Guest Bloggers, Medicare

Medicare for You: What You Need to Know (Part 2)

April 13, 2023 • By

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Last Updated: April 13, 2023

Cropped shot of a mature man working on his laptop at homeThis is part two of our series on Medicare benefits. Did you miss the first blog? Please check it out here.

Did you know you can save money on Medicare costs this year? The Inflation Reduction Act which President Biden signed into law in August 2022, will help you save money on Medicare prescription drug costs and recommended adult vaccines starting in 2023.

Let’s explore a few of the ways that this new law will lower your Medicare prescription drug costs.

If you:

  • Have Medicare prescription drug coverage – you’ll pay nothing out-of-pocket for recommended adult vaccines (including the shingles vaccine) starting in January 2023.
  • Take insulin covered by your Medicare drug plan – you’ll pay no more than $35 in cost-sharing for a month’s supply of each covered insulin product starting in January 2023.
  • Take insulin through a pump covered under Medicare’s durable medical equipment benefit – you’ll pay no more than $35 for a month’s supply starting in July 2023.

Starting in 2025, annual out-of-pocket costs for people with Medicare prescription drug coverage will be capped at $2,000 thanks to the Inflation Reduction Act.

Medicare Savings Programs

If you have limited income and resources, you may qualify for Medicare Saving Programs administered by your state Medicaid program. These programs could help save you money on health and prescription drug costs and reduce your Part B premium. For more information, contact your state Medicaid program or call 1-800-MEDICARE and ask about Medicare Savings Programs.

Medicare is here to help

Having Medicare means you’re getting the health care coverage you need to stay safe and healthy. That’s our priority at the Centers for Medicare & Medicaid Services. We’re here to help you compare Medicare coverage choices and learn about options to help pay for your Medicare costs.

Please visit Medicare.gov to learn more about Medicare. We encourage you also to access personalized health insurance counseling at no cost. This is available from your State Health Insurance Assistance Program (SHIP). To find your local SHIP, visit shiphelp.org or call 1-800-MEDICARE. Many SHIPs offer virtual counseling.

Please share this article with your loved ones – and post it on social media.

Traditional or Original Medicare, Medicare Advantage Plans, and Medicare drug plans are administered by the Centers for Medicare & Medicaid Services. 

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Comments

  1. Dan

    Biden is interested in helping the middle class folks the best. Middle class is the backbone of America, maybe a lot of us have a broken backbone or other bones but Biden sincerely cares, he’s honest and like other Politicians he doesn’t lie.
    He pulled us thru covid, I didn’t like all the money mismanaged and millions given to business owners, some that forged family members names as employees to qualify for free millions but other than that He’s an amazing President with decades more experience than “ your fired” man.😎

    • Dan

      Think America
      Think Love
      Be a giver not a taker
      Be Honest
      Be Fair
      Be the best you can not the worst

    • Rick D.

      Wow, I really needed a laugh. That as you made it sound sincere. Nobody could be that stupid so I know you were kidding. Thx

  2. Laura P.

    It may be beneficial to put into law that prices are fixed each year on all insurance Medicare plans and pharmaceuticals. If prices need to rise why not cap per year at no more than our outdated 3% cost of living raises per year!
    We the people have worked long and hard throughout the years, if able. We do not call for high salaries as we age since we are considered more of a liability with little return to the corporations. Our salaries go down after 50. Some may argue that fact. I have lived it and experienced it.
    We are all feeling the crunch of inflation today. Families with young children as well. In reality we were never going to skate away from Covid losses, regardless of who came on as POTUS. Arguing who is to blame is a waste of good time which ultimately divides us in the USA.
    I am a healthcare provider so I am aware of the stressors we face trying to take care of people in a system that is possibly broken. I can scale down on all levels. That is not my complaint. As a Senior citizen I cannot afford continual cost fluctuations, as I suspect many others are experiencing as well. One can hope…

  3. Dean P.

    Why did the Biden administration limit the cost savings of diabetic meds to just insulin. There are so many people with type 2 diabetes/Elevated AiC/CKD ,taking meds like Synjardy, Jardiance, Mounjaro, Ozempic, but the costs for these needed meds are astronomically ridiculous. And if you are on Medicare ,you are ineligible for medication plans or coupons. Which is quite messed up. Why didn’t Biden add these meds to that no more than $35 per month mandate? Or is he still in bed with all his corporate contributers like the drug and medical companies he has to pay favors back to ?

