The Inflation Reduction Act & Medicare: What You Need To Know

What you need to know:

The IRA Part D benefits apply to seniors enrolled in Medicare Advantage (MA) plans.  This includes those on original Medicare with a standalone drug plan and those enrolled in MA plans with Prescription drug coverage.

The benefits of the IRA available in 2023 are:

Part D (effective January 1, 2023):

  • There will be a $0 cost on most adult vaccines.
  • There will be a $35 monthly cap on insulin out-of-pocket costs for Part D enrollees. Beneficiaries are not required to meet their deductible.

Part B:

  • Effective April 1, 2023, beneficiaries will have less coinsurance responsibility for certain rebatable drugs.  In certain cases, the beneficiary will have a coinsurance range of 0-20%.
  • Effective July 1, 2023, a cap on insulin applies to Medicare Part B as well.
  • Insulin obtained using Part B benefits will be capped at $35 for a one-month supply.
  • If a beneficiary gets more than a 30-day supply of insulin at one time, the cost will not exceed $35/month for each month. (A two-month supply will cost $70 and three months will cost $105.)
  • If the plan has a deductible, it will not apply to these insulin supplies. The only cost-share is the co-pay/coins, which will not exceed $35/month.

Note: These benefits will be automatically rolled out to all eligible Medicare beneficiaries. No actions are needed on the part of the beneficiary.

Agent Action: Carriers may have new versions of the addendum available to replace what's currently available in their Medicare plan booklets. Check your agent portal for the updated guide.

To read more about the Inflation Reduction Act's effect on Medicare benefits, click the button below.

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