Upcoming Medicare Changes in 2023

If you are providing care for an elderly loved one or client, it's important to stay up to date with all of the changes occurring in 2023. There are quite a few. Meena Seshamani, a surgeon and health economist who is also the director of the federal Center for Medicare has said that the organization is making every effort to prioritize their patients' needs by increasing affordability and making the care they provide as accessible as possible.

Lower Premiums and Deductibles

It is likely excellent news that American residents will no longer have to pay high premiums and deductibles. Thanks to landmark legislation, even the cost of prescription drugs will drop significantly.

Telehealth

Over the pandemic, a lot of people suffered from some level of anxiety or depression, often both. As a result, many turned to counsel but, due to COVID-19 restrictions, these services were frequently offered through telehealth. In 2023, the coronavirus is expected to be officially over sooner than later—finally. Still, it might continue for quite some time. No one is certain yet.

That said, the future of telehealth still hangs in the balance. Some services could continue while others may be phased out. Congress may act to extend telehealth options for patients, but we do not yet know what their decision will be. That said, it is now certain that patients will be able to speak with behavioral health specialists over the telephone and through video if they wish to: Face-to-face interaction of some kind used to be required, but that is no longer the case.

An Increased Focus on Behavioral Health

The pandemic has increased awareness surrounding mental health issues, and Medicare is making some major changes in 2023. The organization will be paying for licensed clinical social workers, psychologists, and other behavioral health specialists who will now be a part of a beneficiary's primary care visit. The program will also improve access to family and marriage therapists for anyone who needs help in that area and will expand its services for individuals who suffer from substance abuse. For example, Medicare will purchase mobile vans so they can provide opioid treatment to people who don't want to travel to see their healthcare providers or are unable to make the journey.

Some Access to Dental Care

While Medicare doesn't cover routine dental care, it will pay for some dental work in specific situations as of 2023. However, this solely applies to procedures that are necessary in conjunction with another medical issue, such as the pulling of a tooth during jaw surgery and cleaning or other dental work that will improve the outcome of cancer treatment or an organ transplant.

Social Security Cost-of-Living Adjustments

This is likely welcome news: Your elderly loved one will essentially receive more money in their pocket every month thanks to a recent adjustment. For most Medicare beneficiaries, Part B premiums are directly deducted from their Social Security payments. Thanks to the COLA—Cost of Living Adjustment—these benefits will increase by 8.7% in 2023. As a result, American residents who are enrolled in both programs will have more money coming their way every 30 days.

Lower Premiums

It's no surprise that nearly everything is exorbitantly expensive these days, so it is probably excellent news that your senior loved one's monthly charges will decline by 7% in 2023. However, this only applies to Medicare beneficiaries with incomes over $97,000. Individuals who are comfortable financially will pay more than the standard premium, but the exact amount will vary. For instance, if someone earns up to $123,000 per year they will pay $230.80 per month. This is the minimum amount and will only increase if one's annual income is higher.

Decreased Part B Deductibles

In 2023, the annual Part B deductible will be $226. This is a $7 decrease from 2022. While annual deductibles will vary depending on your plan, the government has set a limit of $505 for 2023.

Increased Part A Deductibles

Part A covers inpatient hospital care, hospice, and some other healthcare services. In 2023, patients will be charged $1600 for every hospital stay, which is a $44 increase from 2022. The monthly premium will also rise to $506 for people who have not worked long enough to qualify for premium-free Part A. 

Insulin Copays Have Been Capped

Thanks to the Inflation Reduction Act of 2022, copays for a 30-day supply of any insulin that a Medicare drug plan covers will be capped at $35 in 2023. Even if enrollees have not yet met their annual Part D deductible, they will not be required to pay more than this amount. That said, it's important to read the fine print and note that not every plan covers every type of insulin.

Starting on July 1, 2023, Medicare enrollees who take their medication through a pump will no longer have to pay a deductible. The $35 cap also applies to them. This is part of the Part B medical equipment benefit. 

Another provision in the IRA calls for certain high-priced pharmaceuticals to be subject to negotiation with drugmakers. However, this option will only take effect in 2026. Starting in 2026, covered insulin copays that have been part of the new negotiations will either be $35 or 25% of the negotiated price—whichever is less.

Free Vaccines

Under the new law, vaccines recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices—also referred to as ACIP— will now be available to Medicare members free of charge. Again, it's important to read the fine print: While some vaccines are already free under Part B, others are covered under the Part D prescription drug plan and require beneficiaries to cover part of the cost. The benefits you receive are also highly dependent on the plan you opt for.

Drugmakers Will Face Penalties for High Price Increases

If drugmakers raise rates for pharmaceuticals higher than current inflation, they will pay the price in 2023: A provision in the IRA states that pharmaceutical manufacturers are required to pay a rebate to Medicare should they increase the prices of their drugs higher than the general rate of inflation. The rebates they owe will be the amount of the pharmaceutical's price above inflation multiplied by the amount Medicare paid for every sale of the drug.

Pharmaceutical Price Negotiations Will Begin in September of 2023

For the first time in history, Medicare will announce the 10 Part D pharmaceuticals subject to negotiation with drugmakers. This process will begin in September 2023.

Improved Enrollment Access

Beginning in 2023, no one will have to wait for their coverage to take effect as long as they have signed up during the official enrollment periods. Thanks to a new federal regulation, additional enrollment windows have also been established. This includes people who didn't sign up when they were first eligible through no fault of their own.

This year, you will sign up and only have to wait until the beginning of the next month for your coverage to take effect. The new special enrollment options will be available for individuals affected by natural disasters, people who did not sign up because they were given incorrect information about the correct timeline from their employers, and enrollees who no longer qualify for Medicaid and must switch to Medicare as a result.

Senior Helpers Boston

Our team at Senior Helpers Boston provides transitional care, live-in care, and recovery care. You can find us in Boston, Watertown, and Cambridge. Please contact us for more information. We are eager to assist you and your loved ones in every way we can!