It’s not often that there’s exciting news to share about Medicare, yet recent legislation is, in fact, good news.
On Aug. 16, President Joe Biden signed the Inflation Reduction Act into law. Among other things, this bill includes important expansions to Medicare that will be phased in between now and 2026.
Starting next year, Medicare will cap beneficiaries’ insulin co-pays at no more than $35 per month. Also, drug companies will be required to pay rebates if certain drug prices increase faster than inflation. Finally, Medicare beneficiaries will have access to additional free vaccines, such as that for shingles.
In 2024, Medicare Part D drug plans will face limits on how much they can increase their monthly premiums. Next, Medicare beneficiaries who reach the “catastrophic” prescription drug coverage level will have their co-insurance obligation eliminated. Finally, the low-income subsidy, also known as Extra Help, will be expanded to provide assistance to beneficiaries with incomes up to 150% of the federal poverty level. (Those on the low-income subsidy can get help with their Medicare Part D premiums, deductibles and out-of-pocket costs).
Starting in 2025, Medicare beneficiaries will pay no more than $2,000 in annual out-of-pocket drug costs. And in 2026, Medicare will be permitted to negotiate with drug manufacturers regarding the prices of some medications; the White House estimates that 5 million to 7 million Medicare beneficiaries’ prescription drug costs could go down as a result.
Even with these expansions, many elders and persons with disabilities may be wrongfully denied Medicare coverage. Some may be denied coverage for physicians’ services, durable medical equipment, home health care or skilled nursing facility care. Others could be forced to leave the hospital prematurely, will be denied prior approvals by their managed care plans or will be made to wait for coverage to begin while facing permanent surcharges on their monthly health insurance premiums.
Countless others could hit roadblocks, such as medication denials, created by Medicare’s complex systems. As a result of these denials, beneficiaries risk gaps in insurance coverage, interference with access to necessary medication or medical care, and/or severe financial duress.
Medicare beneficiaries can get help with these issues, and more, by reaching out to the Medicare Advocacy Project (MAP), which is available to help elders and persons with disabilities. Whatever the problem, MAP’s experienced advocates provide free legal assistance for Medicare-related issues.
In Worcester County, MAP can be reached through Community Legal Aid, which provides free civil legal assistance to low-income and elderly families and individuals in central and western Massachusetts. We encourage anyone facing a Medicare denial or appeal to reach out to us through our website, www.communitylegal.org, or through our intake line, 855-252-5342.
Rachel Shannon Brown is senior supervising attorney at Community Legal Aid Inc.
This article originally appeared on MetroWest Daily News: Inflation Reduction Act offers Medicare recipients many new benefits