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The IRA Strikes Again ! No, Not The Irish !

We reported previously that the Inflation Reduction Act (IRA) mandates that all Medicare Part D plans (Part D covers medications) in 2023 and in the future will need to 100% cover all vaccines that the CDC recommends for people over 50 (except those that are already covered by Part A/B - Flu for example).


Here are the numbers:


In 2021, 3.4 million Medicare enrollees spent $234 million on out-of-pocket (OOP) cost for vaccines. This translate to $70 per medicare enrollee out-of-pocket. In Virginia, it was $83.72 per enrollee.


This year in 2023, Medicare Part D enrollees paid a big zippo for those recommended vaccines.


So, you say, what is the big deal about paying $70 ? What this figure does NOT show is how many vaccines were NOT given because of cost. For instance, the shingles vaccine (recommended by the CDC and healthcare providers) usually costs hundreds of dollars.


In my healthcare practice, many elderly declined that vaccine as well as a Tdap because of the expense. The new IRA coverage of these vaccines not only helps the wallet but also the health of the patient. I have seen too many people hospitalized for shingles or another preventable disease and they return to me in a declined condition and the spiral down begins.


What is really interesting is that there were 48 million Medicare Part D enrollees in 2021. So, that means that either 45 million did not get vaccines or they paid OOP which may not be recorded in the Medicare records (since the vaccine was not billed to Medicare). Wow, that could mean that the OOP cost is even much higher and the IRA benefit is even much bigger.


It is a WIN-WIN !


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