Medicare’s open enrollment period is approaching, and it’s the perfect time to review your coverage and consider any changes you may need to make. With new changes on the horizon due to the Inflation Reduction Act (IRA), it’s more important than ever to ensure that your Medicare coverage aligns with your health care needs.
Medicare Open Enrollment Period: October 15 – December 7, 2024
During Medicare open enrollment, you can make several changes to your coverage, including:
- Joining or dropping a Medicare Advantage Plan or switching between plans
- Switching from Original Medicare to a Medicare Advantage Plan (or vice versa)
- Adding, dropping, or switching Medicare prescription drug plans (Part D)
Any changes made during this period will take effect on January 1, 2025. Additionally, if you are in a Medicare Advantage Plan, you will have another opportunity between January 1 and March 31, 2025, to make adjustments, including switching plans or returning to Original Medicare.
Lower Drug Prices for Medicare Members
One of the most significant changes brought by the IRA is the negotiation of prescription drug prices. Starting in 2026, Medicare beneficiaries will see reduced prices for 10 high-cost medications, which are widely used and lack generic competition. These reductions aim to lower out-of-pocket costs for beneficiaries.
Here’s a snapshot of the first 10 drugs that will be affected by the negotiated prices:
| Drug Name | Condition Treated | 2023 List Price | 2026 Negotiated Price |
| Januvia | Diabetes | $527 | $113 |
| Fiasp/NovoLog | Diabetes | $495 | $119 |
| Farxiga | Diabetes, Heart failure, Kidney disease | $556 | $178.50 |
| Enbrel | Rheumatoid arthritis, Psoriasis, Psoriatic arthritis | $7,106 | $2,355 |
| Jardiance | Diabetes, Heart failure, Kidney disease | $573 | $197 |
| Stelara | Psoriasis, Crohn’s disease, Ulcerative colitis | $13,836 | $4,695 |
| Xarelto | Prevention of blood clots, Artery disease | $517 | $197 |
| Eliquis | Prevention of blood clots | $521 | $231 |
| Entresto | Heart failure | $628 | $295 |
| Imbruvia | Blood cancers | $14,934 | $9,319 |
In addition to these 10 drugs, by 2025, 15 more medications under Medicare Part D will be subject to price negotiation, with further drugs included in subsequent years.
Additional Medicare Changes from the IRA
The IRA introduces other key changes to Medicare that will benefit many beneficiaries:
- Out-of-pocket drug cap: Starting in 2025, out-of-pocket costs for prescription drugs will be capped at $2,000 annually.
- Insulin cost cap: The monthly cost for insulin is capped at $35 per prescription under Medicare Part D.
- No-cost vaccines: Recommended vaccines will be available at no cost to those with Medicare prescription drug coverage.
- Expanded Extra Help: The Medicare Part D low-income subsidy (LIS), also known as Extra Help, will be available to individuals earning up to 150% of the federal poverty level.
Rising Drug Prices Still a Concern
Despite these welcomed changes, Americans continue to pay higher prices for medications than most other countries. According to The Commonwealth Fund, U.S. citizens spend nearly three times more on pharmaceuticals than residents of other developed nations. Many Medicare beneficiaries still struggle with costs, with some delaying or skipping medication due to financial concerns.
Stay Informed and Plan Ahead
With changes to drug pricing and Medicare benefits on the horizon, it’s essential to stay informed and plan for the future. The Elder Law attorneys at Mandelbaum Barrett PC are here to help you navigate your Medicare options and make informed decisions about your coverage.
If you have questions or want to learn more about how the upcoming changes may affect you, contact us today.