Inflation Reduction And Medicare

Inflation Reduction And Medicare

Inflation Reduction Act

Signed August 16, 2022, the Inflation Reduction Act will make numerous improvements to the Medicare program, including:
• Insulin Coverage
• Access to Vaccines
• Part D Out-of-Pocket Costs
• Extra Help Qualifications

Insulin Coverage

Starting in 2023, all Part D plans will cap the cost of a month’s supply of covered insulin at $35
• Insulin costs will not count towards the Part D deductible, if applicable
• Plans have until March 2023 to update their systems. If you paid more from January through March 2023, you must be reimbursed by the carrier within 30 calendar days
Starting July 1, 2023, limits the cost of individuals who receive insulin through Part B for their insulin pump at the same $35 for a month’s supply

Vaccine Coverage

• Starting in 2023, people with Part D will pay no out-of-pocket for vaccines that are recommended by the Advisory Committee on Immunization Practices
• This now includes the shingles vaccine

Part D Out-of-Pocket Costs

Catastrophic Drug Copays
• Starting in 2024, people with Part D drug costs high enough to reach the Catastrophic Coverage phase in their plans, will have a $0 copay

Maximum Out-of-Pocket
• Starting in 2025, your yearly Part D out- of-pocket costs will be capped at $2,000
• You’ll also have the option to pay out-of- pocket costs in monthly amounts over the plan year, instead of when they happen

High-Priced Brand Name Negotiations

• Starting in 2026, Medicare will negotiate directly with manufacturers for the price of certain high-cost brand name Part B and Part D drugs that don’t have competition

• Medicare will select and negotiate costs for:
o 10 Part D drugs in 2023 (effective in 2026)
o 15 Part D drugs in 2025 (effective in 2027)
o 15 Part D and B drugs in 2026 (effective in 2028)
o 20 Part D and B drugs in 2027 (effective in 2029)
o 20 Part B and D drugs in 2028 and ever year after

Extra Help Qualifications

Starting in 2024, certain people with limited resources who earn less than 150% of the Federal Poverty Level will receive Full Extra Help status:
• $0 premium (up to benchmark premium)
• $0 deductible
• Lower copays


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