Advertising Supplement
Open Enrollment 2022
Ready to enroll? Here’s what you need to know about 2023 Medicare changes
Medicare beneficiaries will get some financial relief in 2023 as Plan B premiums and deductibles drop. Here are the primary Medicare changes for the coming year: • Part A premiums, deductibles, and coinsurance will increase. • Part B monthly premiums will decrease to $164.90. • Part B deductibles also will decrease to $226. • Part D (prescription benefit) donut hole is gone, but the maximum deductible for a standard plan will increase to $505 in 2023. The threshold for catastrophic coverage (where out-of-pocket spending decreases significantly) also increases to $7,400. Covered vaccines are free; insulin costs no more than $35 per month. • Income brackets for high-income premium adjustments for Medicare Part B and D start at $97,000 (up from $91,000 in 2022). • Medicare Advantage enrollment average premiums also are decreasing. • The maximum allowable out-ofpocket cap for Medicare Advantage plans increases to $8,300 (but most plans have lower out-of-pocket caps). • Kidney transplant recipients can keep limited Part B coverage for life to cover immunosuppressive drugs (complete Part B ends 36 months post-transplant). Medicare Part A Medicare Part A covers hospitalization costs, and although most people don’t have to pay a Part A premium, some out-of-pocket costs are associated with this coverage. Roughly 1 percent of enrollees pay a premium, while the rest receive free coverage based on work history. The Medicare Part A deductible will
increase to $1,600 in 2023 and applies to each benefit period, rather than a calendar year deductible like Part B or private insurance plans. The deductible applies to all Part A enrollees, although supplemental coverage pays all or part of the Part A deductible for many people. The Part A deductible covers the first 60 inpatient days during a benefit period. If the person needs additional inpatient coverage during that same benefit period, there’s a daily coinsurance charge. In 2023, it will be $400 per day for the 61st through 90th day of inpatient care. The coinsurance for lifetime reserve days is $800 per day. Medicare covers the first 20 days of care received in a skilled nursing facility. After that, coinsurance applies to days 21 through 100. In 2023, the coinsurance will be $200 per day. Medicare Part B In addition to the Part B monthly premium decrease to $164.90, deductibles also will decrease for the first time since 2012. The Part B deductible for 2023 is $226, down from $233. Medicare Part D The average Part D premium will be $31.50 per month in 2023, down from $32.08 in 2022. For stand-alone Part D prescription drug coverage, the maximum allowable deductible for standard Part D plans will increase to $505 in 2023. The out-of-pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023, up from $7,050 in 2022. This is a combination of drug manufacturer discounts and your costs; out-of-pocket costs for the enrollee will be around $3,100 at the catastrophic coverage level.
The copay amounts for people who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brandname drugs. Beneficiaries with highercost medications will continue to pay 5% of the cost during the catastrophic coverage phase. Recommended vaccines covered under Part D no longer require a costsharing payment. All Part D plans also must provide all covered insulin products with copays of no more than $35 per month. The Affordable Care Act eliminated the so-called Medicare Part D donut hole, means enrollees no longer have pay 100% of the costs for brand-name or generic drugs once they reach a certain threshold. Before 2010, enrollees were responsible for their deductible, then 25% of the costs until they reached the donut hole. Now enrollees only pay 25% of costs (after meeting their deductible) until they reach the catastrophic coverage threshold. High-income adjustments If you have a high income, you’ll pay more for Medicare Part B and Part D in 2023. Medicare introduced high-income brackets in 2007 for Part B and 2011 for Part D, and they originally started at an income of $85,000 ($170,000 for a married couple). The income brackets for the surcharge were adjusted for inflation starting in 2020. For 2023, the threshold increases to $97,000 for a single person and $194,000 for a married couple. This increase is due to high inflation in 2022. (The 2023 surcharge is based on 2021 tax returns, and you can appeal if your income has changed since then). The Part B premium for 2023 ranges
from $230.80 to $560.50 per month. That decreased from 2022 when premiums ranged from $238.10 to $578.30 per month. Medicare Advantage The average Medicare Advantage (Medicare Part C) premium will be about $18 per month in 2023, down from $19.52 monthly in 2022. Medicare Advantage plans protect against high out-of-pocket costs for Part A and Part B services. Unlike Original Medicare, which does not have a cap on out-of-pocket costs, Medicare Advantage plans must cap out-of-pocket expenses. For 2023, the cap is increasing to $8,300. But most Advantage plans will continue to have out-of-pocket caps below the government’s maximum. The cap does not include prescription drugs covered under Medicare Part D (even if integrated with a Medicare Advantage plan). Kidney transplants Historically, Medicare coverage for kidney transplant recipients has only lasted 36 months after the transplant. But that’s changing in 2023, and kidney transplant recipients will be able to continue to have limited Medicare Part B coverage for immunosuppressive drugs. As of 2023, the monthly cost for Part B, which covers immunosuppressive drugs, will be $97.10. The cost will be higher for those with income above $97,000 for a single individual or $194,000 for a couple. Those who turn 65 or become eligible for Medicare based on disability can transition back to full Medicare coverage.
Medicare prescription drug plans drop for 2023
The Medicare Part D program helps people with Medicare pay for brandname and generic prescription drugs. According to the Centers for Medicare & Medicaid Services, Part D remains one of Medicare’s most popular programs, with more than 49 million Medicare beneficiaries enrolled for prescription drug coverage. The average Part D premium will be $31.50 per month in 2023, a decrease from $32.08 in 2022. For stand-alone Part D prescription
drug coverage, the maximum allowable deductible for standard Part D plans will increase to $505 in 2023. When researching Medicare Part D plans, it’s important to compare prices and coverage options to find the best fit for your needs. Several programs can help reduce or cover the costs of healthcare for seniors. The PACE program provides all-inclusive care for elderly patients. Medicare’s Extra Help program can also assist with expenses.
The out-of-pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023, up from $7,050 in 2022. This is a combination of drug manufacturer discounts and your costs; out-of-pocket costs for the enrollee will be around $3,100 at the catastrophic coverage level. Catastrophic coverage phase copayments for those who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brand-name
drugs. Beneficiaries with higher-cost medications will continue to pay 5% of the cost during the catastrophic coverage phase. CMS carefully analyzes changes to the Part D program and engages with stakeholders to identify improvement opportunities, particularly for reducing costs. The American Society of HealthSystem Pharmacists expects total drug spending in the U.S.to increase by 4% to 6% in 2022.