An exciting new policy change is coming to Medicare Part D for insulin users!
The Medicare Annual Enrollment Period is here. If you are a Medicare policyholder, you should have already gotten a notice outlining all of the changes coming to your personal Medicare plan. You may have been informed of one of these important changes—the charges for insulin are being capped for anyone that has a Medicare Part D plan as of January 1st, 2023. If you haven’t already, be sure to go over all of the changes happening to Medicare at the start of the new year so you know how your policy will change and can make adjustments if needed before open enrollment ends.
Insulin Cost Cap
According to the official Medicare website, “Plans can’t charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take, and can’t charge you a deductible for insulin.” It’s important to note that this specifies insulin that is covered by Medicare Part D—insulin that is not covered by Medicare won’t be affected by the cap. Since this is completely new and hasn’t been fully implemented into the system yet, Medicare says that this new cap “may not be reflected in your estimated total costs when you review and compare plans.” This is important to note when you’re filling out your Open Enrollment Form so that you aren’t surprised by the difference in the expected charges if you use insulin that is covered by Medicare Part D. Another important thing to note—those who receive Extra Help also qualify for this cost cap.
60- or 90-Day Supply
The $35 per month cap also applies to patients who receive their insulin in 60- or 90-day increments. If you receive your insulin every 60 days, your costs will be capped at around $70, while policyholders who receive a 90-day supply will pay around $105. Ultimately, your costs will always be capped at $35 for each month’s supply of insulin.
Everything Else
According to Medicare’s official site, “Starting July 1, 2023 similar caps on costs will apply for insulin used in traditional insulin pumps (covered by Medicare Part B).” This is another important caveat to note, as it means coverage will come much later in the year for those who use traditional insulin pumps. However, it does provide these new benefits to a broader range of policyholders who require insulin. Up until these benefits come into effect, those with traditional insulin pumps “pay 20% of the Medicare-Approved Amount after you meet the Part B deductible.”
If you have any questions about the incoming changes to Medicare Part D and insulin coverage, you can contact a Medicare representative or speak to a trusted benefits advisor, such as the experts at Aging Benefits Advisory,
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