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Minneapolis, MN – The Inflation Reduction Act passed last year promises to provide much-needed financial relief to Medicare enrollees in the form of prescription drug savings in 2023. This week, medicareresources.org offered several tips that can help enrollees make sure they don’t miss out on new opportunities to save.
“It’s really important that Medicare enrollees be aware of these legislative changes, which took effect Jan. 1 and are already lowering prescription drug costs for many,” said Jenny Chumbley Hogue, an analyst for medicareresources.org. “Enrollees can take advantage of those cost savings by taking a few basic steps.”
Even prior to 2023, vaccines for flu, pneumococcal, Hepatitis B, and COVID-19 have been fully covered under Medicare Part B. But starting Jan. 1, Medicare beneficiaries with Part D prescription drug coverage have access to a list of additional recommended vaccinations with no out-of-pocket costs. The list includes vaccinations for shingles as well as for tetanus, diphtheria and pertussis (Tdap).
“The same vaccine you may have paid $75 for last year could now cost you nothing out of pocket if you have Medicare drug coverage,” said Chumbley Hogue. “If you’ve put off immunization in the past due to cost, take another look this year.”
As of Jan. 1, out-of-pocket costs for any covered insulin products are capped at $35 a month for all Part D plans under the Inflation Reduction Act (IRA). And starting in July, out-of-pocket costs for insulin covered under Medicare Part B – and used with an insulin pump – will also be capped at $35 a month.
“This could save the millions of Medicare beneficiaries with diabetes hundreds of millions of dollars a year, but enrollees need to make sure they are seeing these changes,” said Chumbley Hogue.
Although the $35 limit on insulin cost-sharing took effect Jan. 1, Part D plans have until the end of March to update their systems. As a result, some Part D enrollees who fill covered insulin prescriptions in the first three months of 2023 may find that they’ve been charged more than $35. If an enrollee in this situation hasn’t received reimbursement after the update, they should contact their Part D plan. The plan then has 30 days to issue reimbursement.
Enrollees who feel they aren’t currently enrolled in Medicare coverage that fits their healthcare needs might also have an opportunity to change their coverage for 2023:
Not all plans cover all types of insulin, so Medicare beneficiaries may need to switch plans to take advantage of the $35 cap. During last fall’s annual enrollment period, the Medicare Plan Finder tool at Medicare.gov also may not have reflected the $35 caps for covered insulin products because Part D insurers submitted plan details before the IRA was enacted. As a result, some beneficiaries may have made their Part D plan choice based on expected higher cost-sharing for insulin.
Now that cost-sharing for insulin has been reduced for covered insulin products, some beneficiaries might find that their costs for other drugs, or a plan’s monthly premium, become more of a deciding factor in picking a plan. The Centers for Medicare & Medicaid Services (CMS) is giving these enrollees a special enrollment period – through the end of 2023 – to choose a different Part D plan for 2023, if necessary.
“Medicare beneficiaries with Part D coverage are already seeing cost savings if they use insulin or need certain vaccines, and beneficiaries who use insulin pumps will start to see additional savings this summer,” Chumbley Hogue says. ”It’s the perfect example of how coverage is always changing – and why it’s important for consumers to review their Medicare coverage annually to make sure they still have the plans that best meet their needs and budget.”
Medicareresources.org is one of the longest running online sources of in-depth information about Medicare. The site provides an overview of the basics of Medicare coverage options, enrollment and eligibility; coverage FAQs; state-specific Medicare information; and a glossary of Medicare terms. The medicareresources.org website is owned and operated by Healthinsurance.org, LLC.
Amy Fletcher Faircloth, [email protected]