most plans, you would also pay $5,300 per year for Lacombe.

REBECCA: Okay. Well, last week, we discussed a cap on Medicare drug costs at $2,000. Why would Lacombe cost more, or any drug?

SYLVIA: So when we talked about the new Medicare prescription drug cap, that price that starts in January 2025, that caps your drugs. Nobody can pay more than $2,000 a year for the cost of their Medicare Part D drugs. This drug and any drug that you don't self-administer like a pill that you take yourself. If you have to go to a health care professional setting so your doctor's office to get your liquid, it's going to be an infusion that's not under Medicare Part D, so the cap does not apply. That's under Medicare Part B. And there still is no cap on those drugs.

REBECCA: Okay. Got to remember that one. We're out of time. But Sylvia, thank you so much for sharing your time with us tonight.