The Medicare prescription drug plan has been a hot topic in the healthcare debate. Everyone has their own ideas on how to solve the situation. The two biggest things you will hear from politicians and media personalities are “drug companies are making too much money” and “Medicare must be overhauled.” While their opinions vary, many want to use the Medicare prescription drug plan to get this done.
The days ahead could mean drastic changes to the plan we currently have. Whether it’s increased cost sharing or replacing private plans with Original Medicare — whatever happens, is bound to affect you. Hence, it’s important to know what’s going on now so you’re prepared in the future.
Insulin Costs Will Be Capped
Did you know that in 2023, insulin costs will be capped? The Centers for Medicare & Medicaid Services (CMS) announced this was part of the CMS’s effort to help improve the affordability of prescriptions. Some plans already have insulin caps through the Inflation Reduction Act, while others will be instituting caps. Additionally, deductibles will not apply to the cost-sharing. The goal is not to make beneficiaries choose food over medication.
100% Coverage for Recommended Vaccines
In the past, some beneficiaries were required to pay for their shingles vaccines. Starting January 1st, recommended vaccines will be fully covered. There are provisions to eliminate 5% coinsurance in the catastrophic phase of coverage in 2024 and cap beneficiaries’ out-of-pocket Part D expenses at $2,000 beginning in 2025.
Possible Change to Covered Drugs
Tiers of drugs and associated pricing may be changing. This is not unusual. Each year there are changes. Researching the cost at each pharmacy will make a big difference and result in potential savings.
Beneficiaries With Higher Income Pay More for Coverage
Medicare Part D plans have different premiums based on the income of the person who enrolls in them. The highest-income enrollees pay significantly more than other beneficiaries in their region. This means that if you live in a state with high prescription drug costs, you may be required to pay more for coverage than someone with a lower income living in another state.
According to the Centers for Medicare & Medicaid Services, premiums for Part D coverage will average $31.50 next year, down from $32.08 in 2022. In addition to any premium you pay, you will be subject to income-related monthly adjustment amounts, or IRMAAs, if your income exceeds certain limits (see chart below). Additional amounts are included in Part B as well.
You’ll be assessed those surcharges in 2023 based on your tax return from 2021. Your income can be reconsidered if it has decreased since then.
Planning For Changes
With some anticipation and some research into next year’s plans, you can be prepared to make an educated decision on your prescription drug coverage for the year. This information will help that needing assistance choose the best Medicare supplement plan for their personal health care needs.