Medicare Corner
Have costs for Medicare Part D (prescription drug coverage) changed in 2023?
* Note the out-of-pocket costs that help you get out of the donut hole include what you’ve spent on covered drugs since the start of the year (deductible, copays); most of the discount for brand-name drugs while you’re in the donut hole; and any drug costs paid by family members, most charities, State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs (ADAPs), and/or the Indian Health Service. How have insulin and vaccine costs changed in 2023? The 2022 Inflation Reduction Act created permanent changes to insulin and vaccine costs for Medicare beneficiaries. Starting in January 2023, copays for each Part D-covered insulin product will be capped at $35 per each month’s supply, with no deductible. Starting in July 2023, copays for each Part B-covered insulin product will be capped at $35 per month, with no deductible. Additionally, starting in 2023 you will owe no copays or deductibles for vaccines covered by your Part D plan, including the shingles vaccines. What are Special Enrollment Periods (SEPs) SEPs are periods of time outside of normal enrollment periods in which you can make changes to your Medicare.
your plan’s benefits, costs, and covered drugs for 2023. If you have a Medicare Advantage Plan with prescription drug coverage, you should have received one EOC that describes both your health and prescription drug coverage for 2023. Part D plans must include the minimum coverage that is set by law, but each plan may offer varying types of coverage. For example, in 2023 Part D plans can set a maximum deductible (amount you pay out-of-pocket before your insurance begins to pay) of $505. However, some plans may not require you to pay any deductible. The following chart shows costs last year compared to this year. Be sure to review your plan materials for specific cost changes .
If you have Medicare prescription drug coverage, often referred to as Part D, your plan should have notified you about any changes in costs for 2023. Part D plans can change the drugs they cover, their pharmacy networks, and their costs (such as copayments, coinsurance charges, and deductibles) from year to year. Remember, there are two main ways that you can get your Medicare prescription drug coverage: • A Medicare Advantage Plan that covers both health and drug coverage, or • A stand-alone Part D plan that works with Original Medicare. Your Part D plan should have sent you an ANOC or EOC notice informing you of
Medicare Part D Costs: 2022 vs. 2023
2022
2023
Part D maximum deductible
Up to $480 /year
Up to $505 /year
Part D coverage gap threshold You reach the coverage gap, or donut hole, when you and your plan together have spent this much on covered drugs since the start of the year. Part D catastrophic coverage limit You get out of the donut hole and reach catastrophic coverage when you have spent this much out of pocket * since the start of the year.
$4,430
$4,660
$7,050
$7,400
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This project was supported in part by grant number 90MPPG0022, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy
February 2023, Never Too Late | Page 5
Pima Council on Aging
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