How Recent Changes in Vaccine and Insulin Coverage Benefit People with Medicare

As inflation continues to squeeze the finances of many Americans, especially individuals living on fixed incomes, such as seniors, coverage changes included in the Inflation Reduction Act (IRA) may provide some welcome relief with significant cost savings for Medicare beneficiaries in 2023.

As the leader of Humana’s Medicare Part D Plan (PDP), which provides prescription drug coverage for people eligible for Medicare, I believe the changes to insulin and vaccination coverage will benefit our members. Preventive care is critical to long-term health, and anything we can do to eliminate barriers to care may help improve health outcomes overall.

If you aren’t familiar with the IRA, here are the key points I believe will likely have the biggest impact on Medicare beneficiaries.

Low-cost Insulin
Medicare beneficiaries using insulins to treat diabetes will now pay no more than $35 per month for a 30-day supply of any Part D insulin product covered by their prescription drug plan, whether it’s a stand-alone Part D plan or included in a Medicare Advantage (MA) plan. This cost cap is applied irrespective of the cost-sharing tier of the particular insulin or whether their deductible has been met. The new cap on out-of-pocket costs means that the more than 1.5 million Medicare beneficiaries on insulin will end up spending about $760 million less this year on their treatments than in 2020.

Additionally, Humana members eligible for the Insulin Savings Program (ISP) as part of the Centers for Medicare and Medicaid Services (CMS) Part D Senior Savings Model will continue to receive their covered one month’s supply of select insulins at a cost of no more than $35 for the rest of this year. These programs will sunset at the end of 2023, as they are being replaced by the new IRA benefits.

No-Cost Vaccines
Also in 2023, Medicare beneficiaries will pay nothing for almost all vaccinations, no matter what cost-sharing tier the vaccine is on or whether their deductible has been met. This means that vaccinations for shingles and tetanus, diphtheria, and pertussis (Tdap), as well as any other covered adult Part D vaccines that have accompanying recommendations by the Center for Disease Control’s Advisory Committee on Immunization Practices, will be available at no cost to members. As in the past, there will continue to be no out-of-pocket costs for vaccines covered through the Part B medical benefit including those for COVID-19, flu and pneumonia.

The following vaccines are most important for seniors’ health and are available at $0 cost to all Medicare beneficiaries.

COVID-19
As COVID-19 has clearly demonstrated, vaccines can be critical for protecting the health and lives of seniors. While 95% of Americans 65 and older received their initial COVID-19 vaccine, only 41% have received a booster shot. As protection from the vaccine wanes over time, it’s important for seniors to work with their doctor and stay up-to-date with these life-saving immunizations, especially for at risk patients. While adults ages 65+ make up only 16% of the U.S. population, they account for 45% of hospitalizations and 80% of deaths associated with COVID-19.  

Shingles
While shingles, also known as herpes zoster, is typically not life-threatening, it is an infection of the nerves and surrounding skin that can be extremely unpleasant and painful. Approximately one million cases of shingles occur each year in the U.S. The risk of contracting the disease increases as we age, with those 65 and older getting shingles at 2.5 times the rate of the general population. The vaccine, which is administered in two doses, two to six months apart, is about 90% effective for preventing the disease in older adults with healthy immune systems and continues to provide protection for at least seven years.

Flu and Pneumonia
For seniors, flu (influenza) and pneumonia can be serious and deadly diseases. Approximately 70-85% of flu-related deaths occur in people 65 years and older, and pneumonia is the second leading cause of hospitalization among Medicare beneficiaries with a mortality rate as high as 20%. The two diseases are closely associated since one of the complications of flu is pneumonia, caused by either a secondary bacterial infection or by the influenza virus itself. To help prevent these severe outcomes, seniors should get an annual flu shot by October of every year. With different types of pneumonia vaccines available, check with your doctor about whether you may need to receive repeat doses.

Tdap
Tdap is a combination vaccine that protects against three different health risks – tetanus, diphtheria and pertussis. Tetanus (also referred to as lockjaw) is an infection caused by a bacteria found in the environment that enters the body through open cuts and wounds; diphtheria is a serious, contagious disease that infects the respiratory system; and pertussis (also known as whooping cough) is a highly communicable respiratory tract infection that is marked by a hacking, uncontrollable cough and can cause difficulty breathing. While most people received the initial Tdap vaccine in their childhood, a Tdap booster shot is needed every 10 years.

Vaccinations are one simple and effective way older adults can work toward achieving their best health. With more free vaccines now available to Medicare beneficiaries, there’s no better time to do it.