Medicare Changes in 2023: What to Expect

4 minute read

By Clarissa Mitton

Open enrollment is around the corner and being informed about the upcoming Medicare changes can help you make the right choices for your healthcare needs. You can learn everything you need to know about these changes with a quick online search.

Medicare is an important part of healthcare planning for many Americans, making it critical to understand any changes around coverage, premiums, copays and more. A number of items are changing for the upcoming year, which we’ll cover here.

Medicare Part B Costs Have Decreased

In 2023, Medicare Part B, which covers doctor visits and medical equipment, brings good news for beneficiaries. The standard premium for Part B has decreased to $164.90 per month, down from $170.10 in 2022. If your income is higher, you might pay more. Additionally, the Part B deductible has also dropped to $226, making healthcare more affordable for many.

Medicare Part A Costs Have Increased

On the flip side, Medicare Part A, covering hospital stays and skilled nursing facilities, has seen an increase in costs. While most people don’t pay a premium for Part A, those who do will see their premiums rise to $506 per month, up from $499 in 2022.

Furthermore, the deductible for a hospital stay has increased to $1,600 for each benefit period, up from $1,556 in the previous year. Copays for inpatient stays have also gone up, including $400 per day for days 61 to 90 in a hospital and $800 per “lifetime reserve day” after day 90, among others.

New Insulin Cost Caps

One significant change in 2023 is the cap on insulin costs for Medicare beneficiaries. Insulin now costs a maximum of $35 per month, with no deductible. This change took effect on January 1, but it’s important to note that insurance plans had until March to fully implement this system. If you paid more than $35 for insulin in January and/or February, be sure to inquire about reimbursement for the difference. Starting in July, insulin used with a traditional pump covered by Medicare will also be capped at $35 for a month’s supply.

Shifted Medicare Start Dates

Medicare enrollment timelines have shifted this year. If you sign up for Medicare during the month of your 65th birthday or within the three months following, your coverage now begins the month after enrollment.

Similarly, if you enroll during the general enrollment period from January 1 to March 31, your coverage starts the following month, as opposed to the previous start date of July 1. These changes help reduce gaps in healthcare coverage for new beneficiaries.

Expanded Vaccine Coverage

Medicare now covers all adult vaccines recommended by the Advisory Committee on Immunization Practices under Part D. This includes vaccines like the shingles vaccine and the tetanus-diphtheria-whooping cough vaccine. Previously, these vaccines might have incurred deductibles and cost-sharing, but now they are fully covered.

Enhanced Drug Coverage for End-Stage Renal Disease

Beneficiaries with end-stage renal disease now have improved drug coverage options. Previously, they lost benefits 36 months after a kidney transplant, unless they qualified for other Medicare coverage. Starting in October, they can apply for immunosuppressive drug coverage through a new benefit called Medicare Part B Immunosuppressive Drug (Part B-ID). This coverage, which began on January 1, 2023, comes with a premium of $97.10 per month and covers continuous immunosuppressive drugs, providing crucial support to those in need.

Pharmaceutical Manufacturers Face Penalties

Starting in 2023, pharmaceutical manufacturers must pay rebates to Medicare if they increase drug prices beyond the rate of general inflation. Companies marketing both Part D prescription drugs and Part B drugs will be penalized for price hikes exceeding inflation.

These penalties will be based on the difference between the price increase and the inflation rate, multiplied by Medicare’s total spending on the drug. This measure aims to deter drug companies from raising prices significantly above inflation.

Commencement of Drug Price Negotiations

By September 1st, Medicare will announce the first 10 Part D drugs that will undergo price negotiations with drug manufacturers, marking a significant shift in drug pricing. This negotiation process, mandated by the new law, is expected to enhance affordability for Medicare recipients.

The negotiated prices for these selected drugs, chosen from the 50 medications with the highest spending under Medicare prescription drug plans, will become effective in 2026. This development holds promise for reducing the financial burden of prescription drugs on Medicare beneficiaries.

Telehealth Flexibility in Behavioral Health

While many telehealth expansions were temporary, one area where the new telehealth flexibilities have become permanent is in the realm of behavioral health. Medicare beneficiaries will continue to have the option to access behavioral health visits via telephone, in addition to video calls, providing greater convenience and accessibility for individuals seeking mental health support.

Learn More About Medicare Changes Today

As open enrollment approaches, staying informed about the changes to Medicare is essential. These changes impact your healthcare costs, coverage, and options. Don’t miss the opportunity to make informed decisions about your Medicare plan. Research online today to ensure you are well-prepared for open enrollment and can select the best Medicare plan to meet your needs.

Clarissa Mitton