{"entity":{"id":"idea-cost-part-b-cap","kind":"idea","name":"Cap what Original Medicare patients pay for Part B cancer drugs","aka":[],"tldr":"Oral cancer drugs under Part D now have a yearly cap of $2,100, but infused drugs under Part B still carry 20% coinsurance with no limit; a Part B cap would close the biggest hole left in Medicare cancer coverage.","summary":"The Inflation Reduction Act capped Part D out-of-pocket spending ($2,000 in 2025, $2,100 in 2026) but left Part B untouched. A patient on an infused checkpoint inhibitor without Medigap or Medicaid owes 20% of the Medicare-approved amount indefinitely. Options include a Part B out-of-pocket cap funded by a premium adjustment, or a guaranteed-issue window for Medigap after a cancer diagnosis so that people can buy the protection that already exists.","asOf":"2026-09-10","links":[{"label":"Medicare.gov: Chemotherapy coverage","url":"https://www.medicare.gov/coverage/chemotherapy"},{"label":"Medicare.gov: Medigap","url":"https://www.medicare.gov/health-drug-plans/medigap"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-drug-pricing"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A Part B cap or diagnosis-triggered Medigap guaranteed issue will reduce the share of Original Medicare cancer patients with out-of-pocket drug spending above $5,000 a year by more than half.","rationale":"Medicare Advantage plans already carry an in-network cap ($9,350 in 2025), so the actuarial mechanics are proven; the gap is in Original Medicare.","test":"Actuarial modelling by CMS and the Congressional Budget Office, followed by a state-level Medigap guaranteed-issue pilot (several states already require it) evaluated on take-up and out-of-pocket spending.","maturity":"speculative","actor":"policy","cost":"large","horizonYears":4},"route":"/ideas/idea-cost-part-b-cap/","neighbours":{"term":[{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"}],"bottleneck":[{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}]}}