数百万购买独立处方药计划的 Medicare 参保人将在 2027 年看到其平均月保费上涨 50%，一项新分析发现。
Millions of Medicare enrollees who buy stand-alone prescription drug plans will see their average monthly premiums rise by 50% in 2027, a new analysis finds.
但参保人可以在该计划的开放注册期内（截至 12 月 7 日）转投成本更低的计划，从而避免这一平均涨幅——即从每月 34 美元增至 51 美元。
But enrollees can avoid the average increase — from $34 a month to $51 — by switching to lower-cost plans during the program’s open enrollment period, which runs through Dec. 7.
弗吉尼亚州阿宾登的罗伯特·特拉维斯·斯科特在 10 月下旬收到通知后便这样做了：他原有的 AARP-联合健康保险 Medicare 药品计划保费将从 2026 年的每月 39.60 美元涨至 2027 年的 121.90 美元。他在网上稍作比价，便找到一款保费为 19.30 美元、福利相近的 Humana 计划。
Robert Travis Scott of Abingdon, Virginia, did just that in late October after he received a notice that his AARP-UnitedHealthcare Medicare drug plan premium would be increasing from $39.60 a month in 2026 to $121.90 in 2027. With just a little work checking prices online, Scott found a Humana plan for $19.30 with similar benefits.
“确实，我对刚找到的这个新计划很满意，”他说。他表示对原计划涨幅之大感到震惊，并担心其他老年人不去货比三家以省钱。他估计自己为明年省下了约 1000 美元。
“Yes, I am quite happy about that,” he said of the new plan he just found. He said he was stunned his existing plan was going up so much and worried that other seniors won’t shop for plans to save money. He estimates he saved himself about $1,000 for next year.
“随着一些计划大幅提高保费，如果 Medicare 独立药品保险参保人在开放注册期袖手旁观，今年面临的风险更大，”KFF 的副总裁兼 Medicare 政策项目主任朱丽叶·库班斯基说。KFF 是一家健康信息非营利组织，旗下包括 KFF Health News。
“With some plans increasing premiums substantially, the stakes are higher this year for people with Medicare stand-alone drug coverage if they sit on the sidelines during open enrollment,” said Juliette Cubanski, a vice president and the director of the Program on Medicare Policy at KFF, which conducted the analysis. KFF is a health information nonprofit that includes KFF Health News.
药价上涨是令选民在 11 月中期选举前愤怒的一长串负担能力问题之一。唐纳德·特朗普总统声称其政府已成功与药企谈判降低了价格，但他在一些民调中的支持率已跌至其两个任期以来的最低水平。
Rising drug costs are among the litany of affordability issues angering voters ahead of November’s midterm election. President Donald Trump, whose approval rating in some polls has dipped to the lowest level of his two terms in office, claims his administration has succeeded in negotiating lower prices from drug manufacturers.
“我们在制药方面做得非常出色，涉及数千亿美元，”特朗普在10月28日俄亥俄州的一次竞选集会上说，当时距离11月3日的中期选举尚有一段时间。“仅凭这一点，所有参选人都应该获胜。我们拥有世界上最低的药价。我们从药价最高的国家变成了药价最低的国家，享有最惠国待遇，在世界任何地方都是如此。”人们实际为药品支付的金额差异很大，取决于个别患者需要什么药物以及他们的保险覆盖范围。
“What we’re doing great with is pharmaceuticals, hundreds of billions,” Trump said at a campaign rally in Ohio on Oct. 28, ahead of the Nov. 3 midterms. “You should win just on this, everybody running. We have the lowest drug prices anywhere in the world. We went from the highest drug prices, we now have the lowest drug prices, favored nations, anywhere in the world.”How much people actually pay for drugs varies widely, depending on what medicines individual patients need and their insurance coverage.
作为私人Medicare Advantage计划（替代传统Medicare覆盖）一部分获得药品覆盖的Medicare受益人，将看到保费涨幅小得多。KFF的分析发现，这些参保人2027年将作为其整体月保费的一部分，平均支付9美元用于药品，即每月涨幅不到2美元。
Medicare beneficiaries who get their drug coverage as part of private Medicare Advantage plans, which replace traditional Medicare coverage, will see much lower premium increases. The KFF analysis found these enrollees will pay an average of $9 for drugs as part of their overall monthly premium in 2027, or an increase of less than $2 per month.
