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Medicare Advantage Open Enrollment Period

From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.

What can I do?

  • If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).
  • You can drop your Medicare Advantage Plan and return to Original Medicare. You'll also be able to join a separate Medicare drug plan.

Inflation Reduction Act – Saving you money

Lower drug costs and improved Part D Coverage for Medicare recipient’s

Insulin:

The cost of a month’s supply of each Part D-covered insulin is capped at $35 – and you don’t have to pay a deductible for insulin. Plans have until the end of March 2023 to update their systems to reflect the $35 cap on insulin. If you are charged more for a covered insulin product in January and/or February 2023 – your plan must reimburse you within 30 calendar days for any amount you paid above the $35 cap.

If you have drug costs high enough to reach the catastrophic coverage phase in your Medicare drug coverage, you won’t have to pay a copayment or coinsurance starting in 2024.

Extra Help affording prescription drug coverage (Low Income Subsidy – LIS) will expand in 2024

Your yearly Part D out of pocket costs will be capped at $2,000 starting in 2025.

For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition.

  • Medicare will soon announce the first 10 drugs selected for negotiation in 2023
  • Negotiated prices for these first 10 drugs will be effective in 2026.
  • Medicare will select and negotiate costs for:
    • 15 Part D drugs in 2025 (effective in 2027).
    • 15 Part B and Part D drugs in 2026 (effective in 2028).
    • 20 Part B and Part D drugs in 2027 (effective in 2029).
    • 20 Part B and Part drugs in 2028 and every year after.
  • Manufacturers that don’t follow the negotiation requirements will have to pay a tax and will have to pay penalties if they don’t fulfill other manufacturer requirements.

Vaccines:

People with Medicare Part D drug coverage now pay nothing out of pocket for even more vaccines – including the shingles vaccine.

On 8-7-22 H.R. 5376 – Inflation Reduction Act of 2022 passed the senate

https://www.congress.gov/bill/117th-congress/house-bill/5376

In part, the bill could provide positive impacts on people covered under the Affordable Care Act as well as Medicare beneficiaries.  It should be noted, effective dates are all different.  See proposed bill attached.

The bill requires the Centers for Medicare and Medicaid Services (CMS) to negotiate the prices of certain prescription drugs that do not have a generic equivalent and that account for the greatest Medicare spending.  Prescription drug manufacturers will have to issue rebates for certain brand drugs without generic equivalents.  under Medicare caps annual out-of-pocket spending at $2,000 in 2025 (with annual adjustments thereafter). It also establishes a program under which drug manufacturers provide discounts to beneficiaries who have incurred costs above the annual deductible beginning in 2025.

If signed into law, The  Inflation Reduction Act – will prevent steep increases in premiums:  8-11-2022 The Senate passed a three year extension (through 2025) of enhanced subsidies for people buying their own health  coverage on the Affordable Care Act Marketplaces (like MNsure here in MN)  Affordable Care Act Subsidies, including to allow taxpayers with income above 400% of the federal poverty line to qualify for the credit.  https://www.kff.org/policy-watch/five-things-to-know-about-renewal-of-extra-affordable-care-act-subsidies-in-inflation-reduction-act/