President Biden’s signing of the Inflation Reduction Act (IRA) marks the beginning of implementing many years of substantial change to the Medicare Part B and Part D programs.
The two (2) most imminent changes, which take effect January 1, 2023, include:
Limiting the member cost-share of covered insulins to $35
Introducing $0 member cost-sharing on Part D vaccines
How does the IRA impact 2023 Medicare Advantage plans (MAPD) and Prescription Drug Plans (PDP)?
It limits the member cost-share on covered insulins to $35.
This means members won’t pay more than $35 for a one-month supply of each insulin product covered by their plan, no matter what cost-sharing tier it’s on, even if their plan has a deductible that hasn’t been met.
While some members already benefit from plans that offer $35 insulin, this legislation ensures that all seniors who use insulin benefit from this out-of-pocket cost limit.
Members receiving LIS will continue to pay the CMS statutory maximum cost share for insulin, which is less than $35.
It eliminates member costs and improves access for Part D vaccines.
2023 plans will cover most Part D vaccines for a $0 cost share, even if a plan has a deductible that hasn’t been met.
How will insulin and vaccine benefits be displayed on Medicare Plan Finder?
Beginning October 1, the Medicare Plan Finder site (www.medicare.gov) will reflect Part D sponsors’ insulin and vaccine benefits and cost sharing as they were submitted in their 2023 bid and formulary submissions, prior to IRA being enacted. However, new insulin and vaccine drug footnotes and other help features will be displayed to explain the benefit changes resulting from the IRA.
Because of this, CMS is granting a Special Enrollment Period (SEP) for Exceptional Circumstances to allow beneficiaries to add, drop, or change their Part D coverage if they find a better option after the 2022 Annual Enrollment Period (AEP) and through the end of 2023.
This SEP will be available for all beneficiaries who use a covered insulin product and begins on December 8th, 2022, and ends on December 31, 2023. Beneficiaries may use this SEP one time during this period.
To utilize this SEP, beneficiaries must call 1-800-MEDICARE so a customer service representative can process the enrollment change; you cannot use a broker for this SEP. Consistent with current policy, when Part D enrollees change plans mid-year, their True Out-of-Pocket (TrOOP) costs carry over from one plan to the next.
What’s coming in 2024?
Additional IRA requirements that will be implemented in 2024 include:
$0 cost sharing in the catastrophic phase for Part D
Expansion of the low-income subsidy eligibility to 150% of the federal poverty line
What additional impacts will IRA have in the future?
Additional IRA requirements will be implemented annually through 2029. We’ll share more information as we approach those implementation dates.