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Throughout calendar year 2023, the Center for Medicare and Medicaid Services (CMS) will be allowing individuals who use insulin products to request a "Special Enrollment Period (SEP) for Exceptional Circumstances" should they wish to add, drop, or change their Part D coverage. Beneficiaries can call 1-800-Medicare to use this SEP.
Background
The Inflation Reduction Act of 2022 provided significant relief to Medicare beneficiaries by mandating a $35.00 monthly cap per insulin product for those enrolled in Medicare Part D prescription drug plans. The timing of the legislation, however, meant that the updated pricing was not programmed into the Medicare Plan Finder for 2023. Beneficiaries who utilized the Plan Finder to research their 2023 plan options during the Annual Open Enrollment Period (OEP) from October 15th through December 7th may not have understood the additional steps needed to identify the true cost of their insulin prescriptions under the new law. (For reference, please see this link to slides from Avisery's October 2022 OEP Webinar that provides guidance on the steps needed to calculate a plan's total insulin costs.) Because the Plan Finder will not be updated until the next OEP, the information will remain inaccurate for most of 2023 and could impact any Part D enrollment decisions made through September of this year.
As a result of not understanding the insulin pricing for 2023, individuals relying on the Plan Finder may make ill-informed choices about enrolling or not enrolling in Part D or selecting a specific plan. In response, CMS will be offering beneficiaries who use insulin products the opportunity to request an "SEP for exceptional circumstances" to add, drop or change their Part D coverage. This SEP will be available until December 31, 2023 and may be used only once per individual. Beneficiaries should call 1-800-Medicare to request the SEP.
Please note that, per standard CMS policy, in the event of a mid-year Part D plan change, a beneficiary's True Out of Pocket (TrOOP) costs will be carried over to the new plan.
As always, if you have any questions, please reply to avisery@ageoptions.org.
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