As 2023 gets underway, Medicare beneficiaries will have the opportunity to take advantage of new benefits under the Inflation Reduction Act (IRA). Passed in August of 2022, this landmark legislation makes significant changes to the Medicare program – lowering prescription drug costs, expanding benefits and making insulin more affordable. While many of the benefits of the IRA will roll out over the next several years, some went into effect on January 1, 2023.
We know you may have questions about the IRA and what it means for you, so we wanted to provide answers. We’ll start with some of the most pressing questions, but check our blog for future updates, as significant portions of the policy continue to roll out until the end of 2026.
Do IRA Part D benefits apply to seniors enrolled in Medicare Advantage (MA) plans?
Yes, all Medicare beneficiaries with drug coverage will benefit from the Inflation Reduction Act. This includes those on original Medicare with a standalone drug plan and those enrolled in MA plans with prescription drug coverage.
What IRA benefits will be available in 2023?
- There will be a $0 cost on most adult vaccines as of January 1, 2023.
- There will be a $35 monthly cap on insulin out-of-pocket costs for Part D enrollees (as of January 1, 2023) and those covered under Part B (as of July 1, 2023).
Which vaccines will be free through the IRA?
Under the new legislation, most adult vaccines covered under Medicare Part D (and on the Advisory Committee on Immunization Practices list) will now be free — no deductible, coinsurance or other cost-sharing. Most notably, shingles and tetanus, diphtheria and whooping cough (Tdap) vaccines will be available now at no cost.
If you have Medicare Part B (either through Original Medicare or MA), you already have 100% coverage for flu, pneumonia, hepatitis B and COVID-19 vaccines. The new legislation expands the list of vaccines that are fully covered.
How will the IRA help with insulin costs?
- As of July 2023, the cost of a month’s supply of insulin will now be capped at $35 for those covered under either Part B or Part D.
- If you get more than a 30-day supply of insulin at one time, the cost will not exceed $35/month for each month of your supply. (A two-month supply will cost $70 and three months will cost $105.)
- If your plan has a deductible, it will not apply to these insulin supplies. The only cost-share is the co-pay, which will not exceed $35/month.
Will my $35 copayment for a month’s supply count toward my deductible?
Yes, before you meet your Part D deductible, your $35 (or less) copayment will be applied to your deductible. Learn more at Medicare.gov.
What other benefits will be rolling out?
- 2023: Drug manufacturers will pay rebates to Medicare if certain drug prices increase faster than the rate of inflation.
- 2023: Medicare will be able to negotiate drug prices with manufacturers. However, negotiated prices won’t be available to consumers until 2026.
- 2024: Eligibility under the Part D low-income subsidy program will be expanded.
- 2024: Part D premium increases will be limited to 6% over the previous year.
- 2025: Out-of-pocket prescription drug costs can’t exceed $2,000 annually.
Do I need to do anything to access these benefits?
No, these benefits will automatically be rolled out to all eligible Medicare beneficiaries. No further actions are needed.
Have additional questions about your Medicare Advantage plan and these new enhancements? We have more information about the 2023 Inflation Reduction Act for Aspire members on our website. You can also give our team a call to learn more about the coverage available through an Aspire Health plan at (866) 798-1530, TTY users call 711.