There are some big changes coming in 2023 for Medicare’s 65 million beneficiaries. These will help make healthcare more accessible and affordable.
Changes to Premiums and Deductibles
Part B monthly premiums have decreased by 3% to $164.90 in 2023 – the first rate decline in nearly 10 years. Most people receive Part A for free, but if you do pay for Part A, your premiums will increase by 1%.
For those with Original Medicare, the Part A deductible for 2023 is $1,600 – an increase of $44 from the 2022 deductible of $1,556. For Part B, the deductible will decrease from $233 in 2022 to $226 for 2023.
The Cost of Insulin Is Capped
As a result of the Inflation Reduction Act passed in 2022, insulin costs cannot exceed $35 per month and are not subject to a deductible. This provision is being rolled out in two phases. Already in effect, as of January 1, 2023, are insulin medications not taken with an insulin pump and covered under Part D. Starting on July 1, 2023, insulin medications used with a traditional pump and covered under Part B will also be capped at $35 for a month’s supply.
The new ruling applies to any insulin covered by your insurance plan. Since every insurer has its own unique drug formulary, insurers don’t cover every insulin medication. If you find that your insurer does not cover you preferred insulin medication and want to change plans, you can take advantage of a Special Enrollment Period for insulin users to switch plans once in 2023.
Shingles Vaccines Are Covered
All adult vaccines recommended by the Advisory Committee on Immunization Practices and covered under Medicare Part D are now covered in full. This includes the two dose Shingrix vaccine that previously may have been subject to deductibles and cost sharing.
End-Stage Renal Disease Drug Coverage
Medicare beneficiaries with end-stage renal disease usually lose their benefits 36 months after a kidney transplant. Since January 1, 2023, they have been able to apply for Medicare Part B-ID Immunosuppressive Drug coverage. The premium in 2023 is $97.10 a month. This benefit covers only continuous immunosuppressive drugs and beneficiaries are not allowed to have other health coverage.
Extra Help/Low-Income Subsidy 2023 Limits
The Extra Help program makes it easier for people with lower incomes and limited resources to pay for their part D prescriptions. It helps cover premiums, deductibles, and copays. The savings are estimated to be $5,300 per year.
Every year, Medicare updates the criteria to qualify. It is based on your income from the previous year. In 2023, the income and asset guidelines are:
- Single person – Yearly income of less than $21,870 ($1,823 monthly) and less than $16,660 in other resources.
- Married person living with a spouse and no other dependents – Yearly income of less than $29,580 ($2,465 monthly) and less than $33,240 in other resources.
Other resources include money in a checking or savings account, stocks, bonds, mutual funds, and IRAs. They don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.
Even if your income is higher than the cutoff, you may be able to receive some help. You can apply online, by phone by calling 1-800-772-1213, or in person at your local Social Security office.
Expanded Dental Coverage
Recognizing that dental health can have an impact on the outcomes of some medical procedures, Medicare will now pay for medically-necessary dental services when it considers these services are integral to treating certain conditions. This includes dental exams and treatment of infection prior to and following organ transplant and cardiac valve replacement. In 2024, this will expand to include surgery and medical treatment of head and neck cancers.
Enrollment Period Changes
Beginning in January, if you enroll for Medicare during official enrollment periods, you don’t have to wait for your coverage to take effect. If you sign up for Medicare the month of your 65th birthday or during the three months after, your coverage now starts the month after you sign up. Before, you would have had to wait up to three months for coverage to begin. Similarly, if you sign up for Medicare during the general enrollment period from January 1 to March 31 each year, your coverage will start the next month instead of on July 1.
Additional Special Enrollment Periods
Medicare has established more Special Enrollment Periods to cover exceptional circumstances. These include individuals who:
- Missed their initial enrollment period because they were affected by a natural disaster.
- Were given incorrect information from an employer, leading them to not sign up when they were supposed to.
- Lose Medicaid eligibility on or after January 1, 2023, and do not have Medicare because they missed an enrollment opportunity. In these cases, individuals can begin coverage on the first of the following month after enrollment or retroactively back to the date their Medicaid coverage ended but no earlier than January 1, 2023.
Those who were unable to enroll in Medicare due to circumstances outside their control can request a Special Enrollment Period by calling 1-800-MEDICARE (1-800-633-4227). A Medicare representative will review their cases.
Some Telehealth Rules Will Change
During the pandemic, Medicare expanded the availability of telehealth, allowing patients to talk to their doctors by phone, not just on video calls. The end of the COVID-19 Public Health Emergency on May 11, 2023, means this telephone-only benefit will end unless Congress acts to extend the benefit.
The only area where new telehealth flexibilities are already permanent is behavioral and mental health. Beneficiaries will be able to continue accessing these visits by telephone, in addition to video calls.
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