A veteran who’s saved but can’t afford to retire because of the cost of his medications. A disabled man who’s had to delay refilling prescriptions because of cost and suffered tremors in the meantime.

Those are some of the stories AARP Nebraska has collected recently as part of the national organization’s ongoing campaign urging state and federal lawmakers to lower prescription drug prices. Drug pricing measures currently are wending their way through both houses of Congress.

While drug prices aren’t the only health care cost that’s risen in recent years, they may be the most visible.

“The price of prescriptions has just gotten crazy,” said Bob Lassen, a semi-retired pharmacist from Firth, Nebraska, who serves on AARP Nebraska’s executive council.

The organization’s research indicates that 29% of all Nebraska adults, not just seniors, stopped taking medications as prescribed during 2017 because of cost.

High drug prices, however, put a particular squeeze on seniors because most use more drugs than younger people.

Those who track the issue say the problem goes beyond prescription drug costs alone to include a variety of out-of-pocket medical expenses that combine to affect older Americans.

One study based on federal Bureau of Labor Statistics data indicates that people in their 70s spend nine times more on health care than those in their 20s. An 80-year-old spends about 18 times more than a 20-year-old on prescription drugs.

A new way the Census Bureau is measuring poverty factors in medical out-of-pocket expenses and other necessary costs people incur. The new measure also considers differences in the cost of living across the states — think California vs. Nebraska — which was a major adjustment.

Adding medical out-of-pocket expenses results in an increase in poverty rates for people over age 65. While the traditional poverty calculation put 9.7% of older Americans in poverty in 2018, the new supplemental poverty measure boosted that rate to 13.6%.

“Seniors vote, so it’s something policymakers might want to pay attention to,” said David Drozd, a demographer for the University of Nebraska at Omaha’s Center for Public Affairs Research. He compiled the poverty figures.

For older people, increases in health care costs come at a time when many are no longer working and therefore have less income.

Social Security alone raises people above the poverty level but just barely, Drozd said.

The squeeze isn’t new to those who work with older adults.

Christopher Kelly, an associate professor in UNO’s gerontology department, said it’s been the conventional wisdom that people over 65, the baby boomer generation in particular, are doing well financially.

But there’s actually more income disparity among older adults than among younger ones. And that income inequality increases with age. Lower-income individuals have had less opportunity to save or to participate in pensions or 401(k) plans. Those who’ve worked less than full time may not have been eligible for company 401(k) offerings.

“I think the income inequality gap is growing in old age, and I think this is an under-addressed issue,” he said.

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While Medicare is a great program that covers hospital and doctor costs, he said, it doesn’t cover everything. Original Medicare, for example, doesn’t cover vision, hearing and dental.

Unlike commercial plans that cap annual out-of-pocket drug spending, Medicare has no limits for prescription medications in its drug plan, known as Part D. That’s a particular problem with the rising cost of some specialty medications.

Kelly said seniors often purchase supplemental plans to cover additional items, but those able to buy them tend to be in the middle and upper income brackets.

“We ought to be thinking about what impact that (has) for a pretty wide swath of health care that older adults have to pay for themselves,” he said.

Janelle Cox, a division director for the Eastern Nebraska Office on Aging, said case managers in her office hear a lot about medical out-of-pocket expenses at this time of year. That’s when many people have spent enough on drugs that they find themselves in the prescription drug coverage gap, known as the “doughnut hole.”

“On paper they may look good, but in the months of September, October, November, they can’t meet their bills,” she said.

While that gap has narrowed and will close next year, seniors still face some added costs.

Such expenses aren’t typically counted toward determining eligibility for assistance programs and services, even for Medicaid, she said.

In addition, Medicare, like all other types of health insurance, still is subject to what manufacturers are charging for medications, said Sue Fredricks, executive director of Volunteers Assisting Seniors in Omaha. The organization provides free help to people navigating the Medicare system.

Medicare does have an extra assistance program with higher income and asset limits than Medicaid. If patrons’ income and assets still are too high, the volunteers work to help people find assistance programs through drug manufacturers.

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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