Another change to the Medicare drug benefit that begins in 2025 is the requirement that Part D plans offer enrollees the option of what is called smoothed cost-sharing. This means you can opt to have your out-of-pocket costs spread out over the year. This is designed to protect people from being hit with such a big drug bill at one time that it may discourage them from filling their prescriptions.
Premium increases limited
According to the new law, beginning in 2024 and continuing through 2029, Part D premiums cannot increase by more than 6 percent a year. In 2022 the national average Part D premium is $33.37 a month. The amount of these premiums varies widely, depending on where you live and what plan you select.
Insulin charges curbed
Beginning in 2023, copays for a 30-day supply of any insulin that a Medicare drug plan covers will be capped at $35. Note that Part D plans will be required to adhere to the $35 copay limit even if an enrollee has not met their annual deductible.
The price could be lower if insulin becomes subject to negotiation with drugmakers. Given that, although the monthly maximum copay will be $35 from 2023 to 2025, beginning in 2026 (the first year negotiated prices would take effect), insulin copays will be $35 or 25 percent of the drug’s negotiated price (whichever is less).
Many vaccines free
Starting on Jan. 1, 2023, Medicare enrollees won’t have any out-of-pocket costs for vaccines that the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends for adults.
Medicare Part B, which applies to doctor visits, diagnostic tests and other outpatient services, already fully covers some vaccines, including flu shots, pneumonia vaccines, hepatitis B inoculations and coronavirus vaccines (initial shots as well as boosters).
But other vaccines, most notably the expensive vaccine for shingles, are covered under the Part D prescription drug plans, and many of those plans currently require enrollees to share the cost of those shots. The new law eliminates that cost-sharing.
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.
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