Medicare open enrollment for 2023 is coming up, from October 15 to December 17. There are five types of Medicare plans, including Part A, B, C, D, and Supplemental. Now is the time to reach out to a Medicare specialist to learn more and to look into alternatives for Part C (Medicare Advantage plans), Medicare supplemental insurance plans, or Part D, prescription drug coverage. In addition, learn what changes Congress made to Medicare that went into effect this year.

What are some of the Medicare changes effective 2023?

Some costs have decreased, others have increased, and there are notable tweaks to how Medicare works.

• Beginning 2023, when a person applies for Medicare during either the general enrollment or a special enrollment period, coverage will be effective at the beginning of the following month. Previously, beneficiaries had an approximate three-month waiting period.
• The Medicare Part B premium, which covers doctor’s appointments, tests, and durable medical equipment, is reduced from $170.10 to $164.90 monthly.
• Medicare Part A premium, which covers inpatient hospital stays or skilled nursing facilities, is increasing from $499 to $506 per month. In addition, hospital stay deductible is rising from $1556 to $1600. Furthermore, hospital stays and skilled nursing facilities also went up:
  • $400 from $389 a day for 61 to 90 days in a hospital
  • $800 from $778 per “lifetime reserve day” after 90 days in a hospital, up to a limit of 60 days in a person’s lifetime.
  • $200 from $194.50 a day for days 21 to 100 in a skilled nursing facility

Are there any changes to Medicare Part B and D for medication or immunizations in 2023?

• Insulin costs are capped, with a 30-day supply at $35 per month with no deductible. Not every plan covers every type of insulin, so you should compare Part D plans.
• Insulin through a pump will not have a deductible and a $35 co-pay cap.
• Medicare Part D, drug coverage, will fully cover adult vaccines recommended by the Advisory Committee on Immunization Practices. Coverage includes the shingles and tetanus-diphtheria-whooping cough vaccines, previously subject to deductible and cost-sharing.
• Medicare Part B Immunosuppressive Drug or Part B-ID provides new coverage, which only covers continuous immunosuppressive drugs, and beneficiaries cannot have other health coverage.   
• A new law calls for some high-priced drugs to be subject to price negotiations with drugmakers. Any drugs that have been part of the recent negotiations will be $35 or 25% of the negotiated price, whichever is less. Furthermore, negotiated prices for the first group of drugs will take effect in 2026.
• Another new law provision requires pharmaceutical manufacturers to pay a rebate to Medicare if they raise the prices of their drugs more than the general inflation rate.

Will there be changes to behavior health?

There will be changes to behavioral health. Licensed clinical social workers, psychologists, and other behavioral health specialists will be part of the primary care physicians (PCP) team so patients can get behavioral health services immediately. Plus, the program improves access to licensed marriage and family therapists. Moreover, Medicare covers telehealth visits for behavioral health via telephone or video. Before, telehealth visits were not covered, but COVID allowed coverage for these visits, and Congress made this permanent.

Who to consult during open enrollment for 2023 Medicare?

Consult any health insurance agent/broker who specializes in Medicare coverage. Another option is contacting HICAP (Health Insurance Counseling and Advocacy Program). HICAP is a government agency that provides help for people on Medicare to understand their Medicare benefits and options. Visit the California Health Advocates’s website to find your local HICAP office.

STAGES is here to educate people since open enrollment for Medicare is coming up.