The new Inflation Reduction Act will add a cost limit to prescriptions drug users, it will limit insulin co-payments, and allow for some vaccines to be free!

In all the years of Medicare, it has never capped the fees for prescription drugs for its beneficiaries. But times are changing, due to the Inflation Reduction Act of 2022. The new law is making several changes that will be a big benefit to users! In the Medicare Part D drug benefits, it will soon be putting a limit on out-of-pocket co-payments for insulin and make getting vaccines (like the expensive Shingles vaccine) free of cost.

These changes will begin in the next few years. Take a look at how the new changes of Medicare Part D will benefit you:

  1. Capping Out of Pocket Costs

Starting in 2025, the maximum amount that beneficiaries would have to pay out of pocket for prescription drugs each year will be $2,000. This out-of-pocket limit applies if you get your prescription drugs through a stand-alone Part D plan, or through your Medicare Advantage plan.

  1. An Option to Spread out the Costs of Expensive Medications

Beginning in 2025, this option will be called smoothed cost-sharing. This means you can opt to have your out-of-pocket costs spread out over the year. This is to help protect people from being hit with such a big drug bill all at one time and be able to spread it out.

Example: If you have a very expensive drug that you need, in January of each year you get hit with a $2,000 copayment. With the new change, you can choose to spread that $2,000 over 12 months, as 166.67 per month.

If your Prescription Drug plan has a deductible, then that amount will also go towards your 2000 max out of pocket.

Example: If your deductible is $300, once you’ve met that, your out-of-pocket costs will be capped after spending the additional $1,700 in that year. (Many of those plans, however, have no deductible.) As for Copayments, Part D (Stand-alone Prescription Drug Plans) will also be required to limit the copayment to $35.00, even if the beneficiary has not yet met the deductible.

  1. Insulin Costs will be Capped

Beginning in 2023, copayments for a 30-day supply of any insulin will be capped at $35.00 on some prescription drug plans. If you would like to make sure you are on the correct plan for prescription drugs and that your plan will only charge you a $35.00 copayment for your insulin, then give me a call so I can set up an appointment with you during open enrollment, which starts on Oct 15, 2022. These Part D plans will be required to stick to the $35.00 copayment limit even if the beneficiary has not met the deductible, yet. This will be a huge benefit to insulin users in the coming year!

  1. Premium Increases will be Limited

Beginning in 2024 and continuing through 2029, Part D premiums cannot increase by more than 6 percent a year. This will be good news to many people who have seen several premium increases over the years.

  1. Free Vaccines

Beginning in 2023, there will be no out-of-pocket costs for some vaccines*. As you may know, Part B already covers some vaccines, such as flu shots, hepatitis B and coronavirus, pneumonia, and a few others. However, the shingles vaccine was one of more expensive ones that may not have been covered. In the new plan, this vaccine should also be covered.

*Only those vaccines suggested by the CDC

If you have additional questions about what your Medicare Perception drug plan cover, or if you just want to make sure, based on your perception which plan will be best for you please reach out to Amy Kelley – Insurance Nana.

With these new changes, you might discover that your out-of-pocket expenses for your prescription drugs become more affordable in the years to come!

Call the Insurance Nana today to discuss any of your Medicare questions.