How the new Inflation Reduction Act impacts Medicare beneficiaries

Couple smiles after understanding how IRA will improve their Medicare coverage

The Inflation Reduction Act (IRA), a new law passed by Congress in August 2022, will mean enhanced benefits for Medicare beneficiaries starting in 2023. If you are a member of ApexHealth or considering a Medicare Advantage plan, you may be wondering how this legislation affects you. Good news! The benefits will apply to those enrolled in a Medicare Advantage Prescription Drug plan, as well as those on Original Medicare. Here’s a look at the most significant changes for you in 2023.

$0 cost for most adult vaccines — including shingles

Adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) that are administered to adults who are covered under Medicare Part D are now $0. There is no deductible, coinsurance or other cost-sharing. This includes the shingles vaccine.

While Medicare Part B — either as part of Original Medicare or a Medicare Advantage plan — has always covered 100% of the cost for some vaccines, others were only covered through Part D plans and subject to cost sharing. The following vaccines are now among those covered at no cost:

  • Shingles 
  • Tetanus, diphtheria and whooping cough (Tdap) 

Receiving the recommended vaccines is an important part of the care you need for the life you lead, so be sure to take advantage of the coverage available!

$35 monthly cap on out-of-pocket insulin costs

There’s also good news in the IRA for Medicare beneficiaries with diabetes. Prior to the IRA, what enrollees paid for insulin under Part D varied by plan, and costs under Part B included both deductibles and 20% coinsurance. As of January 1, 2023, the monthly cost of insulin is capped at $35 for Part D enrollees with no deductible. Starting July 1, 2023, costs for people using insulin through a traditional pump will also be capped at $35 per month. 

The cap applies to each month’s supply. For multi-month supplies of insulin, the cap works as follows: 

  • $70 for a 60-day supply
  • $105 for a 90-day supply 

Additional provisions in the IRA may mean seniors pay even less than $35 per month for insulin starting in 2026.

What’s next for Medicare and the Inflation Reduction Act?

In the coming years, the IRA will continue to provide extra support for individuals on Medicare. Here’s a look at what we can expect in the future:

  • 2023: Manufacturer rebates to Medicare for certain drug prices that increase faster than inflation
  • 2023: Drug price negotiations between Medicare and manufacturers, with negotiated prices available to consumers in 2026
  • 2024: Expansion of eligibility under the Part D low-income subsidy program 
  • 2024: A 6% year-over-year limit on Part D premium increases 
  • 2025: A $2,000 annual cap on out-of-pocket prescription drug costs 

ApexHealth wants to make it easy for you to understand any changes to your benefits and your Medicare Advantage plan! If you have questions, contact us through our ApexAssistants. Give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.


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