Medicare Patients to Benefit from Inflation Reduction Act’s Insulin Cap

Greg Wilson

Medicare Patients to Benefit from Inflation Reduction Acts Insulin Cap

    The Inflation Reduction Act went into effect on January 1, 2023, capping the monthly out-of-pocket cost of insulin for Medicare beneficiaries at $35.

    Does Medicare Cover Insulin?

    Yes, Medicare covers insulin as a Part D drug, which means it is covered under the Medicare prescription drug benefit. However, there may be some restrictions on coverage, such as the need for prior authorization or limits on the quantity of insulin that is covered. Additionally, beneficiaries may be responsible for paying deductibles, coinsurance, and copayments for their insulin prescriptions. Medicare beneficiaries need to review their specific Medicare plan to understand the terms of coverage for insulin and other prescription drugs.

    What Does Medicare Part D Cover?

    Medicare Part D is the optional prescription drug benefit available to Medicare beneficiaries. It is designed to help cover the cost of prescription drugs that are not covered under Medicare Part A (hospital insurance) or Part B (medical insurance). Private insurance companies approved by Medicare offer Part D.

    Part D coverage includes both brand-name and generic prescription drugs. It also includes many other types of drugs not covered under Part A or Part B, such as over-the-counter drugs, certain vaccines, and injectable drugs that are not self-administered. There may be exceptions and limits to coverage, and beneficiaries may have to pay copayments, deductibles, and coinsurance for their prescriptions. People with Medicare need to look over their Part D plan to understand how their prescription drugs are covered.

    Republicans, on the other hand, stopped a clause that would have limited how much people with private insurance would have to pay out of pocket for the medicine earlier in the year.

    According to the CDC, 21 million of the estimated 34.2 million Americans who have diabetes are under the age of 65.

    The blocked clause makes it so that a large number of people can't get their costs capped.

    The RAND company estimated that the price of insulin in the United States in 2018 was approximately $98.70 per vial, up to ten times more expensive than in other nations.

    When insulin costs get too high, people often use less of it, which can lead to hospitalization or death. A person with diabetes usually needs between one and three vials of insulin every month.

    According to a survey by the JAMA Network Open in 2020, people with high deductible insurance plans had an average monthly out-of-pocket expense of $141. Insulin costs can vary based on the type of insulin, the patient's insurance, and whether or not a rebate is available.

    While the federal government hasn't decided what to do, some states have passed laws to make insulin easier to get or cheaper for people to buy. The Alec Smith Insulin Affordability Act, passed in Minnesota in 2020, sets the price of a 30-day supply of emergency insulin at $35.

    If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.

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