Recent Changes in Medicare

By Barbara Wilcox, SHIP Counselor

This article was originally published September 26, 2023, in Issue 4 of the Retiree Guardian. Newsletter of the CenturyLink Retirees. — We hope you find it of value and invite you to join us at the CenturyLink Retirees.

There are two reasons why there are changes taking place in Medicare coverage and services this year. The first is the ending of the COVID 19 Public Health Emergency (PHE) and the second is the reduction in Medicare costs contained in the 1922 Inflation Reduction Act. Many of these changes produce cost savings for us Medicare beneficiaries in 2023, and there are more cost savings scheduled in future years. Also, new developments in vaccines are making more preventative services available under Medicare.

COVID-19 Public Health Emergency Ended May 11, 2023. – During the Public Health Emergency, there were some expansions of Medicare coverage. Some of those expansions remain in place after May 11 and others do not. Here is a summary.

• COVID tests: The costs for COVID tests are constantly changing. During the PHE, COVID tests were fully covered by Medicare with no copays, and we could order tests for use at home at no charge. Then, when the PHE ended, tests were covered only if a doctor ordered them. Now, the Federal government is again making tests available for home use free of charge. If you are on Medicare Advantage, check with your plan to see what it will cost to be tested.

• COVID vaccination and booster shots: During the PHE Medicare fully covered these vaccinations with no deductible, copay or coinsurance. Now, any vaccines or booster shots that have been granted full approval by the FDA are covered under Medicare Part B at no cost. If you are on Medicare Advantage, your plan is required to cover the shots in network at no cost to you. New and updated vaccines are being made and released as time goes by, so watch for advice from the CDC for the new vaccines and who should get them.

• COVID treatment: During the PHE, the Federal government purchased a supply of some treatments, such as Paxlovid, and this medication will continue to be available at no cost through 2023 when you get it from a Medicare provider. Starting in 2024, the normal deductibles and co-insurance will apply, as for treatment of any disease.

• Telemedicine: During the PHE rules around telemedicine were relaxed to make it more possible for us to see our doctors and get medical help without going in person. Now, Medicare is continuing to pay for telemedicine visits, and many of the expansions of telehealth services covered by Medicare will remain in place through December 31, 2024. But some of the previous rules are being re-established. For example, the providers will have to use HIPPA compliant technology to guard privacy and security.

• Other Rules: Some pre-COVID rules are being reinstated. For example, a 3-day hospital stay is again required for people on Original Medicare for Medicare to cover a medically necessary stay in a skilled nursing facility (rehab). For those on Medicare Advantage plans, the plans are no longer required to provide expanded care out of network. Check with your plan to find out what network restrictions you may have.

Inflation Reduction Act of 2022 – This Act, which was effective last year, contains a number of provisions that effect Medicare, including provisions that reduce out-of-pocket expenses for prescription drugs and vaccines for many of us. Watch for additional benefits over the next couple of years. Here are some highlights.

• Vaccines: Any vaccine recommended by the CDC for adults is now available with no copay. This includes both Part B vaccines, which you receive in a doctor’s office, and Part D vaccines, which you receive in a pharmacy. This is especially good news for those who have not yet received the Shingrix two-dose vaccine for shingles. Medicare Part D plans and Medicare Advantage Plans now have to offer these shots with no deductible, copay or coinsurance.

• Prescription Drug Costs: In 2024, if your prescription costs put you in the Catastrophic Phase of coverage, you will pay no more cost-sharing for prescriptions for the remainder of the year. Beginning in 2025, ALL of us on Medicare will have our annual prescription drug out-of-pocket costs capped at $2,000 per year.

• Insulin: Copays for a 30-day supply of covered insulin are capped at $35. This is true for both Part D insulins that you receive from a pharmacy and Part B insulins that you use with an insulin pump.

• Medicare Drug Price Negotiation Program: The first ten drugs have been selected for this program, and their negotiated prices will be in effect in 2026. If you take any of these drugs, you can expect to see lower prices beginning in 2026. In future years, more drugs will be added to the list, including Part B drugs that are administered in a medical facility. Here is the initial list of drugs: Eliquis; Jardiance; Xarelto; Januvia; Farxiga; Entresto; Enbrel; Imbruvica; Stelara; Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill.

• Rebates for Drug Prices That Increase Faster Than Inflation: These rebates will go to Medicare itself, which will help funding for the Medicare program to last longer.

Additions to Fall Vaccine List – We are all used to getting our annual flu shot in the fall, fully paid for by Medicare because it is a preventive service. There are two additional shots available this fall, also fully paid for. They are the vaccine for RSV (Respiratory Syncytial Virus) and the latest update to the COVID-19 vaccine. All three shots are recommended for us seniors, although you may not want to get them all at the same time.