Each year the Centers for Medicare and Medicaid Services (CMS) review the federally regulated Medicare program and, if needed, implement changes. There have been multiple changes made for 2023 that are important to understand to get the most out of your Medicare benefits.
What is Medicare?
Original Medicare was signed into law in 1965 by President Lyndon B. John. The law created federally-funded health insurance coverage for older Americans, known as Part A (hospital insurance) and Part B (medical insurance).
In 1972, Original Medicare was expanded to cover the disabled and people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant. Medicare does not pay for all medical bills at 100% but covers most expenses, typically 80%. If a Medicare-eligible individual would like to have nearly 100% of their medical expenses paid, a Medicare supplement plan can be purchased to cover much of the remaining 20%.
In 2006, Part D prescription drug coverage was added as an option to supplement medications not covered by Medicare Part B.
Medicare Advantage, also known as Part C, is Medicare coverage through private insurance companies. These plans are required to cover the same benefits as Original Medicare Part A and Part B and can also include prescription drugs and even dental care as a bundled package under one policy.
What Are The Changes For 2023?
The most impactful change to Medicare in 2023 is pricing – both monthly premiums and the Part B deductible decreased. The average monthly premium for Medicare Part B enrollees is $164.90 for 2023, a decrease of $5.20 from 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from 2022. Also, in 2023, eligible Medicare enrollees who are 36 months post-kidney transplant can elect to continue their Part B coverage of immunosuppressive drugs by paying $97.10 a month. However, the Part A deductible will rise to $1,600 per hospital stay, an increase of $44 from 2022.
Older and disabled Americans are at a higher risk if they contract COVID-19. CMS takes the health and well-being of citizens seriously and advises every eligible Medicare recipient to get a COVID-19 vaccine and supplemental boosters. Medicare covers the cost of vaccines related to COVID-19.
Expanded Special Enrollment Period
Beginning January 1, 2023, you may be eligible for a Special Enrollment Period if you missed the Annual Enrollment Period due to exceptional circumstances, like being impacted by a natural disaster, incarceration, or losing your Medicaid coverage.
Insulin Capped at $35 Each Month
Medicare beneficiaries with diabetes now have a lower cost for insulin in 2023. A one-month supply of Part D-covered insulin is capped at $35, and there’s no deductible payment required. This applies to everyone who takes insulin, even if they are enrolled in the Extra Help program. Of note, plans have until the end of March 2023 to update their systems, so lower costs might not be reflected during the first quarter of the year. However, Medicare will reimburse for the difference if the price exceeds $35. Contact your plan to learn how to get reimbursed.
Coverage Start Date
If you pay for Medicare Part A but don’t sign up for Part B during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up during the General Enrollment Period from January 1–March 31 each year. New for 2023, when you sign up during this General Enrollment Period, your coverage starts the first day of the month after you sign up.
Colonoscopy and Flexible Sigmoidoscopy Coverage
If your doctor finds and removes a polyp or other tissue during a colonoscopy or flexible sigmoidoscopy, you pay 15% of the Medicare-approved amount for your doctors’ services. If you have the procedure in a hospital outpatient setting, you also pay the hospital a 15% coinsurance payment. Your Part B deductible doesn’t apply.
CMS has launched a new number for depression, suicide or a life crisis. If you or someone you know is in crisis, call or text 988, or chat at 988lifeline.org. Calling the telephone number will route an individual to the National Suicide Prevention Lifeline.
Lung Cancer Screening
Medicare covers lung cancer screening as free preventive care once per year if you are between the ages of 50-77, don’t have any symptoms of lung cancer, are a current smoker or quit smoking within the last 15 years, have a history of smoking at least 20 cigarettes a day for 20 years, and have an order from your doctor. You must meet these requirements to qualify.
Extended End-Stage Renal Disease Benefits
New in 2023 for those under 65 who have End Stage Renal Disease (ESRD) – your Medicare coverage will continue to pay for your immunosuppressive drugs beyond 36 months if you don’t have other health coverage.
These changes are outlined in the 2023 “Medicare and You” manual that CMS pushes each year. It’s a good idea to review the booklet each year to find out what changes have been made to better your Medicare benefits.