2023 Medicare Coverage Share Cost Updates

By Montgomery County SHIP

Prescription Drug Cost Savings:

Insulin Cost Sharing

Beginning January 1, 2023, beneficiaries pay no more than $35 for each one-month supply of an insulin medication covered by their Medicare Part D plan. If the plan has a deductible, it does not apply to insulin. Note that this change only applies to the insulin that is on a Part D plan’s formulary, or list of covered drugs.

Beginning July 1, 2023, this change is also effective for Part B-covered insulin. Beneficiaries will pay no more than $35 for insulin if used with durable medical equipment, like an insulin pump.

Vaccine Cost Sharing

Beginning January 1, 2023, there is $0 cost sharing and no deductibles for Part D-covered vaccines. This applies to vaccines, including the shingles vaccine, recommended by the Advisory Committee on Immunization Practices (ACIP) for adults.

Part B Coverage Of Immunosuppressant

Starting in 2023, there is a new, limited Medicare benefit called the immunosuppressive drug benefit, or the Part B-ID benefit. The Part B-ID benefit provides Part B coverage of immunosuppressant drugs for people whose End-Stage Renal Disease (ESRD) Medicare benefits have ended 36 months after their transplant and who do not have other health insurance that covers immunosuppressant medications.

To get coverage, the person must:

Qualify for Part B coverage of immunosuppressant prior to losing Medicare Part B.
*Someone qualifies for Part B coverage of immunosuppressant if they had Part A at the time of their kidney transplant.

Not have Medicaid or other public or private health insurance that covers immunosuppressants.

Beneficiaries whose ESRD Medicare eligibility expired before January 1, 2023, can still enroll in Part B-ID. Those who qualify should contact Social Security to enroll.

Part B-ID has a monthly premium of $97.10 in 2023. Individuals enrolled in Part B-ID can apply for the Medicare Savings Program (MSP) for help with premium costs and, if eligible for the Qualified Medicare Beneficiary MSP, cost-sharing assistance.

Part B-ID coverage may not be the best choice if someone has or has access to any other insurance. This is because Part B-ID only covers immunosuppressant drugs, does not include coverage for any other benefits or services, and does not allow a person to access Part A.

Source: SHIP TA Center Medicare Messenger, December 2022

What’s New in 2023? By Emily Whicheloe, Director of Education, Medicare Rights Center & SHIP TA Center