What Changes Are Coming to Medicare in 2023?
There are several Medicare changes taking place in 2023. Here is our overview of what’s coming and what you need to know for the upcoming year.
From the Medicare Part B premium decrease to the Inflation Reduction Act, here's what you need to know about Medicare changes in 2023.
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1. Medicare Part B Premium and Deductible Decrease
The Medicare Part B premium is decreasing in 2023. In 2022, we saw a high increase due in part to the Alzheimer’s drug Aduhelm, which we’ll discuss more later. Fortunately, this year’s standard premium cost is going down by $5.20.
In 2022 the Part B premium was $170.10. In 2023 the Part B standard premium will be $164.90.
The Part B deductible is also decreasing from $233 in 2022 to $226 in 2023.
If you have a high income, you pay a higher premium for Medicare coverage. We have discussed what those changes will look like in more detail in a previous blog.
2. Medicare Part A Costs Updates
Medicare Part A costs will be seeing a slight increase in 2023. The deductible for Medicare Part A, which is hospital coverage, will be $1,600. That’s a $44 increase from 2022.
Please note: If you have a Medicare Advantage plan, you do not pay the Medicare Part A deductible because they have their own deductibles. Medicare Supplements also typically do not need to worry about Part A deductibles, as many plans cover that cost.
Most Medicare beneficiaries do not have a Part A premium since they meet the work criteria. You or your spouse must have 40 quarters of Medicare-covered employment, which covers most employment in the United States.
For those who do have to pay the premium, it has increased slightly to $506/month in 2023, which is a $7 increase from 2022.
For those with 30–39 quarters of Medicare-covered employment (or those who were married to someone who did), they can buy Part A at a reduced rate of $278 in 2023, a $4 increase from 2022.
3. Lower Insulin Costs Under the Inflation Reduction Act
One of the biggest changes coming to Medicare in 2023 is the Inflation Reduction Act. This legislation seeks to curb the skyrocketing costs for medications and especially insulin.
Starting in 2023, there will be a $35/per month copayment cap on insulin prescriptions for those with Medicare Part D drug coverage. This cost savings will stay in place until 2025.
4. Free Vaccinations
Another key benefit of the Inflation Reduction Act is that all CDC-recommended vaccines will be free to Medicare users. That means flu and COVID-19 shots, travel inoculations and more.
We are especially excited to see the shingles vaccine on this list. Shingles is a painful reemergence of the chickenpox virus that can happen at any point in your life, although most cases happen to those who are older.
The shingles vaccine is highly effective, and was previously not included in Part B vaccine coverage. Adding the shingles vaccine will help more seniors avoid this painful illness.
5. Kidney Transplant and Immunosuppressive Drug Coverage
One of the biggest announcements for 2023 is the coverage extension for those who have received kidney transplants and are on immunosuppressive drugs. In the past, Medicare coverage for those who receive kidney transplants only extended 36 months post-surgery.
Beginning January 1, 2023, Medicare will offer a new benefit that helps continue to pay for immunosuppressive drugs beyond those 36 months if you don't have other health coverage. This new benefit only covers immunosuppressive drugs. It does not include other items or services and is not a substitute for full health coverage. It is a way to cover lifesaving medication for those without alternative coverage.
6. Enrollment Period Update
Beginning in 2023, there is an update to when you will receive your Medicare coverage when first enrolling in Medicare.
Starting January 1, 2023, your Medicare Part B coverage starts the first day of the month after you sign up if you sign up during the last three months of your IEP. Before this announcement, if signing up for Medicare Part B during the last three months of your IEP, your coverage didn’t start until two to three months after you enrolled.
7. Lung Cancer Screenings
Medicare Part B is adding lung cancer screenings to its list of screening services. You may qualify for a yearly screening if you meet the following criteria:
- You’re 50–77 years old
- You don’t show signs or symptoms of lung cancer
- You currently smoke or have quit in the last 15 years
- You have a tobacco smoking history of at least 20 pack years (meaning you’ve had on average 20 cigarettes/one pack a day for at least 20 years)
- You get an order from your doctor
8. Part D Catastrophic Coverage Threshold Increasing to $7,400
In 2023 the Part D (drug coverage) catastrophic coverage threshold will increase from $7,050 to $7,400.
Once you reach this threshold, you’re eligible for the catastrophic benefit period, where coinsurance is only 5% of the cost of the drug, or $4.15 for generic and $10.35 for brand name.
9. Aduhelm Decision
Going into 2022, Medicare’s Aduhelm decision was one of the most anticipated coverage announcements. It is a high-cost Alzheimer’s drug that was expected to have major cost implications for all Medicare users, which was one of the reasons premium costs skyrocketed in 2022.
Biogen, the makers of Aduhelm, cut the costs of the drug nearly in half in late 2021 after the announcement of the 2022 Part B premium increase. Medicare coverage of the drug is still extremely limited going into 2023.
Medicare is only providing Aduhelm coverage to those in qualifying clinical trials with no announcement of general coverage in sight. This leaves the future of monoclonal antibody treatments for Alzheimer’s disease and Medicare’s coverage for those treatments unclear.
Those are the major Medicare changes to expect in 2023. If you have any questions about how these changes will affect you or your coverage, give us a call at 833-801-7999, and our licensed insurance agents will be happy to help you!
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