超过一半的Medicare受益人参加了Medicare Advantage健康计划，这些计划通常包含药品福利，而不是参加传统计划。
More than half of Medicare beneficiaries are enrolled in Medicare Advantage health plans, which usually include a drug benefit, instead of the traditional program.
根据KFF的数据，近2500万人参加了Medicare独立处方药计划。约3100万人通过Medicare Advantage计划获得药品覆盖。保费只是Medicare参保人面临的较高成本的一部分。
Nearly 25 million people are enrolled in Medicare stand-alone prescription drug plans, according to KFF. About 31 million get drug coverage through Medicare Advantage plans. Premiums are just part of the higher costs Medicare enrollees are facing.
大多数购买独立药品计划或通过Medicare Advantage计划获得药品福利的参保人，2027年也将面临药品覆盖的年度免赔额。
Most enrollees who buy a stand-alone drug plan or get drug benefits through Medicare Advantage plans will also have an annual deductible for drug coverage in 2027.
根据KFF的分析，2027年独立计划的平均免赔额将为643美元，高于2026年的540美元。拥有Medicare Advantage计划的人群药品免赔额将平均为489美元，高于2026年的360美元。
The average deductible in 2027 will be $643 for stand-alone plans, according to the KFF analysis, up from $540 in 2026. Drug deductibles will average $489 for those with Medicare Advantage plans, up from $360 in 2026.
此外，KFF的分析发现，明年大多数拥有药品覆盖的Medicare参保人将不得不支付共同保险而非固定共付额。这可能意味着自付费用的可预测性降低，因为共同保险要求支付药品成本的一定比例，而不是固定金额。
In addition, most Medicare enrollees with drug coverage next year will have to pay coinsurance rather than copayments, the KFF analysis found. That can mean less predictable out-of-pocket costs because coinsurance requires paying a percentage of the cost of a drug, not a fixed amount.
预计保费上涨的一个可能原因是，医疗保险和医疗补助服务中心（CMS）于7月决定提前终止一项为期三年的试点项目，该项目旨在抑制独立处方药计划的保费。该项目在2025年和2026年向独立计划支付补贴。
One possible cause of the projected premium hikes is the Centers for Medicare & Medicaid Services’ decision in July to end early a three-year pilot program designed to keep down stand-alone premiums. The program paid subsidies to stand-alone plans in 2025 and 2026.
KFF表示，CMS决定在仅两年后终止该补贴项目，可能导致2027年独立计划的保费上涨。
KFF said CMS’ decision to end that subsidy program after only two years could cause stand-alone premiums to rise in 2027.
CMS局长梅赫梅特·奥兹曾称该补贴项目为保险行业的救助计划。
CMS Administrator Mehmet Oz has called the subsidy program an insurance industry bailout.
KFF指出，其分析结果与CMS的预测不同，CMS预测基于2026年9月的参保情况，全国平均保费将从35美元增加1美元至36美元。KFF表示，CMS未解释其计算方法，且有可能CMS假设人们会转向成本更低的计划。CMS未立即回应关于KFF调查结果的置评请求。
KFF noted its analysis differs from CMS’ projection for a $1 increase in the national average premium, from $35 to $36, based on September 2026 enrollment. It said that CMS did not explain its calculation methods and that it’s possible CMS assumed people would switch to lower-cost plans. CMS did not immediately respond to a request for comment on the KFF findings.
KFF发现，约1040万医疗保险参保人，即未获得低收入补贴的独立处方药计划参保人的76%，如果继续留在同一计划中，将在2027年支付更高的月保费。
About 10.4 million Medicare enrollees, or 76% of enrollees in stand-alone drug plans who don’t get low-income subsidies, will pay a higher monthly premium in 2027 if they stick with the same plan, KFF found.
这其中包括目前处于零保费计划中的410万参保人。KFF分析发现，由于2027年将不再有零保费计划可供选择，他们将自动面临更高的保费。
This includes 4.1 million enrollees who are currently in a zero-premium plan. They’ll automatically pay more in 2027, because there will be no zero-premium plans available, the KFF analysis found.