Medicare leaders tout benefits coming through Inflation Reduction Act

Medicare’s top leaders hope physicians will help spread the word about how the federal Inflation Reduction Act (IRA) will change health insurance and prescription drug prices.

Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and some of her top deputies held a conference call Aug. 25 to discuss the financial savings coming to people as early as January 2023.

“I think if we can take any lesson from both our marketplace enrollment over the course of the last year or so, and from the COVID-19 pandemic, it is that it is critical when trying to get out information, for people to hear it from providers and other trusted messengers,” Brooks-LaSure said. She was joined by deputy administrators Meena Seshamani, MD, PhD, director of the CMS Center for Medicare, and Ellen Montz, PhD, director of the CMS Center for Consumer Information and Insurance Oversight.

The IRA could affect millions of people, based on the latest enrollment figures for Medicare, Medicaid and the Children’s Health Insurance Program, which CMS announced the same day. As of May, more than 64.55 million people were enrolled in Medicare, split with about 34.89 million in original Medicare and about 29.65 million in Medicare Advantage or other health plans. More than 50.08 million people are enrolled in Medicare Part D for prescription drug benefits.

President Joe Biden signed the IRA into law on Aug. 16. The CMS leaders said the timing is important because Medicare enrollment will begin Oct. 15 and enrollment for insurance through the Affordable Care Act (ACA) Marketplace begins Nov. 1.

Prescription drugs

“The question that I get asked them most about across all of our programs is, why do prescription drugs cost so much, particularly for people who rely on the Medicare program?” Brooks-LaSure said. The IRA is the answer people have been waiting for, she said.

Seshamani outlined some of the coming changes:

• Starting Jan. 1, Medicare Part D vaccines will be available free for people with coverage. The vaccines are those recommended by the Advisory Committee on Immunization Practices and one example is inoculation against shingles.
• An estimated 1.4 million Medicare enrollees who use insulin to control diabetes will have out-of-pocket costs capped at $35 a month.
• Medicare Part D will have a prescription drug out-of-pocket cap of $2,000 a year starting in 2024.
• Medicare Part D users will have an option to spread out drug costs by using monthly payments.
• CMS will negotiate prices for drugs used in Medicare Part D. The first 10 drugs for negotiation will be announced in 2023, with prices announced in 2024 to go into effect in 2026. There will more negotiated drug prices for 2027 and years after.

The drug price negotiations will strengthen the program and ensure its sustainability for future generations, Seshamani said.

“It’s an exciting time in healthcare’s history,” said Seshamani, who described her own experience as a physician helping a patient use a smartphone app to hunt for cheaper prescription drug prices.

Health Insurance

The American Rescue Plan Act of 2021 included health insurance tax credits for people who enrolled in insurance through the ACA Marketplace. Millions of insureds saved an average of $800 a year due to those subsidies that will continue through 2025, Montz said.

“This law allows consumers to get the health care they need, all while keeping more money in their pockets,” she said.

The CMS leaders want new people to enroll for the health insurance and those who currently have ACA insurance should return to the online Marketplace to shop around for the best plans.

“As the administrator mentioned, if there’s one thing our success over the past few years has shown us, it’s something that is quite simple. And that’s, if you make health care coverage more affordable, and you actually tell people about it, they sign up,” Montz said.

The ACA health insurance plans have about 14.5 million people insured. Overall, this summer a report by the U.S. Department of Health and Human Services estimated national rate of people without health insurance hit a record low of 8% in the first quarter of 2022, although that means 26.4 million people do not have it, according to the federal figures.