Question: I use Insulin and I heard we will be paying a lot less for insulin in 2023. Can you explain how?

Answer: Insulin has been very expensive for a number of years. In the past, Medicare eligible individuals spent thousands of dollars each year to pay for their insulin. Beginning in 2023 the Inflation Reduction Act (IRA) will change the way that Medicare Part D covers Insulin. The Centers for Medicare & Medicaid Services (CMS) has announced that ALL Medicare Part D plans must include all insulins included in their formularies, at copays of $35 or less for a 30-day supply of insulin through ALL phases of Part D coverage. The Deductible, Initial Coverage, Coverage Gap and Catastrophic coverage will all be no more than $35 for a 30-day supply. There are some plans that are offering copays as low as $11 for the insulin covered on their formulary.

For Medicare enrollees who are used to paying hundreds per month for their insulin this will be an impressive savings. As enrollees move through the phases of coverage, they will see a consistent pricing structure at the pharmacy for their insulins covered on the formulary.

It is also VERY important to understand that the passing of the IRA by Congress, did not give the insurance plans or CMS an opportunity to update their websites and coverage documents in time to get them to you for this year’s Medicare Annual Open Enrollment Season.

This means as you evaluate your 2023 coverage options, it is best to pull your Insulin off your drug list and choose the best plan based on everything else you take. Then go back and enter your insulins in to be sure they are covered on the formulary in 2023. The Annual Open Enrollment Period, October 15 to December 7 is especially important to those Medicare recipients using insulin. You can compare your current plan with all the plans available to get your best possible savings. You don’t have to choose your plan based just on who covers your insulin the cheapest. Your other medications can make the choice of your plan, and you check to ensure your insulin is included on the formulary.

For those on Medicare who are not comfortable using a computer, you can call 1-800-MEDICARE (1-800-633-4227) to get assistance 24 hours a day, 7 days a week. You won’t see the savings at the pharmacy in 2022, the lower costs will begin January 1, 2023.

The other change this year is that most vaccines will be covered by ALL Medicare Part D plans at $0 cost share to you. Getting your Shingles Vaccine will be very affordable in 2023. No matter which plan you have, the vaccine will be $0 co-pay to you. This $0 cost share also applies to other vaccines covered by Medicare Part D, in all phases of coverage.

Of course the Annual Open Enrollment Period is the designated time to evaluate your current coverage in comparison with all the plans available. This is the time to be sure that your current coverage covers all your medications and to see if any other plan is offering better savings to you. This year that evaluation can literally save you hundreds or thousands of dollars if you take insulin and reduce your costs for common vaccines.

2023 is a year that is looking better and better for those with Medicare. Your Social Security is going up by 8.7%. The Medicare Part B premium is going down to $164.90. Insulin and vaccines are covered better than ever before. I am so excited to work with seniors and help them benefit from the increases in income, reduction in premiums and savings in the cost of certain types of medications. I look forward to more improvements in the coming two years. 2023 is just the beginning of the IRA savings coming to those with Medicare.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.