For Medicare beneficiaries, 2023 has started with a few doses of good news that will mean lower out-of-pocket costs for millions of Americans.
Thanks to the Inflation Reduction Act, starting this year monthly out-of-pocket insulin costs for Medicare beneficiaries enrolled in a Part D plan are capped at $35 and most vaccines will also be covered with no out-of-pocket costs.
These are significant money-saving developments, considering about one-third of Medicare beneficiaries are diabetic and that the shingles vaccine is the most expensive vaccine for adults — and it will now be free.
Insulin capped
The Inflation Reduction Act of 2022 includes a provision that caps the out-of-pocket cost of injectible insulin for Part D enrollees at $35 a month, from Jan. 1 this year.
The cap is expected to save Medicare beneficiaries on average about 35% on their insulin outlays this year, although some people with more expensive insulin products will save more. The $35 a month cost applies without them having to reach their Part D plan deductible, which is $505 in 2023.
While Part D plans must cap insulin costs, they are not required to offer every form or brand of insulin. So, it’s important that you check to ensure that your particular brand is covered by your plan.
Because Medicare’s online calculator had not been updated to include the new cap on insulin costs, some beneficiaries may have learned after the fact that their plan no longer covers their type of insulin.
That’s why Medicare has begun a one-time special enrollment period through the end of 2023 that allows beneficiaries who need insulin to drop, add or change Part D plans.
Vaccines
Cost-sharing for vaccines covered by Part D plans has been eliminated as of Jan. 1, 2023.
The vaccines will be free without deductibles or copays, just like the way Medicare Part B covers the flu and pneumonia vaccines. But other vaccines, for which most Part D beneficiaries have had to pay some copays and which were subject to deductibles, will also be available with no out-of-pocket costs for the beneficiary, including:
- Hepatitis A vaccines,
- Hepatitis B vaccines,
- Tdap, which protects against tetanus, diphtheria and whooping cough, and
- Shingles vaccine.
The latter is the most expensive adult vaccine, costing Medicare beneficiaries an average of $114 out of pocket in 2018 for the required two doses.
This should come as welcome relief for many seniors, considering that only 46% of Americans older than 65 have received the shingles vaccine, Shingrix. This vaccine is about 90% effective, and a new study has found that its protection persists a decade after inoculation.
The takeaway
As mentioned above, Medicare will allow beneficiaries that need insulin to drop, change or add a new Part D plan for all of 2023.
Medicare Part D is an optional (but highly recommended) insurance that covers prescription medications. Original Medicare enrollees (Parts A and B) can also sign up for a Part D plan to ensure their pharmaceutical needs are covered. Many Medicare Advantage plans include a Part D plan, but not all.
If you don’t sign up for a Part D plan when you are first eligible to do so, and you decide later you want to sign up, you will be required to pay a late enrollment penalty equal to 1% of the national average premium amount for every month you didn’t have coverage.
If you have questions about these changes for 2023, please call us.
