Monday, August 22, 2022

Healthy Habits: Inflation Reduction Act and Medicare

 Dr. David Wilcox is author of the book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival. With the passing of the Inflation Reduction Act, there are several changes to health care on the horizon. Many will be centered around Medicare recipients. Every American needs to know how these changes will affect their health care and out of pocket costs. With health care being the complex entity it is, I had a chance to interview him to learn more.

How will the Inflation Reduction Act affect healthcare? What are some of the specific changes that will affect Medicare?
  • Medicare will begin to negotiate prescription drug prices. 
    • 10 drugs can be negotiated starting in 2026 
    • 15 drugs can be negotiated starting in 2027 
    • 20 drugs can be negotiated every year beginning in 2029 
  • Out of pocket medication costs are capped for Medicare part D and Medicare Advantage plans to $2000 a year beginning in 2025 with the option to break that amount into monthly payments 
  • For Medicare recipients only insulin will be capped at $35 out of pocket cost. Politicians successfully stripped a provision that would have extended the cap to private plans as well 
  • The legislation would also extend enhanced ACA federal health insurance subsidies for another three years. The boosted subsidies helped fuel a record 14.5 million signups for the ACA exchanges this year. The extension will prevent an estimated 3.4 million Americans from losing health coverage. The extension lasts until 2025. 
  • Drug companies will be required to rebate back price differences to Medicare if they raise prices higher than the rate of inflation, coined an "inflation rebate." The Part B inflation rebate goes into effect Q1 2023. The Part D inflation rebate goes into effect annually, starting with the one-year period beginning on October, 1, 2022 
  • The legislation makes all vaccines covered under Medicare Part D free to beneficiaries with no deductibles, co-insurance or cost-sharing, starting in 2023. 
Why is it important for consumers to be aware of how legislation will affect healthcare?

The pharmaceutical companies will off set the Medicare savings covered in this act by raising prices elsewhere as they are a business and must answer to their stock holders. Unfortunately, people with insurance will bear the additional costs for medications. Included in the bill was a cap on insulin for all insured Americans but the pharmaceutical companies waged a seven figure campaign against this bill and in the end the politicians removed the $35 cap on insulin for all insured Americans. The real winners are those who are on Medicare or Medicare Advantage programs. The losers of this bill are average Americans with or without insurance.

How can ordinary Americans get involved in the decision-making process with healthcare and legislation?

By staying connected with your representatives and writing them when significant legislation such as the Inflation Reduction Act is being considered. Following your representative's track record on healthcare is another good way to stay informed and know what to expect. The more constituents that make their voice heard, the greater the influence. Use your social network of likeminded people to do a mass letter writing campaign as representatives know that voters elect them and will be more apt to listen if many constituents share the same opinion.

Here is the link to my book How to Avoid Being a Victim of the American Healthcare System: A Patient's Handbook for Survival which can be purchased on Amazon. 

At my website I offer a free healthcare resource guide for people who sign up. It is one click access to see how well your doctor and hospital are rated as well as a price transparency guide to help you price out your healthcare. There are also one click links to GoodRx and Mark Cubans online generic pharmacy. You can find it here:

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