Changes to Medicare that benefit you

The Inflation Reduction Act (IRA) was signed into law in 2022. It aims to help improve the Medicare program by expanding benefits, lowering drug costs, and more. These changes are being rolled out over time. Here’s what’s you need to know.

What’s available to you now

• Lowered the cost of covered insulins. You’ll pay no more than $35 for a one-month supply of covered Part B and Part D insulins, regardless of the drug tier it’s on or coverage stage you’re in.
• Made Part D vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) available at no cost.
• Expanded eligibility for a Low-Income Subsidy (LIS), or “Extra Help” by raising the income threshold from 135 to 150 percent of the federal poverty limit.
• Eliminated the Catastrophic Coverage stage for prescription drug coverage, capping costs at $8,000. That means you pay nothing for covered drugs for the remainder of the year if you reach this limit.

What’s to come in 2025?

• Will cap out-of-pocket drug costs at $2,000 for 2025, eliminating the Coverage Gap stage. This means you pay nothing for covered drugs for the remainder of the year if you reach this limit.
• Will introduce the Medicare Prescription Payment Plan (MPPP) option to pay your out-of-pocket costs for covered drugs over the course of the year, instead of all at once at the pharmacy.

What is MPPP and how does it work?

The IRA will introduce the Medicare Prescription Payment Plan (MPPP) in 2025. This new program allows you to pay the price for your prescriptions in monthly installments instead of when you pick them up at the pharmacy. Total costs will still be capped at the new limit ($2,000 for 2025).

This won’t lower your total costs, but it can help you plan and budget accordingly by providing you with stable monthly payments. You will need to opt in to the Payment Plan. Information on options for opting in will be released in the coming months.

Want to learn more?

For more information on the IRA, how it enhances the Medicare program, and how it benefits you:

• Visit www.cms.gov/inflation-reduction-act-and-medicare.
• Call our Member Help Team at the number on the back of your member ID card.