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The Inflation Reduction Act and Medicare

The Inflation Reduction Act is a new federal law that helps improve Medicare. It expands Medicare benefits. And it helps lower out-of-pocket drug costs.

 

The Inflation Reduction Act lowers costs of insulin and other drugs under Medicare.

Lower copays for insulin and vaccines

 

Vaccines at $0 copay

 

With this new law, there is a $0 copay* for most Part D vaccines at any network pharmacy. That includes the shingles vaccine.

 

Insulin copay limit of $35

 

With the new law, your copay for a month’s supply of covered insulins will be no more than $35.* That’s with Medicare Part B or Part D. Just go to any network pharmacy.

 

For Part B insulin, this copay limit only applies to:

  • Insulin dispensed through a pump
  • Medicare-covered durable medical equipment
 

These benefits apply no matter what tier the drug is on. Even if you haven’t paid your deductible yet. These copay limits apply through all coverage phases. That includes the coverage gap.

 

Other benefits of the Inflation Reduction Act

 

Lower coinsurance for some Part B drugs

The new law has rebates that will also lower the cost share for some other Part B drugs. Certain Part B drugs will get a coinsurance adjustment. We pass those savings on to you.

 

These drugs may change each quarter. This change doesn’t apply to Part D drug coverage. Ask your pharmacist to learn if your drug is part of this change.

$0 copay in the catastrophic phase

There’s a limit to what you have to pay out-of-pocket for your covered Part D drugs each year. Once you reach that limit, you enter the Medicare catastrophic phase. In the catastrophic phase, you would normally pay a lower copay for your drugs.

 

With the Inflation Reduction Act, that lower copay is now $0. This benefit started on January 1, 2024.

Expanded low-income subsidy (LIS or “Extra Help”)

Do you qualify for the Extra Help program? It’s open to Medicare Part D members with incomes up to 150% of the federal poverty level. Starting in January 2024, if you qualify, you’ll pay:

 

  • A reduced drug plan premium
  • A $0 drug plan deductible
  • A lower cost for covered generic and brand-name drugs