Medicare Insulin Cap Not Reflected on 2023 Plan Finder

In August 2022, Congress passed the Inflation Reduction Act which resulted in a plethora of changes to Medicare coverage, specifically Medicare Part D. One of these changes includes a $35 out-of-pocket maximum for insulin each month. However, this change to Medicare Part D plans was not announced in time for the Centers for Medicare & Medicaid Services (CMS) to make the necessary changes to their Medicare Plan Finder tool on Medicare.gov.

What is the Medicare Insulin Cap?

With the recent passing of the Inflation Reduction Act, several cuts have been made to Medicare drug prices. One of the most notable cuts is seen by those who depend on insulin each month.

If you are on a Medicare Part D plan and are prescribed insulin, your monthly out-of-pocket maximum cost will be $35 as on January 1, 2023. If you use an insulin pump, your $35 copayment will go into effect on July 1, 2023.

This is a huge price cut for some. In recent years, the cost of insulin has risen significantly, making it difficult for many seniors to receive the care they require. The new $35 insulin cap is allowing people on Medicare peace of mind in knowing that their insulin costs will now be more affordable across the board.

Why Do Medicare Part D Plans Not Reflect the Insulin Cap?

If you have been researching 2023 Medicare Part D plans and notice your monthly insulin cost to be higher than the $35 maximum, you are not alone. Due to the timing of the newly passed bill, CMS did not have enough time to make the necessary changes to the Medicare Plan Finder in time for the 2023 plan roll out.

The Medicare Plan Finder is a useful tool for consumers and insurance agents to help find the best Medicare Part D plans for your drugs. The tool sorts plans by cost to help you find the best option for your budget.

Yet, during this Annual Enrollment Period, the Medicare Part D Plan Finder tool is not as accurate as in past years. This is due to the tool showing incorrect insulin costs.

Currently, with an inaccurate insulin cost, the Plan Finder cannot accurately calculate when you may move to the next drug coverage phase, and how that will affect your copayments and coinsurance for other prescriptions you may need.

Because of this issue, it is more important now than ever to speak with a licensed Medicare agent when enrolling in Medicare Part D specifically.

Special Enrollment Period for Insulin-Dependent Seniors

Due to the error in the Plan Finder tool, CMS is allowing insulin-dependent seniors to use an extenuating circumstances Special Enrollment Period throughout 2023 to fix any anticipated enrollment mistakes.

Typically, if you wish to make a change to your Medicare Part D plan, you must do so during the fall Annual Enrollment Period for the upcoming year. However, this Special Enrollment Period allows you to switch your 2023 Medicare Part D plan one time between December 8, 2022, and December 31, 2023.