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As Medicare beneficiaries look at their options for 2023 during this fall’s open enrollment period, enrollees who need insulin to help control their diabetes will find they have a great new benefit — but they might also need some help finding the best and most affordable prescription drug plan.
The good news: Starting in 2023, the Inflation Reduction Act, signed into law in August, caps insulin users’ out-of-pocket costs at $35 per month for each insulin product covered by their Medicare Part D prescription drug plan or their Medicare Advantage plan.
The challenge: The cap was enacted after insurers set their premiums and copays for 2023. So the Medicare Plan Finder — the primary tool beneficiaries use to review and select Part D and Advantage plans — doesn’t include that $35-a-month cap in its estimates of a beneficiary’s annual drug costs.
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The result: Confusion. The cap applies only to insulin products on a plan’s list of covered medications, called a formulary. Most drug plans don’t cover all of the more than 70 insulin products on the market. And some plans actually charge less than $35 a month for particular products, but those lower copays are difficult to ferret out on the Medicare Plan Finder. Adding to the complexity of making a choice of plans, many diabetics use several prescription drugs besides insulin.
So, finding the lowest-cost, most effective plan that covers all an enrollee’s medicines among the 20 or more plans that might be offered in someone’s zip code could be mind-numbingly complicated, at least for 2023.
How to cope? Determined do-it-yourselfers might be tempted to winnow the options on their own.
But Medicare officials and the local offices that support beneficiaries have a different message: Get help. “People with Medicare who take insulin are encouraged to call 1-800-MEDICARE or to contact their State Health Insurance Assistance Programs (SHIP) for help comparing coverage and costs this year,” Meena Seshamani, M.D., director of CMS’s Center for Medicare, said in an emailed statement. This is just a one-year glitch, the Centers for Medicare & Medicaid Services says, so it’s best handled by those with practice navigating the Plan Finder.