(Prevously published in the 2023, issue 1, of the Retiree Guardian)

What’s New in Medicare

By Barbara Wilcox, SHIP Counselor

Changes are coming to Medicare which will reduce costs, enhance benefits and make it easier to enroll without late penalties or gaps in coverage. Some of the changes were made by Congress and some result from provisions in existing law or changes to rules. Some of these changes take effect in 2023 and others will take effect later.

Reduced Costs

Congressional action plus other changes will reduce 2023 costs for many if not most Medicare beneficiaries.

Part B premium and deductible reduced.

The Centers for Medicare and Medicaid Services (CMS) explained the cost reductions this way.

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Lower-than-projected spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account of the Supplementary Medical Insurance (SMI) Trust Fund, which [were] used to limit future Part B premium increases.

Prescription Drug Cost Savings

Good news for diabetics. Beginning January 1, 2023, cost sharing for any insulin on a Medicare Part D (or Medicare Advantage) formulary is limited to no more than $35 per month for each covered insulin. There is no deductible for insulin. Insulin used with durable medical equipment, like an insulin pump, is covered under Part B, and this $25 cost cap also applies to Part B insulin beginning July 1, 2023.

Some vaccines, such as the Shingrix shingles vaccine, are covered under Part D. Beginning January 1, 2023, there is $0 cost sharing and no deductible for Part D vaccines.

The inflation Reduction Act of 2022, passed by Congress last August, contains additional cost-saving measures for prescription drugs that will take effect over the next four years.

Enhanced Benefits

CMS is changing some rules to make it easier to get behavioral health services and opioid treatment services under Medicare. This includes expanded coverage for telehealth services in some circumstances.

Other rules changes are clarifying circumstances when dental services will be covered by Medicare. For example, Medicare will cover dental treatment to eliminate infection before certain surgeries, such as cardiac procedures or an organ transplant.

Enrollment in Medicare

There have been a number of rules changes that make it easier for people to get enrolled in Medicare without gaps in coverage and with no or reduced late-enrollment penalties if they missed their Initial Enrollment Period when they first became eligible for Medicare. While most readers of this article are already enrolled in Medicare, some may have friends or family members who aren’t enrolled yet. These changes are effective January 1, 2023. Here are some highlights.

• Once a person becomes eligible for Medicare, in most cases by reaching age 65, their Part A and Part B will become effective the first day of the month following the month in which they enroll. For example, if a person enrolls in the Initial Enrollment Period but during the three months following their birthday month, they no longer have to wait for their coverage to begin.

• Special Enrollment Periods (SEPs) have been expanded to include more circumstances beyond what has been available in the past. For example, if the person is impacted by an emergency or disaster, as declared by a federal, state or local government, if a person is given incorrect information by their employer, if the person is released from incarceration, or if the person has been covered by Medicaid and that Medicaid coverage is ending, they will have an SEP for enrolling in Medicare without penalty. The exact rules depend on the circumstances. A person can request an SEP for any unusual circumstances that were beyond their control.

• If a person misses their Initial Enrollment Period when they first become eligible for Medicare and also misses any SEPs they may be eligible for, they still can enroll during the General Enrollment Period, January 1 through March 31 of each year. Now, they don’t have to wait for their coverage to begin, as it will begin the first day of the month following their enrollment. Late enrollment penalties will still apply, but they may be less than they would have been under the old rules.

Enrollment in Medicare is handled by the Social Security Administration.

Beware of “new” Medicare card schemes.

While the rollout of new Medicare cards ended in 2019, scams about Medicare cards continue. You will not be getting an updated Medicare card this year, but scammers may try to convince you otherwise. For example, scammers may falsely tell you that Medicare is again issuing new cards—perhaps plastic ones, metal ones, chipped cards, or black and white COVID-19 cards. The scammers may tell you that in order for them to send your new Medicare card, you need to verify your identity, which may include your Medicare number. This is an attempt to gain your personal or financial information. Beware of unsolicited calls from anyone claiming to work for Medicare or anyone who needs you to verify your identity so they can send you an updated Medicare card.

Questions?

Contact your local SHIP program by calling 1-888-696-7213.