This 2023 Medicare Change Could Save Seniors on Insulin Hundreds of Dollars Per Year

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  • The average senior on insulin paid $54 for a 30-day supply in 2020.
  • This will drop as new caps on Part D-covered insulin go into effect on Jan. 1.
  • Additional caps on insulin costs will start on July 1, 2023.

Get ready to breathe a little easier next year.

Insulin is a life-saving medication for people with diabetes, but unfortunately, many drug manufacturers don't offer it cheaply. This is true even for seniors with Medicare Part D plans that help with prescription drug costs. The average senior spent about $54 per month on insulin in 2020, according to the Kaiser Family Foundation, and some paid as much as $116 per month. That amounts to $1,392 per year on insulin alone.

Fortunately for seniors, insulin costs are going to look a lot different in 2023 thanks to a new Medicare change. Here's what you need to know.

New caps on insulin costs kick in Jan. 1

In an effort to make healthcare more affordable for seniors, Medicare will cap insulin prices at $35 for a 30-day supply beginning on Jan. 1, 2023. Those who get a 60- or 90-day supply could pay up to $70 or $105 per prescription, but their costs should still average out to no more than $35 per month.

One important caveat is that this cap only applies to insulin covered under Medicare Part D plans. It does not apply to insulin used in a traditional insulin pump, which is covered under Medicare Part B. If you don't have a Part D plan, you'll pay 20% of the Medicare-approved amount for the pump until you meet the deductible and 100% of the cost for all insulin-related supplies.

But there's good news on that front too. The government will impose caps on insulin used in traditional insulin pumps beginning on July 1, 2023.

Other ways to keep your out-of-pocket healthcare costs down

This new rule will be a big help to seniors used to paying even more for their insulin. But with inflation making other medical care more expensive, there's still no guarantee of saving money on healthcare in 2023.

The Medicare open enrollment period has closed for 2023, but ideally, you took the time to compare some plans to see whether there was a more affordable option for you than your current plan. If not, make a plan to do so next year (or sooner if you qualify for a special enrollment period). You may be eligible for one of these if you had other insurance coverage that you lost. For example, if you retire and lose your employer-sponsored health insurance, you would qualify for a special enrollment period for Medicare.

You could also look into a Medicare supplement plan, also known as a Medigap plan. It's possible that some insurers may be willing to offer you a policy outside of the open enrollment period if you meet their medical underwriting requirements, but this isn't a guarantee. If you are able to get a Medigap policy, it may provide you with extra help paying for things that original Medicare doesn't. But it will also have costs of its own.

If you wind up with large medical bills, see if you can work with the provider to set up a payment plan so you don't have to pay them all at once. Often, it's possible to pay your balance off over time without incurring interest.

It's not always possible to predict or even control your healthcare expenses. It'd be nice to see even more price caps on prescription drugs and services for seniors, but for the time being, you have to rely primarily on what you can do yourself to keep your costs as low as possible.

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