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Medicare cost share changes under the Inflation Reduction Act
March 9, 2023

This article is for providers caring for our Medicare Advantage members

We’d like to make you aware of upcoming cost share changes to Part B benefits that will happen this year as part of the Inflation Reduction Act. These changes apply to all of our Medicare Advantage plans.

  • Starting April 1, 2023, Medicare Advantage members may pay a lower co-insurance for some Part B drugs if the drug’s price increased faster than the rate of inflation.
  • Starting July 1, 2023, Medicare Advantage members taking insulin will not pay more than $35 for a month’s supply of insulin furnished under Part B. This limit only applies to the insulin itself, and not the pump or other durable medical equipment associated with Part B insulin.

What lower co-insurance means for you

If you collect co-insurance from a member on the date of service, and the member pays more than the adjusted co-insurance for a Part B rebatable drug, you may have to issue a refund to that member. Therefore, we strongly encourage you to bill the member after the claim has paid.

The Centers for Medicare & Medicaid Services (CMS) will publish the adjusted co-insurance for each Part B rebatable drug in the quarterly pricing files posted on the CMS website. Keep in mind the list of applicable drugs and members’ co-insurance for those drugs could change each quarter.

Some plans may also have co-insurance that is less than the co-insurance listed in these pricing files. In this scenario, members will pay the lower co-insurance.

Questions?

For more information on reduced drug prices, and enhanced Medicare benefits under the Inflation Reduction Act, refer to the CMS Frequently Asked Questions.

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