Is Insulin Still Covered by Your Medicare Drug Plan in 2023?
Written by
Vance Cariaga
Edited by
Cory Dudak
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Medicare recipients who suffer from diabetes are poised to save money this year thanks to a provision in the 2022 Inflation Reduction Act (IRA) that lowers the cost of insulin.
About 1.4 million Medicare enrollees will benefit from the new rule, according to an AARP blog published on Jan 23. Beginning in January, copays for insulins covered by Medicare are limited to $35 a month. For Medicare enrollees with diabetes who take their insulin through a pump, the $35 maximum copay for insulin will begin on July 1, 2023.
But taking advantage of the new benefit might be “a little tricky,” the AARP said. That’s because the IRA was signed into law in August 2022, after the premiums and copays for 2023 were already established and loaded onto the Medicare Plan Finder website, which helps beneficiaries compare and choose Part D prescription drug plans and Medicare Advantage plans. Medicare officials have said the Plan Finder can’t be updated with the $35 copay cap information until 2024.
The ensuing confusion prompted the Centers for Medicare & Medicaid Services (CMS) to create a Special Enrollment Period that give beneficiaries who use insulin until the end of 2023 to switch plans if they didn’t get the best deal during last year’s open enrollment period.
CMS recommended enrollees consult either the Medicare hotline (800-633-4227) or State Health Insurance Program (SHIP) counselors to help them navigate the Plan Finder and select a plan that best meets their needs. There are SHIP offices in every state, as well as the District of Columbia, Puerto Rico and U.S. territories.
Among the other provisions included in the Inflation Reduction Act are the following:
- Medicare will be able to negotiate prices for prescription drugs, reducing costs for 5 to 7 million enrollees.
- Beginning in 2025, drug costs for 1.4 million enrollees will be capped at $2,000.
According to the American Diabetes Association, 15.9 million seniors age 65 and older have diagnosed or undiagnosed diabetes. Without the new guidelines, those who take insulin to manage the disease would still pay roughly $300 to $1,000 a month out of pocket for their insulin supply, according to the National Committee to Preserve Social Security & Medicare. High prices have prompted some seniors to ration their insulin, and some have died as a result.
Selena Fragassi contributed to the reporting for this article.
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