Even Bigger Than The Headlines

Here’s the complete list of Prescription Drug (Part D) changes and the implications. After a few days, it’s clear that the “negotiation” by Medicare isn’t even close to the largest, most valuable change.

  • 2023: Vaccines at $0 copay, means that shingles, a very expensive vaccine, will be $0.

  • 2023: Insulin capped at $35. It isn’t clear whether or not the plans will have time to turn around and re-design the benefits. If the answer is yes, then Medicare Advantage coverage will improve a lot. For Type 1 diabetics, the selection process for Part D and Medicare Advantage will become much simpler.

  • 2023: Price increases of a medication cannot exceed inflation, but the difference will be sent to Medicare, not you.

  • 2024: Catastrophic Stage goes to $0. If you reach $7050 True Out Of Pocket costs, then your costs will then be $0, it is currently set at 5%.

  • 2024: Part D premiums can increase by a maximum of 6% a year. This will not have a large impact.

  • 2024: Extra Help expanded to 150% of the Federal Poverty Level (currently set at 130%). It is not only that more people will qualify, but the Late Enrollment Penalties (both Part B and Part D) will be waived.

  • 2025: $2000 cap for out of pocket costs for prescription drugs. This is the largest component, affecting the most people. This cap will be adjusted by inflation. It’s not close: this is the largest change.

  • 2026: Medicare negotiates prices for 10 medications, followed by 15 medications in 2027, and 20 medications in 2028. The list will be determined by those medications where Medicare has spent the most money.

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