Is Insulin Still Covered by Your Medicare Drug Plan in 2023?
As of Saturday, Oct. 15, Medicare open enrollment is available for anyone eligible to join the program in 2023 or anyone looking to change plans for next year. With the open window, organizations like the nonprofit advocacy group The Senior Citizens League are telling people — particularly diabetics who need regular insulin — to look closely into their options.
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That’s because there are some big changes coming to the program as part of the Biden-Harris administration’s Inflation Reduction Act, as GOBankingRates reported last month. The law, passed by Congress on Aug. 16, will give added benefits to more than 50 million Americans beginning next year, according to an official announcement released by the White House. Among the provisions:
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.
A month’s supply of insulin will be capped at $35 for Medicare enrollees who have diabetes.
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.
It’s imperative that anyone enrolled in Medicare or joining for the first time ensures their plan covers the drug. “This year, more than ever, it is vital that people with Medicare review and compare their options to find the coverage that best meets their needs,” said U.S. Department of Health and Human Services Secretary Xavier Becerra in a statement from the Centers for Medicare and Medicaid Services.
“If you are selecting a Medicare prescription drug plan, check if your prescriptions are included on a plan’s formulary,” CMS advised.
This is especially important for those who want to take advantage of the $35/month insulin cap. The Senior Citizens League suggests that once you’ve chosen a Medicare plan, call the number listed for the plan and confirm prescription costs and overall coverage to verify insulin is included before completing enrollment.
Another tip from TSCL is to always do the enrollment through the official Medicare website, located here, rather than the insurance company site or by phone. “Enrollment errors are reduced by using the Plan Finder, and for those who are switching from one plan to another, Medicare will make sure you are correctly dis-enrolled from your previous plan.”
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Medicare open enrollment continues through Dec. 7, and new changes will take effect as of Jan. 1, 2023. For anyone needing help with their application, Medicare counselors are available at 800-MEDICARE.
This article originally appeared on GOBankingRates.com: Is Insulin Still Covered by Your Medicare Drug Plan in 2023?
