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How Will the Inflation Relief Act Affect Me?

As Medicare Agents, we've been getting some questions about the I.R.A. and wanted to post a little information for your viewing.

I.R.A means changes are coming.


How is this plan going to affect Medicare Individuals?

The I.R.A. is getting a lot of press now a days and the benefits for individuals getting their

insurance through the Marketplace and Medicare.


For Marketplace plans, ACA, or Obamacare-Whichever you call it, the major benefit to people

under 65 is the subsidies will be extended. The subsidies were raised in 2020 due to the

Pandemic and were supposed to expire at the end of this year, but because of the passage of the

I.R.A. the increased subsidies will carry on until 2025.


For Medicare recipients there will be a large benefit.

Starting in 2023 some Vaccines will be covered 100%. The list is based on Centers for Disease

Control and Prevention’s Advisory Committee on Immunization Practices recommends for adults.

Click on the link below to see the full list.


https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html


The other big change is the cap on the cost of insulin.

This has been suggested for a couple of years now, but now it is mandatory. The drug plans will cap insulin at $35.00. They have no choice. This is going to be a big help to a lot of Seniors. Now something that is not being mentioned is not

every plan will have every insulin capped at $35.00. They must offer one insulin at each of the

Model Insulins, rapid acting, short-acting, intermediate-acting, and long-acting. It is going to be

very important to make sure your insulin is going to be in the formulary.

Below is a breakdown of some common questions about the change.


https://www.cms.gov/files/document/insulin-common-questions.pdf


For 2024, the Catastrophic phase of Part D is eliminated. If you have a Standalone Part D plan or

a Medicare Advantage Plan with Prescription Coverage, you are aware of the dreaded donut hole

or coverage gap. This is the portion of Part D where you pay up to 25% of your prescriptions cost.

Once you exit the donut hole, in 2023 that amount will be $7400.00, you will pay the greater of 5%

or $4.15 for generic medications and the greater of 5% or $10.35 for name brand. In 2024 the

Catastrophic phase is eliminated. Once you hit the ceiling of the Donut hole or Catastrophic phase,

you pay nothing else for your Medicines for the rest of the year.


Americans will qualify for assistance on their medications.

For 2025, these are the changes the news has been talking about, the biggest change is the out-of-pocket max that seniors will pay is $2000 for their medications. The other change is going to be starting in 2025 the plans cannot increase 6% year over year. In the past a company could change the price of a plan however much they wished to do so. It depended if the CEO wanted a bigger yacht. So, the same plan is not going to increase by more than 6%. The other change is they have made it where Medicare will be able to negotiate with drug companies on the costs of 10 medications. The number of medications that will be able to be negotiated will increase each year. They will not release the 10 medications until September of 2023.

The $2000 cap is going to increase each year. Please keep this in mind.


As more information comes out I will keep you posted.


Randy