Each year, Congress, the Social Security Administration (SSA), the Centers for Medicare & Medicaid Services (CMS), and others make changes to the Medicare program. Sometimes, the changes are small, mostly updates to reflect the ever-changing health care landscape. Other years, there are seismic changes to the program that change both the way you can receive coverage or how much you’ll pay.
Let’s look back at the changes that occurred in 2022 and see how Medicare has evolved for 2023 and beyond. We can say for certain it was one of the more influential years of late!
In April 2022, CMS proposed implementing parts of the Consolidated Appropriations Act, 2021 that change Medicare enrollment rules. Effective in 2023, these changes allow Medicare coverage to start sooner for certain first time beneficiaries and new circumstances to create Special Enrollment Periods (SEPs). Specifically, if you’re in your Initial Enrollment Period (IEP) or General Enrollment Period (GEP) and have already turned 65, coverage generally now begins the month after you enroll. Previously, coverage could start up to three months (for IEP enrollment) or six months (for GEP enrollment) after you enrolled. These new rules also increased access to specific immunosuppressive drugs for kidney transplant patients.
The Inflation Reduction Act of 2022 (IRA), signed into law in August 2022, brought with it some large Medicare changes that aim to make beneficiaries’ prescription drugs more affordable. Starting this year (2023), it requires vaccines to be fully covered and insulin to be capped at $35 per month for beneficiaries. In future years, it implements a new Part D $2,000 out-of-pocket drug cost cap, sets a Part D premium raise cap for insurers, and allows Medicare to negotiate the prices for several prescription drugs.
CMS’ CY2023 Final Rule required that all third-party marketing organizations, including insurance agents, record specific consumer calls in their entirety. This rule was effective starting with the 2023 Annual Enrollment Period, which ran from October 15, 2022, to December 7, 2022. These measures were deemed necessary after a staggering 165 percent increase in complaints to CMS about Medicare sales ads. By requiring calls to be recorded, CMS can monitor for or prove if any marketing or sales rules have been broken.
A smaller, but no less important change included the Food and Drug Administration’s (FDA) finalization of a new ruling on hearing aids, allowing them to be bought over the counter (OTC). Hearing aids no longer require prescriptions, medical exams, or fitting adjustments. Together, these measures are anticipated to benefit around 30 million Americans who previously haven’t had access to hearing aids.
With this year’s Medicare cost adjustment, we have a drop in Part B premiums and deductibles and a modest rise in other costs. See a full list of 2023 Medicare costs below.
2023 Part A Cost Breakdown
|Type of Cost||2022||2023||%|
|Full Part A Premium||$499||$506||1.4%|
|Partial Part A Premium||$274||$278||1.46%|
|Inpatient Hospital Deductible||$1,556||$1,600||2.83%|
|Daily Coinsurance for Days 61 to 90||$389||$400||2.83%|
|Daily Coinsurance for Lifetime Reserve Days||$778||$800||2.83%|
|Skilled Nursing Facility Coinsurance||$194.50||$200||2.83%|
2023 Part B Cost Breakdown
|Type of Cost||2022||2023||%|
|Standard Part B Premium||$170.10||$164.90||-3.06%|
|Part B Deductible||$233||$226||-3%|
|Immunosuppressive Drug Premium||N/A||$97.10||N/A|
2023 Part B IRMAA Breakdown
|File Individual Tax Return||File Joint Tax Return||Monthly Adjustment||2023 Part B Monthly Premium|
|$97,000 or Less||$194,000 or Less||$0.00||$164.90|
|$97,001 to $123,000||$194,001 to $246,000||$65.90||$230.80|
|$123,001 to $153,000||$246,001 to $306,000||$164.80||$329.70|
|$153,001 to $183,000||$306,001 to $366,000||$263.70||$428.60|
|$183,001 to $499,999||$366,001 to $749,999||$362.60||$527.50|
|$500,000 or More||$750,000 or More||$395.60||$560.50|
|File Separate Tax Return from Spouse||Monthly Adjustment||2023 Part B Monthly Premium|
|$97,000 or Less||$0.00||$164.90|
|$97,001 to $402,999||$362.60||$527.50|
|$403,000 or More||$395.60||$560.50|
|File Separate Tax Return from Spouse||Monthly Adjustment||2023 Immunosuppressive Drug Premium|
|$97,000 or Less||$0.00||$97.10|
|$97,001 to $402,999||$356.00||$453.10|
|$403,000 or More||$388.40||$485.50|
2023 Part D IRMAA Breakdown
|File Individual Tax Return||File Joint Tax Return||Monthly Adjustment|
|$97,000 or Less||$194,000 or Less||$0.00|
|$97,001 to $123,000||$194,001 to $246,000||$12.20|
|$123,001 to $153,000||$246,001 to $306,000||$31.50|
|$153,001 to $183,000||$306,001 to $366,000||$50.70|
|$183,001 to $499,999||$366,001 to $749,999||$70.00|
|$500,000 or More||$750,000 or More||$76.40|
There are four proposed rules worth keeping an eye on for the more distant future. These aren’t approved officially but would bring several changes that could influence your coverage.
One of them could improve the prior authorization process by requiring some payers to incorporate electronic systems and speeding up the approval windows, giving beneficiaries a timelier response. The rule also would require a degree of transparency by making some payers include reasons why a prior authorization request wasn’t approved. Another proposed ruling also seeks to streamline the prior approval process, but would expand access to behavioral health coverage. It aims to allow a degree of formulary flexibility to lower Part D costs and protect consumers by strengthening marketing requirements to protect against misleading or pressuring strategies.
Additionally, there’s CMS’ CY2024 Medicare Advantage and Part D Proposed Rule that could bring about Medicare marketing changes for insurers and agents that could affect how they interact with you. And finally, there’s a proposed rule that’s looking to overhaul the enrollment process for Medicaid, making it easier to become eligible and enroll. This could make it easier for Medicare beneficiaries to qualify for a plan like a Medicare Savings Program (MSP) or Dual Eligible Special Needs Plan (D-SNP).
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Each year brings new changes to one of the most popular federal programs, often expanding the coverage and making it easier to understand or enroll. With so many major changes occurring recently, we’re excited to see what 2023 has in store for Medicare!