Medicare Update: Inflation Reduction Act

Medicare Update: Inflation Reduction Act

The Inflation Reduction Act of 2022 introduced many changes to how things are priced in every industry. Just as your tax brackets may change this year, so will your Medicare premiums and guidelines to fit the act’s accordances. Health for California has all the information you need to understand the changes going into effect in 2023 and how they will impact your current or future Medicare coverage.

Updates to Medicare for the 2023 Annual Enrollment Period

Medicare provides discounted health care coverage to individuals over 65 and people with certain disabilities. Under the original Medicare plan, sometimes referred to as Parts A and B, qualified people receive coverage for hospital services (Part A), office visits and emergency care (Part B). Further coverage for items like prescriptions and more expensive procedures and services falls under Part C, Part D or other supplemental plans.

Every year, the government has the option to update Medicare guidelines to change pricing tiers and make additions to or removals of coverage. In 2022, the greatest changes in Medicare have been due to the Inflation Reduction Act, which has targeted significant concerns raised by the general public.

Insulin Cost Cap

People with diabetes or anyone else who buys insulin will experience some relief in buying their medication this year. Any insulin product listed on the Formulary Reference File (FRF) covered by your Medicare plan is now capped at $35 in all phases. Even if you haven’t paid your deductible, you won’t have to pay more than $35 every month.

If the cost-share of your insulin is less than $35, you’ll pay the smaller amount of the tier cost-share.

Lower Copay on Vaccines List

Vaccines keep everyone safe by decreasing the likelihood of catching a virus and the severity of symptoms if you contract it anyway. Ensuring those most at risk for illness get vaccinated as soon as possible is crucial in deterring its spread. In this Medicare update, any vaccine on the CDC Immunization Recommendation List for Adults covered by your plan will have a $0 copay cap in all phases and a waived Vaccine Admin Fee. This plan includes most Part D vaccines at $0 cost-share to you, even if you have yet to meet your deductible.

Note that you may be charged a separate vaccine administration fee separate from your copay to get a vaccine at a network pharmacy. The maximum vaccine administration fee that you may pay at a network pharmacy depends on your specific pharmacy and plan combination. If you are not getting the vaccine administered at a network pharmacy, please contact your carrier for more information about any vaccine administration charges that may apply.

Senior Savings Model Application

Finally, the language has been updated in footnote 20, which details the Senior Savings Model Discount. Now, this discount applies to both the Senior Savings Model and the Inflation Reduction Act. For more information on what this might mean for you, contact your provider to learn more.

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