Medicare coverage is in for some promising changes. Make sure you benefit from these and more updates with the help of a trusted Medicare insurance agent.
Pay No More Than $35 Per Month for Covered Insulin
With the Inflation Reduction Act, Medicare beneficiaries with Part D coverage will now pay no more than $35 for a month’s worth (30 days) of each covered insulin. There is no deductible for insulin, so coverage kicks in right away. If you fill 60 or 90 days of prescription, your costs will be capped at $35 for each month’s worth of insulin.
These insulin prices will be fully in place with all Medicare plans in April 2023. You may end up paying more than $35 for a month of insulin before the end of March, but your plan is required to reimburse you for the difference in cost.
If you take your insulin through a traditional pump, in July 2023 that insulin will be covered by Medicare Part B due to the durable medical equipment coverage.
Save Money on Part D Prescription Costs
The Inflation Reduction Act is helping beneficiaries save money with additional assistance for Part D expenses starting in 2024 and beyond.
If you have a Medicare prescription drug plan, you should know about the coverage gap. The gap means that once you have spent at least $4,660 toward your medications, your plan has limited coverage. You pay about 25% of the cost for your prescriptions, plus 25% of the dispensing fee for brand-name drugs. Once you have paid $7,400 toward Part D costs, you reach catastrophic coverage, which is when your plan kicks back in and you pay minimal costs. With the new Act, beneficiaries with catastrophic coverage will not pay Part D copayments or coinsurance, starting in 2024.
2024 also marks the expansion of eligibility for Extra Help, the program that helps Medicare beneficiaries save money on their Part D prescription drug costs. Generic and brand-name medications have capped costs under Extra Help, which will then include people with limited resources who earn less than 150% of the federal poverty level.
Part D costs will also have an out-of-pocket maximum, starting in 2025. Over a plan year, you will pay no more than $2,000 for your prescription drug costs, and will even be able to spread those costs in monthly amounts over the year as opposed to paying them right away.
Medicare Gets a Say
Before now, Medicare has been unable to work with the pharmaceutical companies on costs for its beneficiaries. With the Inflation Reduction Act, Medicare can now negotiate directly with manufacturers to help lower the costs of high-spending brand-name covered Part B and Part D drugs that don’t have competition. This includes medications that don’t have a generic version because the patent protection for the brand-name has not yet expired.
In 2026, Medicare will have negotiated prices for 10 of these high-cost drugs. It also has plans to negotiate prices for 15 Part D drugs in 2025 (effective 2027), 15 Part B and Part D drugs in 2026 (effective 2018), 20 Part B and Part D drugs in 2027 (effective 2029), and 20 Part B and Part D drugs in 2028 and so on. If pharmaceutical companies disregard these new requirements, they will pay a tax.
Expanded Vaccine Access
People with Part D will now have even more free vaccines available. Medicare is now fully covering the shingles vaccine and others that are recommended by the Advisory Committee on Immunization Practices.
