The Inflation Reduction Act (IRA), which was signed into law in 2022, aims to help improve the Medicare program by expanding benefits, lowering drug costs, and more. The Centers for Medicare & Medicaid Services (CMS) has made significant changes for 2025, including implementing components of the IRA that will impact Medicare beneficiaries.
Changes are being rolled out over time.
What's available to Medicare patients NOW
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The cost of covered insulin has been lowered. Medicare patients pay no more than $35 for a one-month supply of covered Part B and Part D insulins, regardless of the drug tier it's on or coverage stage they are in.
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Part D vaccines, recommended by the Advisory Committee on Immunization Practices (ACIP), have been made available at no cost to Medicare patients.
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The eligibility for a Low-Income Subsidy (LIS) or “Extra Help" has been expanded by raising the income threshold from 135 to 150 percent of the federal poverty limit.
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The Catastrophic Coverage stage for prescription drug coverage has been eliminated, capping costs at $8,000. That means Medicare patients pay nothing for covered drugs for the remainder of the year if they reach this limit.
What's new for 2025
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Out-of-pocket drug costs will be capped at $2,000 for 2025, and the Coverage Gap will be eliminated. This means that once Medicare Part D members reach this limit, they will pay nothing for covered drugs for the remainder of the year. This cap only applies to out-of-pocket drug costs, and it includes payments made by others on a member's behalf.
Note: The cap does not apply to drugs covered under Medicare Part B.
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The Medicare Prescription Payment Plan (MPPP) is a new payment option that allows members with Part D prescription drug coverage to spread out the cost of their prescription drugs over the course of the year in smaller, more predictable monthly payments. The opportunity to opt in is not income-based and is completely voluntary.
Our Medicare Advantage members are receiving letters regarding this information and may also receive calls from the Independence Blue Cross (IBX) Member Help Team (MHT). These members can also reach out to MHT using the phone number located on the back of their member ID card.
To learn more