President Biden’s signing of the Inflation Reduction Act (IRA) marks the beginning of implementing many years of substantial change to the Medicare Part B and Part D programs.
The two most imminent changes, which take effect January 1, 2023, include:
Aetna will be updating materials to convey this information to members. Members will receive information by mail, and information will also be available in enrollment kits and on the Aetna website. In addition, they will be working to operationalize these changes by January 1, 2023, as required.
Please use the information below to help answer your clients’ questions this AEP.
It limits the member cost-share on covered insulins to $35.
It eliminates member costs and improves access for Part D vaccines.
Member materials are being updated in accordance with CMS guidance to ensure members are properly informed of the changes.
Beginning October 1, the Medicare Plan Finder site (www.medicare.gov) will reflect Part D sponsors’ insulin and vaccine benefits and cost sharing as they were submitted in their 2023 bid and formulary submissions, prior to IRA being enacted. However, new insulin and vaccine drug footnotes and other help features will be displayed to explain the benefit changes resulting from the IRA.
Because of this, CMS is granting a Special Enrollment Period (SEP) for Exceptional Circumstances to allow beneficiaries to add, drop, or change their Part D coverage if they find a better option after the 2022 Annual Enrollment Period (AEP) and through the end of 2023. This SEP will be available for all beneficiaries who use a covered insulin product and begins on December 8th, 2022, and ends on December 31, 2023. Beneficiaries may use this SEP one time during this period. To utilize this SEP, beneficiaries must call 1-800-MEDICARE so a customer service representative can process the enrollment change; they cannot use a broker for this SEP. Consistent with current policy, when Part D enrollees change plans mid-year, their True Out-of-Pocket (TrOOP) costs carry over from one plan to the next.
Additional IRA requirements that will be implemented in 2024 include:
Additional IRA requirements will be implemented annually through 2029. We’ll share more information as we approach those implementation dates.
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