Headlines flash the news that Medicare now covers the cost of shingles vaccinations and caps the monthly cost of insulin for diabetics at $35, due to provisions of the Inflation Reduction Act of 2022 (IRA). That sounds like excellent news. Let’s take a look at the details.
Yes, it’s true that, effective January 1, 2023, the shingles vaccine (Shingrix) is covered by Medicare — if you have paid extra for either Medicare Part D (Prescription Drug Benefit) or a Medicare Advantage plan that provides Part D drug coverage. Now, thanks to the Inflation Reduction Act, those with Part D coverage will pay nothing out of pocket for the shingles vaccine. However, it is not covered by Original Medicare Part A and Part B (though Medicare Part B does cover some other vaccines as free preventive care, such as flu and pneumonia vaccines). The Shingrix provisions don’t apply to private insurers, either. Bottom line, if you’ve got Part D coverage this is a real benefit.
Why is news about the shingles vaccine so important? About 1 out of every 3 people in the United States will develop shingles in their lifetime, the Centers for Disease Control and Prevention (CDC) estimates. Anyone who has ever had chickenpox can get shingles, including children, but people who are older or those with weakened immune systems are at increased risk. Shingles is a reactivation of the chickenpox virus. It typically causes a very painful, itchy rash on a person’s body that can linger for months or even years. In some cases, shingles can lead to more serious problems, such as eye damage, hearing problems, pneumonia, and inflammation of the brain. Whether or not you benefit from the shingles vaccine provisions of the IRA, it makes sense to talk to your doctor about getting vaccinated.
OK, what about the cap on the monthly cost of insulin? It’s estimated that over 37 million Americans have diabetes. Many of those living with diabetes need insulin to survive, but the price of the medication in the United States is often expensive. The Inflation Reduction Act of 2022 caps insulin prices at $35 per month for some Americans, but not all. The intention of the original bill was to extend the $35 insulin cap to Americans covered by both Medicare and private insurance. However, Senate Parliamentarian Elizabeth MacDonough ruled that the private insurance part of the cap failed to comply with strict budgetary rules, and it was removed. As a result, the version of the Inflation Reduction Act passed by the Senate caps insulin prices at $35 a month for Medicare patients only. As above, the cap for Medicare Part D enrollees became effective January 1, 2023. A similar cap takes effect in Medicare Part B’s durable medical equipment benefit on July 1, 2023.