2023 Medicare Changes: What Insurance Agents Need to Know

Another year means more changes coming to Medicare. In this article, we'll outline all of the major Medicare changes coming in 2023. 

From decreased Medicare Part B costs to Part D changes coming as a result of the Inflation Reduction Act (IRA), here's what you and your clients should know about Medicare in 2023.

Because there is so much ground to cover, we've added a table of contents so you can click to the section you're interested in:

• 2023 Medicare Costs
• Medicare Technology
• Inflation Reduction Act (IRA) Changes
• Aduhelm & Medicare Updates
• 2023 Medicare Advantage Changes
• 2023 PDP Cost Changes
• Medicare Enrollment Period Changes
• ESRD Medicare Coverage Changes
• Accountable Care Organizations
• Conclusion

2023 Medicare Costs

As always, Medicare costs are changing in 2023. However, as a nice surprise, some of those costs are actually going down.

Part B Premium & Deductible Decrease

For 2022, the Medicare Part B premium jumped higher than to cover projected costs from the new Alzheimer's drug, Aduhelm. It turns out that those costs ended up being much lower than expected, which resulted in a Part B premium decrease for 2023 (more on Aduhelm later in this article).

In 2023, the standard Medicare Part B premium is $164.90, a decrease of $5.20 from $170.10 in 2022.

The Part B deductible is also going down to $226 in 2023, a $7 decrease from $233 in 2022.

These decreases align with the CMS recommendation in a May 2022 report that excess SMI reserves be passed along to people with Medicare Part B coverage. 

Note: to easily show these costs to your clients, you can download a 2023 Medicare Costs fact sheet from CMS, or you can take advantage of our customizable 2023 Medicare Costs handout:

Part B IRMAA

For about 7 percent of people with Medicare Part B that have a high income, their Part B premiums will range from $230.80-$560.50 per month.

Here is the IRMAA chart for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year but file a separate return:

There are also new premium amounts for beneficiaries with immunosuppressive drug only Part B coverage (more about that later in this article). You can reference those IRMAA charts here. 

Part A Costs

Here are some quick Part A cost highlights for 2023:

• 2023 Part A premium: $278-$506 per month
• 2023 Part A deductible: $1,600 ($1,556 in 2022)
• 2023 Part A coinsurance for Days 1-60: $0
• 2023 Part A coinsurance for Days 61-90: $400 per day ($389 in 2022)
• 2023 Part A coinsurance for lifetime reserve days: $800 per day ($778 in 2022)
• Skilled nursing facility daily coinsurance for days 21-100: $200 ($194.50 in 2022)

Most people don't pay a monthly premium for Part A. For those that paid Medicare taxes for less than 30 quarters, the standard Part A premium is $506 in 2023 (a $7 increase from 2022). And for those that paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278 in 2023 (a $4 increase from 2022).

Help your clients understand their 2023 Medicare costs with customizable and fillable Client Guide to Medicare Parts A & B.

Medicare Technology

Integrity has made serious investments in technology to help you produce more and serve your clients more efficiently.

We're so excited about the recent developments with MedicareCENTER and LeadCENTER, and we're excited to continue sharing new features and updates in 2023.

The government is also making investments in their digital presence! The Social Security Administration recently announced their complete overhaul of the SSA.gov home page.

This website should be easier than ever for your clients and prospects to navigate, especially if they want to sign up for Medicare online.

Inflation Reduction Act (IRA) Changes

Big changes are coming to Medicare Part D as a result of the Inflation Reduction Act (IRA), which was signed into law in August 2022. These changes are being slowly rolled out each year, starting on January 1, 2023 and going all the way through 2029 and beyond.

No-Cost Vaccines & $35 Insulin Copay Cap

Two of the most notable changes coming to Part D in 2023 include no-cost adults vaccines (including shingles) and a $35 copay cap on insulin.

1. Starting January 1, 2023, adult vaccines recommended by ACIP, which includes the shingles vaccine, will be available to people with Medicare Part D at no cost to them.

2. People enrolled in a Medicare prescription drug plan will not pay more than $35 for a month’s supply of each insulin that they take, as long as it's covered by their Medicare prescription drug plan and dispensed at a pharmacy or through a mail-order pharmacy. All Part D plans must cover insulin products on their plan's formulary at this $35 monthly copayment amount. Also, Part D deductibles won’t apply to the covered insulin product.

Timing & Implications

Due to the timing of this law and these changes, the Medicare Plan Finder tool shows the original bid amount for covered insulins, not the new $35 cap amount.

Because of that, CMS is granting an SEP in 2023 if beneficiaries can find a lower-cost plan. However, the client must call Medicare directly to do this. 

