If you already pay less than $35 cost share, you’ll keep paying that lower amount.
The Inflation Reduction Act and Medicare
The Inflation Reduction Act is a federal law that helps improve Medicare. It expands Medicare benefits. And it helps lower out-of-pocket drug costs.
The Inflation Reduction Act lowers costs of insulin and other drugs under Medicare.
Lower copays for insulin and vaccines
Vaccines at $0 copays
With this law, you’ll have a $0 copay* for most Part D vaccines at any network pharmacy. That includes the shingles vaccine.
Insulin cost share limit of $35
With the law, your cost share for a month’s supply of covered insulins will be no more than $35.* That’s with Medicare Part B or Part D. Just go to any network pharmacy.
For Part B insulin, this cost share limit only applies to:
- Insulin dispensed through a pump
- Medicare-covered durable medical equipment
These benefits apply no matter what tier the drug is on. Even if you haven’t paid your deductible yet.
Other benefits of the Inflation Reduction Act
Lower coinsurance for some Part B drugs
The law has rebates that will also lower the cost share for some other Part B drugs. Certain Part B drugs will get a coinsurance adjustment. We pass those savings on to you.
These drugs may change each quarter. This change doesn’t apply to Part D drug coverage. Ask your pharmacist to learn if your drug is part of this change.
$0 copay in the catastrophic phase
There’s a limit to what you have to pay out of pocket for your covered Part D drugs each year. Once you reach that limit, you enter the Medicare catastrophic phase. In the catastrophic phase, you would normally pay a lower copay for your drugs. With the Inflation Reduction Act law, that lower copay is now $0. This benefit started on January 1, 2024.
Expanded low-income subsidy (LIS or “Extra Help”)
Do you qualify for the Extra Help program? It’s open to Medicare Part D members with incomes up to 150% of the federal poverty level. Starting in January 2024, if you qualify, you’ll pay:
- A reduced drug plan premium
- A $0 drug plan deductible
- A lower cost for covered generic and brand-name drugs
Out-of-pocket limit for Part D plans
In 2026, your maximum out-of-pocket costs will be $2,100 for covered Part D drugs. Your out-of-pocket costs include your:
- Part D deductible
- Copay
- Co-insurance costs
If you reach this amount, you move to the catastrophic phase. You will pay $0 for covered Part D prescription drugs for the rest of the plan year.
Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan is a payment option. It works with your current Part D drug coverage.
Participation is voluntary and there’s no added cost to join. You can set up monthly payments that vary throughout the year for your out-of-pocket costs.
This payment option might help you manage your expenses. It doesn’t save you money or lower your drug costs.
*For insulin cost share limit of $35
*For Part D vaccine $0 copay
Vaccines eligible for $0 copay/coinsurance include adult Part D vaccines recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Age limits may apply.