    • JT

      Baby steps… And your last sentence was unnecessary. Keep in mind that what Biden did should’ve been done long before he ever became president. Your anger is misplaced. Be grateful for what you got, and continue to let your elected officials know that it’s not enough.

      • Rick d.

        Your response is funny. Defending senile Joey. Thx for the laugh

    • Lisa

      Dean, I’m upset as well that big Pharma will give out free medication cards to those covered by commercial insurance, but leave out probably the most vulnerable population, taking these companies meds. Makes zero sense to me.

      However, when I contacted my insurance program about a medication that won’t be free (because of Medicare) I was told I could contact the pharmaceutical company and see if there was anything they could do, or any other programs. You may have already done this, and if so… I feel your pain.

      Big Pharma (in my opinion) Needs a swift kick in the behind. They sell their medications in Mexico for $5.00, while gauging those in the US! Terrible!

      I’m not in the know about why Biden might have changed how Medicare pays/ doesn’t pay, but I wonder if it has anything to do with our government telling us that the SSI trust fund is going to run out of funds by 2034, so all those years we’ve paid in, we’ll not get back! I don’t know if Medicare is funded by the same trust or not? I guess I have a lot of researching and reading to do, to understand all of it.

      I do feel like the government has borrowed from the SSI fund WAY TOO MANY TIMES over the years, and never paid back. And then, they invest in things that pay 2% interest! Are they kidding? I realize they wanted to have it in a safe investment, but 2% is just terrible mis-management!

      Politicians have the very best medical coverage going. I read all about it, when I read the entire Obama Care bill. All 868+ pages.

      There’s a lot of good in there, but there’s also a lot of things that aren’t so great.
      Because our politicians get this wonderful health care for life, they don’t have to worry about living on a $1,000 SSI check, while trying to purchase food, medications, pay rent, or a house pmt., or
      utilities, etc., etc. And, while there are many who do have other means of income in retirement, it’s still not right to make those on Medicare pay more, not less.

      There will have to come a time when we elect an honest, compassionate president as well as congressmen, senators, and etc. who can re-organize SSI and Medicare to ensure everyone on the program is able to afford their healthcare.
      Surely there are still public servants out there who care about what is happening in this country!

      I hope you get the help you need with your medications Dean, perhaps those of us on Medicare should band together, set up a non-profit, and solicit funds from our caring billionaires like Bill Gates, who gives millions and millions to other countries for their healthcare! We’ll just get the list of billionaires, and start calling!

      Take care Dean and stay well my friend!

    • Claire H.

      I would think you have to start somewhere. His opponents don’t even want to sign for the insulin! You need to watch some of the committee hearings. Let’s all push them now for the other drugs.

  4. steve

    My neighbor was paying 35.00 for insulin when Trump was President and when Biden become President it went back up and now he is talking credit for this reduction cut the lies out and tell the truth for wants

    • RobPos

      I just love these stories about what happened to a friend, or a friend of a friend, or a cousin or whatever. Maybe your friend signed up for Medicare Advantage and the insulin they were taking got thrown off the formulary their MA provider uses, provided by their PBM (Pharmacy Benefit Manager).

      Who knows, but I doubt you do!

      • Becky

        Hey… let’s just try to be nice here.
        No need to use mean language. Medicare insurance plans aren’t accepted everywhere, and at different times, for one reason or another, a pharmacy drops coverage for those who once were able to use that pharmacy.

        Instead of insulting someone, why not give helpful information.

        Just because this person doesn’t appreciate Biden is no reason to put them down. They might have other reasons for their political preferences, you don’t know anything about.

        • Cliff S.

          I throw you a heart felt kiss Becky. Let’s all be nice! Never seen you, do not know you, but I dure do love you!
          PS: I’ll be 91. Still standing.

        • Rick D.

          Yeah, with Joey’s approval in the toilet, how can anyone respect that idiot?

          • Temmi

            Go away!

  5. JOHN F.

    look at the price no high price medications before 2023 now look at them in 2023.

