There are major changes on the horizon as it relates to Medicare. Since premiums and medication have been rising every year, it’s easy to miss the biggest Medicare reforms in two decades. On the bright side, these changes will substantially lower the cost of health care services and prescription drugs starting in 2023.
To increase affordability for prescription drugs and plans, these reforms were part of the Inflation Reduction Act signed back in August. These changes take place through 2029, but some of the biggest reforms begin in 2026. This is when Medicare can negotiate with pharmaceutical companies over drug prices to make them more affordable. While this seems a long way off, the key provisions in 2023 include a $35 cap on most insulin products. Additionally, drug companies must begin paying rebates to Medicare if their prices increase faster than inflation. While these rebates aren’t directly paid to beneficiaries, this may help contain price increases.
Here’s a bigger breakdown of what’s coming down the pipeline:
- More vaccines covered by Medicare Part D
- Rebates must be paid to Medicare by drug companies if their prices rise faster than inflation
- Some insulin co-payments under the Medicare Part D prescription drug benefit are limited to $35 per month
- Part D beneficiary subsidy expanded to those earning up to 150% of the federal poverty line
- 5% coinsurance payment eliminated for part D catastrophic coverage
- Drug costs capped at $2,000 annually for out-of-pocket Medicare prescriptions
- Medicare will begin negotiating the price of some prescription drugs. This includes 10 drugs in 2026, an additional 15 in 2027 and 2028, and 20 more in 2029
With all these changes coming down the pipeline, it may be difficult for beneficiaries to keep up. The three key programs being implemented in 2023 should be the focus, especially the insulin benefit because 3.3 million Medicare beneficiaries use insulin nationwide. The most important thing is to ask the provider because the costs were not listed on the Medicare popular Plan Finder tool due to the late approvals.
Medicare beneficiaries can start by checking costs with the Plan Finder if they input all their prescriptions (minus any insulin products) and choose a plan with the best coverage and cost, then check to see if the insulin is covered. The tool doesn’t know the cost of the insulin is $35, but if it’s there, that should be the cost. This helps determine if the current plan should stand or be replaced, especially for those with private Medicare Advantage insurance. The additional vaccine coverage is also a benefit.
Low-income beneficiaries really benefit in 2024, with expanded eligibility to a qualification of 150% of the federal poverty line, and in 2025, a $2,00 out-of-pocket cap on Medicare Part D coverage. This will be a huge help for the poorest and sickest individuals. It’s important to really shop around and find the best Medicare Advantage plan where the costs and new rules align with your needs.
As a broker who represents many carriers, The Insurance Hub can make the process easier than researching on your own. Contact the knowledgeable licensed agents at The Insurance Hub. 941-706-1111, firstname.lastname@example.org, www.TheInsuranceHub.net. Offices in Sarasota and Bradenton,