Lower costs for insulin and vaccines
These benefits apply no matter what tier the drug is on. Even if you haven’t paid your deductible yet.
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
Vaccines at $0 copay
With this law, there is a $0 copay* for most Part D vaccines at any network pharmacy. That includes the shingles vaccine.
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, 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 prescription 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 copay for covered Part D prescription drugs for the rest of the plan year.
Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan is a new payment option. It works with your current Part D drug coverage. Participation is voluntary and there’s no extra cost to join. You can set up monthly payments that vary throughout the year for your out-of-pocket costs. This payment option may help you manage your expenses. It doesn’t save you money or lower your drug costs. Discover how Medicare Prescription Payment Plan works.