  6. Edwin

    Si me acojo a los beneficios a 66 años y 10 meses cuando es que solicito el Medicare

    • Elia

      Hola, Edwin,
      El Medicare se debe solicitar en uno de los cuatro meses anteriores al mes en que se cumplen los 65 anos de edad. Por ejemplo, yo cumplo 65 en febrero 2024, y planeo solicitar el Medicare en noviembre 2023. Si no lo solicita cuando debe, lo penalizan por medio de cobrarle primas mas altas, y la pena se aplica a las primas de por vida. Si usted tiene otra buena aseguranza medica, ya sea por su trabajo o el de su esposa, no esta obligado a solicitar el Medicare al cumplir 65, sino que se puede esperar hasta que ya no tenga la otra aseguranza, y no lo penalizan.
      Para confirmar esta informacion, puede usted llamar a Medicare a 1-800-Medicare.

    • Ann C.

      Hi, Edwin. For information in Spanish, please visit us at  http://www.segurosocial.gov, http://www.facebook.com/segurosocial, or http://www.twitter/segurosocial.  For Social Security information in other languages, please visit us at http://www.ssa.gov/multilanguage. Thanks!

  7. Debra

    Need help with FEHB
    States $6500 Deductibles ??
    That mean i have pay all costs and is the Deductibles for per year??
    $6500 is alot so nothing is covered and i pay Health insurance?

  8. Paula G.

    I have medicare A and B and Blue Cross as first under my husband. Yet I’m not understanding why I’m still paying out of pocket for co pays and tests. Talked to a rep that was no help at all. So any answers will help

  9. Chike N.

    Prints too small to read

  10. Leticia

    I am caregiver to my mother and she has been taking her incontinence pill thanks to her Medicare advantage insurance but now she is being told she has to pay $400 when she used to pay $30 for a 3 month supply . Why did this happen and how m she very good d back to $30?

    • JOHN F.

      thanks to the Biden Administration they said you will pay less.
      now you know what their interpretation of payless is

    • sara E.

      The problem with Medicare advantage plans is they are not run by the federal govt. like traditional medicare, they are private for profit companies and they can charge what ever they want for healthcare and medications and have a bad reputation for refusing to cover medical care that they should be covering because they do not want to lose money by paying for expensive care. If it was my mom as soon as I could I would find a way to switch to traditional medicare that I am on, no complaints and my elderly parents were on for years and it is a fair system and they cover what they say they will cover. I would also see if your mom might be low income enough to get on medicaid extended if your state allows it and extra help with medicare for paying monthly medicare premiums.

    • Stephanie S.

      Hello Leticia, I wanted to add to Sara’s response. I just started a Medicare Advantage plan and what Sara is referring to that’s called Dual Complete, which means I’m dual-eligible for both medicare and medicaid. I had help from a great insurance agent who one of my providers referred me to before I even got notified by SSA that I would be eligible for medicare a year earlier than they initially told me when I first was approved for SSDI. I contacted him to see about any other plans I might be able to purchase to supplement or replace my medicaid because I was so fed up with medicaid I was willing to pay OOP for better coverage. He was able to see that I would be eligible for Medicare Advantage a month before I started getting letters from SSA, and honestly, even with an MD and MBA, was having a hard time understanding what I needed to do and what I needed. He walked me through all the different coverages but told me not to worry about paying for any of the “Parts” of Medicare coverage because I qualified for this Medicare Advantage w/ Dual-Coverage. My plan provider is United Healthcare, and they also give me $180/month to pay for prescription costs, OTCs, healthy foods and even my utility bills, which is great! A couple days ago I requested refills on my prescriptions, and got a text message that I was going to have to pay $6.70 for one of them, which isn’t really a big deal, but then yesterday I got a notification from DHHS that I qualify for another program called Extra Help under Medicare’s Limited Income Newly Eligible Transition (NET) Program and I won’t have to pay any more than $1.45 for generics and $4.30 for name brand prescriptions not covered by my insurance plan. So I called the pharmacy this morning and told them I was on this program and they added that program to my file and sure enough, the copay went down to $1.45. I’m not sure if there’s anything like the NET Program for people who have been on Medicare for awhile, but you definitely need to look into the Dual-Coverage and contact your State department of Health Services to see if your mother qualifies for Medicaid too, then find an insurance agent (I believe agents who are licensed specifically for Medicare plans are under what is referred to as SHIP?), and then see if they can find a better plan for her. I was reading that you can change providers outside of the enrollment period if you aren’t happy and there’s a different provider with a higher rating (3-star vs 5-star). I hope this helps!

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