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MEDICARE

Inflation Reduction Act

The Inflation Reduction Act is a federal law that aims to reduce out-of-pocket drug costs.
Lower out-of-pocket drug costs

The Inflation Reduction Act reduces the cost of insulin and vaccines. These benefits apply regardless of your plan's drug tier and deductible.

$35 insulin cap

With the law, people with Medicare pay no more than $35 for a month’s supply of insulin. This applies to Medicare Part B and Part D insulins. 

$0 vaccines

With the law, people with Medicare will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Some examples of vaccines covered include RSV, shingles, and tetanus / diphtheria / pertussis.

Other changes include lower cost-share for some drugs and expanded access to premium help.

Catastrophic Phase

No copay for your prescriptions in the Catastrophic Phase

Medicare has a limit to what you have to pay out-of-pocket for your covered Part D drugs each year. Once you reach that limit, you enter the Medicare Catastrophic Phase. This means beginning January 1, 2025, once you reach the Catastrophic Phase, you'll pay nothing for your covered Part D drugs for the rest of the calendar year.

Extra Help

Check your eligibility for the “Extra Help” or low-income subsidy (LIS) program

People with Medicare who earn less than 150% of the federal poverty level are now eligible for the low-income subsidy (LIS), or “Extra Help” program. Everyone who qualifies for Extra Help will pay $0 in premiums, $0 in deductibles, and a lower cost for generic and brand-name drugs.

Part B drugs

Pay less for eligible Part B drugs

Drug companies that raise the prices of certain drugs faster than the rate of inflation are now required to pay Medicare a rebate. Those savings lower your cost-share for some Part B drugs. To learn more and find out if your drug is included, ask your pharmacist. These drugs may change each quarter. This change doesn’t apply to Part D drug coverage.
2025 Medicare changes

$2,000 Part D out-of-pocket maximum

Medicare Part D enrollees will have a $2,000 out-of-pocket maximum for annual prescription drug costs. 

Medicare Prescription Payment Plan

Medicare Part D enrollees will have the option to pay their out-of-pocket prescription drug costs in monthly payments, spread over the year, rather than all at once. 

Learn More

How to enroll in the Medicare Prescription Payment Plan

Current Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Medicare Advantage plan members can opt in to the Medicare Prescription Payment Plan if they prefer to pay in monthly installments.

There are 3 ways to enroll:

Blue Cross NC is working to make health care more affordable, easier to navigate, and accessible for all. That work includes ensuring Medicare enrollees have access to affordable prescriptions when they need them. 

Additional resources

Medicare.gov

Medicare Prescription Payment Plan Fact Sheet (PDF)

Apply for Medicare Part D Extra Help Program | Social Security Administration (SSA)