Changes Continue to Improve for Medicare Prescription Coverage

By Crystal Manning

Many Medicare beneficiaries that have a Medicare Advantage or Medicare supplement plan with a separate Medicare part D plan utilized a savings of almost $470 million in out-of-pocket costs, through lowering drug costs and copays for doctor’s office visits. This year the Medicare Advantage companies provided Part D plans, which cover drugs that patients pick up at a pharmacy, with more negotiating tools so they can put pressure on drug companies and get a good deal for patients. Plans will be able to make sure that beneficiaries have access to new generic drugs sooner, while ensuring that beneficiaries receive high-quality care.

Seniors will continue to save through upcoming improvements. According to Medicare.gov, a new prescription drug law went into effect January 1, 2023, and will help save money for people with Medicare. This law improves access to affordable treatments and strengthens the Medicare program. How will this law help seniors and what does it entail?

Seniors taking insulin will be pleased to know that Medicare drug plans cannot charge you more than $35 for a one-month supply of each Part D-covered insulin. Medicare also eliminated the plans’ deductible on applicable insulin. Also note, on July 1, 2023, the new rules apply if you get a 2- or 3-month supply of insulin your costs cannot be more than $35 for each month’s supply of covered insulin. This also applies if you take insulin through a traditional pump that is covered under Medicare’s durable medical equipment benefit, which is Medicare part B.

Starting April 1, 2023, you might pay a lower coinsurance amount for certain drugs and biologicals covered by Part B, if their prices have increased higher than the rate of inflation. The specific drugs and potential savings change every quarter.

More vaccines will be covered at no cost to beneficiary of Medicare Part D drug coverage. The Part D plan will no longer charge a copayment or apply a deductible for vaccines that are recommended - including the vaccines for shingles, whooping cough, and more.

Another benefit that seniors will be happy to know, if drug costs are high enough to reach the catastrophic coverage phase in your Medicare drug coverage, there will be no copayment or coinsurance, starting in 2024. There will also be an expansion of Extra Help payments for prescription drug coverage (the Part D Low-Income Subsidy (LIS) program) to cover more drug costs for people with limited resources who earn less than 150% of the federal poverty level.

The future of these new regulations includes for the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that do not have competition. Medicare beneficiaries will see these changes in 2026 and other changes in future years. Also noteworthy is the manufacturers that do not follow the negotiation requirements will have to pay a tax and penalties if they do not fulfill other manufacturers' requirements.

There are still plans that you can change to now. If you need assistance to make the best choice contact your local Medicare broker Crystal Manning at (412) 716-4942 or email crystalmanning33@gmail.com. Manning will provide specialized health insurance knowledge and represents most plans in your area. She has her license in 14 states.