UNDERSTANDING MEDICARE
New Medicare Policy Aims to Help Those with Medicare Prescription Drug Coverage (Medicare Part D)
Rising prescription drug prices are impacting millions of people in the United States. The Biden Administration has been working to help lower prescription drug costs for those covered by Medicare Part D. There have been changes made through the President’s Inflation Reduction Act, which is a broad policy aimed at helping people across the country. One of its goals is to help lower prescription drug prices of medications covered by Medicare Part D.
What is Medicare?
Medicare is a government program that provides health insurance to people who are 65 or older and people with disabilities. If you are 65 or older, you automatically qualify in most circumstances. Some people may be eligible for coverage earlier than age 65 if you are disabled, diagnosed with End-Stage Renal Disease (ESRD), or diagnosed with Amyotrophic Lateral Sclerosis (ALS).
There are multiple parts to Medicare. They include:
Part A: hospital stays, nursing home stays, hospice, and at-home medical care
Part B: medical appointments, outpatient treatment, at-home medical care, medical equipment (wheelchairs, walkers, blood sugar meters and test strips, etc.), and preventive treatments (vaccines, check-ups, screenings, etc.)
Part C: Medical Advantage Plan (Part A, Part B, Part D)
Part D: prescription drug coverage
New Development for Medicare Part D
Prescription drug costs in the United States are very high for most Americans, even if they have health insurance. Lowering prescription drug cost for people covered by Medicare Part D has been a plan of the Biden Administration that will launch in 2025. This new program is called the Medicare Prescription Payment Plan. The Medicare Payment Plan allows payments for prescriptions throughout the year instead of paying each time a prescription is filled. Note that you must opt into the program to use it. To opt in, you must have a Medicare plan with Medicare Part D. Otherwise, you will not be able to pay for your prescriptions according to this plan. You do not have to be covered by this program if you do not want to.
There are other changes to Medicare Part D with the Inflation Reduction Plan. They aim to provide Americans relief from pricey out-of-pocket drugs costs and to maintain better
anticipated prices for Medicare Part D participants instead of the constant “up-and-down” of out-of-pocket costs.
Changes include:
• Out-of-pocket insulin costs being capped at $35 per month
• No cost for vaccines recommended by the Advisory Committee on Immunization Practice (ACIP)- Polio, flu vaccine, MMR (Measles, Mumps, Rubella), Chickenpox, etc.
• Expanding the Extra Help program. The Extra Help program is under Medicare Part D. It “provides prescription drug coverage with no deductible, no premiums, and fixed, lowered copayments for certain medications to certain individuals.”[1] Note that this is another program you must opt into, if you are financially eligible. Eligibility depends on income ($22,590 for individual or $30,660 for married), resources ($17,220 for individual or $34,360 for married) etc. You may automatically qualify if you have full Medicaid coverage, “help from your state paying your Part B premiums (from a Medicare Savings Program), and Supplemental Security Income (SSI) benefits from Social Security.” [2]
• Some out-of-pocket costs are capped at $3,500. In 2025, this cap will be at $2,000.
Medicare is a complicated system that is always changing. At CELJ, we want to be able to support you through this complicated system and provide guidance in signing up, coverage, etc. If you have questions regarding Medicare, please contact our office at (716) 853-3087.
For more information about this new policy and general information about Medicare, visit https://www.cms.gov/newsroom/press-releases/biden-harris-administration-releases-final-part-two-guidance-help-people-medicare-prescription-drug and https://www.medicare.gov/.
1 “Help with drug costs,” Get help with costs, Medicare, last accessed July 29, 2024, https://www.medicare.gov/basics/costs/help/drug-costs
2 “Help with drug costs,” Medicare