In addition, for the first few months of 2023, some beneficiaries may still end up paying more than the $35 per month insulin copay cap. In that case, these beneficiaries should be reimbursed by their plan within 30 days.

You can read more about some of these implications here.

Aduhelm & Medicare Updates

The big story going into 2022 was Aduhelm's approval and potential cost burden to the Medicare program.

As we approach 2023, we now know that Aduhelm was approved but only for those in a qualifying clinical trial. On top of that, Biogen slashed its price from $56,000 to $28,200. The financial impact to the Medicare program wasn't nearly what many were anticipating.

At this time, Medicare Part B will pay its share for the Alzheimer's treatment if the individual is enrolled in any trial or study approved by the FDA or the National Institute of Health. The patient must also have a mild form of cognitive impairment or mild dementia in addition to having amyloid plaques in the brain (the proteins Aduhelm is designed to target). 

This Part B coverage decision applies to all drugs in this class – not just Aduhelm. The new treatment Eli Lilly is working to get FDA approval for, Donanemab, would also fall into this coverage category.

We post time-sensitive updates like this on our Facebook page. Be sure to like our page to stay on top of Medicare-related news and announcements.

2023 Medicare Advantage Changes

Another year, another mention of big growth for Medicare Advantage. 2023 is slated to be the biggest year yet for Medicare Advantage enrollments.

In 2023, the average Medicare beneficiary chose from 43 Medicare Advantage plans – that number has steadily increased each year (33 in 2021 and 39 in 2022).

With 66% of MA-PDs charging $0 premium (other than the Part B premium) and more access to quality plans than ever before, it's easy to see why MA is growing so rapidly.

Source: KFF's Medicare Advantage 2023 Spotlight

CMS also reports that the average projected MA premium in 2023 is just $18 per month, a decline of nearly 8% since last year.

MA plans are also offering a wide range of supplemental benefits, such as eyewear, hearing aids, preventive and comprehensive dental benefits, access to meals (for a limited duration), over-the-counter items, and fitness benefits.

It's safe to say MA is only growing. If you aren't yet selling MA plans, we highly encourage you to reach out to us for help getting started!

2023 PDP Cost Changes

The average 2023 premium for Part D coverage will be between $31.50 and $39 per month (KFF). The drug deductible maximum is $505 in 2023 (up from $480 in 2022), and the catastrophic coverage threshold will increase from $7,050 to $7,400.

Once clients reach this threshold, they're eligible for the catastrophic benefit period, where they only pay a small coinsurance percentage or copayment for covered drugs for the rest of the year.

Medicare Enrollment Period Changes

In the past, individuals who waited to sign up for Medicare during the GEP had to wait until July for their coverage to start. Now, it begins the first day of the month after they sign up.

This new start date rule applies to the General Enrollment Period (GEP) and Initial Enrollment Period (IEP).

There are also some new Special Enrollment Period (SEP) provisions for 2023. The 2023 Medicare & You Handbook explains:

"Beginning January 1, 2023, you may be eligible for a Special Enrollment Period if you miss an enrollment period because of certain exceptional circumstances, like being impacted by a natural disaster or an emergency, incarceration, or losing Medicaid coverage."

ESRD Medicare Coverage Changes

If an individual only has Medicare because of End Stage Renal Disease (ESRD), their Medicare coverage, including immunosuppressive drug coverage, ends 36 months after a successful kidney transplant.

However, starting January 1, 2023, Medicare is offering a new benefit that helps continue to pay for those immunosuppressive drugs after 36 months.

This new benefit only covers immunosuppressive drugs and no other items or services. This new benefit is called Medicare Part B Immunosuppressive Drug (Part B-ID). You can read more about it here.

Accountable Care Organizations

Another new highlight for 2023 includes Accountable Care Organizations (ACOs), or a a group of doctors, hospitals, and other health care providers that work as a team to give patients high-quality, coordinated health care.

An ACO is not a Medicare Advantage plan or other insurance plan. If an individual's doctor or other provider is part of an ACO, they may get access to additional tools and services that other people with Original Medicare don't get.

Image source: Blue Cross Blue Shield

As an example, some ACOs offer expanded telehealth services or even approval to send patients to a skilled nursing facility or rehab care even if they haven't stayed in a hospital for 3 days first.

If your client's primary care provider participates in an ACO and they have Original Medicare, they will get a written notice and see a poster in their provider’s office about their ACO participation. There should also be visibility into which providers are part of an ACO when your client logs into their Medicare.gov account.

You can read more about ACOs in the 2023 Medicare & You Handbook.

Conclusion

Medicare continues to evolve, and it's important that we stay on top of those updates so we can educate our clients.

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