Medicare cost-share changes begin Jan. 1, 2023
To align with the recently announced Inflation Reduction Act, we are making changes to cost-share maximums for insulin and certain adult vaccines. These changes apply to specific Medicare plans.
Maximum $35 cost for insulin
Effective Jan. 1, 2023, all Medicare beneficiaries, regardless of income, will pay a maximum of $35 for a 1-month supply of covered insulin products, with no deductible. While a $35 cap has already been in place for select plans, for 2023 it will be extended to all members across all Medicare Advantage Prescription Drug (MAPD) formularies, including Dual Special Needs Plans (D-SNP), Chronic Special Needs Plans (C-SNP) and stand-alone Part D plans.
The $35 cost-share maximum will apply in all benefit phases and for all Medicare beneficiaries with Part D coverage. Claims will adjudicate at the maximum $35 cost share, effective Jan. 1, 2023.
Important things to remember:
- For Part B plan members, the maximum $35 cost share is effective July 1, 2023, but will be covered at the current plan coinsurance through June 30, 2023
- Cost shares vary by plan
- While the insulin copay is capped at $35, the cost share for pumps is not
Removal of cost sharing on adult vaccines
Also effective Jan. 1, 2023, beneficiaries in all UnitedHealthcare® Medicare Advantage plans will have a $0 cost-share for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and covered under Medicare Parts B and D. Beneficiary cost-sharing for ACIP-recommended adult vaccines will be eliminated regardless of any published tier cost-share.
Questions?
For more information, review the Inflation Reduction Act announcement from the Centers for Medicare & Medicaid Services. For answers to specific coverage questions, call the number on the member’s insurance card.
