How Is Medicare Changing In 2023?

Medicare is constantly making changes, and 2023 is no exception.  

From the Medicare Part B premium going down to the Shingles vaccine being free, here are several Medicare changes to expect for 2023.

1. Medicare Part B Premium Decreases By $5.20

The Medicare Part B premium is actually going down by $5.20 in 2023! Your new standard monthly Medicare Part B premium will be $164.90 in 2023. If you have a high income, you may pay more.

Why did the Part B premium go down? The answer is closely related to the new Alzheimer's drug, Aduhelm.

In 2022, the Part B premium had a very steep increase due to the uncertainty of Aduhelm costs, a new Alzheimer's drug. CMS wasn't sure how this very expensive, innovative treatment would impact the Medicare program, and they didn't even know yet if Medicare would decide to cover it. As a result, they were forced to increase the Part B premium to account for that uncertainty.

However, Medicare reached a coverage decision on April 7, 2022. Medicare decided to cover this very expensive drug, but only if you're enrolled in an approved clinical trial. As a result, the Medicare program didn't end up spending nearly as much as expected, and that savings is being passed onto you in the form of a Part B premium reduction.

2. New Part B IRMAA Chart

If you have a high income, you'll pay more for Medicare Part B. The standard Part B monthly premium in 2023 is $164.90.

But if your income (joint tax return in 2021) was higher than $194,000, you could pay anywhere from $230.80-$560.50 per month for Medicare Part B. This is called an Income-Related Monthly Adjustment Amount (IRMAA).

Here is the updated Part B IRMAA chart for 2023:

3. Medicare Part B Deductible Decreases By $7

Another piece of great news? The Medicare Part B deductible is also going down. Your Part B deductible will be $226 in 2023, a $7 reduction.

For those with a Medicare Supplement Plan G, this is your new deductible before your supplement picks up the rest of your Medicare-approved expenses.

Those with a Medicare Advantage plan are not impacted by the Part B deductible. Your plan has its own deductible.

4. Medicare Part A Costs Increase For 2023

Less than 1% of people pay a premium for Medicare Part A, but for those that do, premiums have increased slightly.

You'll pay between $278-$506 per month in 2023 for Part A's hospital coverage, but again, this impacts very few Medicare beneficiaries.

5. Aduhelm Updates

For 2023, Medicare Part B will cover Aduhelm, but only for those who are in an approved clinical trial.

In general, the financial impacts of Aduhelm's hefty price tag are not as extreme as many were speculating. For now, you shouldn't notice any major changes in your premiums due to Aduhelm.

We will keep you updated – be sure to like us on Facebook to get updates!

6. Enrollment Period Updates

Medicare has made a few changes to some enrollment periods.

Starting in 2023, if you sign up for Medicare during the month of your 65th birthday or the three months following as part of your Initial Enrollment Period, your coverage will begin on the first day of the next calendar month.

This also applies for those who need to enroll in Medicare during the General Enrollment Period. In the past, those who missed their initial Medicare enrollment period could sign up for Medicare from January-March, but they had to wait until July for their coverage to take effect. Now, coverage will go into effect on the first day of the next calendar month.

7. Free Vaccines, Including Shingles

The Inflation Reduction Act (IRA) included several changes to Medicare Part D. One of those changes includes the Shingles vaccine (and many others) being free! In the past, you had to pay for the Shingles vaccine, and it was a bit pricey. Now, that cost will be picked up by Medicare.

All vaccines recommended for adults by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) will be free for Medicare users starting on January 1, 2023.

8. Lung Cancer Screenings

Medicare is adding lung cancer screenings to its Part B coverage, starting in 2023!

You may qualify for a yearly screening if you meet the following criteria:

• You’re 50–77 years old
• You don’t show signs or symptoms of lung cancer  
• You currently smoke or have quit in the last 15 years
• You have a tobacco smoking history of at least 20 “pack years” (meaning you’ve had, on average, 20 cigarettes/one pack a day for at least 20 years)
• You get an order from your doctor

9. Insulin price cap of $35 per month

Beginning in 2023 and extending through 2025, the copayment for a 30-day supply of Medicare Part D-covered insulin will be capped at $35.

This copay amount will be the same even if you have not met your Part D deductible. Insulin cost interventions will alter slightly starting in 2026. Insulin costs will either be $35 or 25% of the medication’s negotiated cost, whichever is lower.

10. New Accountable Care Organizations (ACOs)

An ACO is a group of doctors, hospitals, and/or other health care providers that work together to improve the quality and experience of care you get.

If your primary care provider participates in an ACO, you may have access to additional tools or services that other people in Original Medicare don’t get. For example, in some ACOs, your provider can offer expanded telehealth services.

‍This means you’d be able to get certain healthcare services no matter where you’re located, and from your home (instead of going to a health care facility) using technology, like your phone or a computer, to communicate in real time with your health care provider.

In addition, a doctor or other provider who is part of an ACO may be approved to send their patients for skilled nursing facility or rehabilitation care even if they haven’t stayed in a hospital for 3 days first, which is usually a requirement in Medicare.

For you to qualify for this benefit, your doctor or other provider has to decide that you need skilled nursing facility care and meet certain other eligibility requirements.

Ask your provider if they offer these services!

11. 2023 Medicare & You Handbook

Every year, CMS releases a new Medicare handbook. You can get the digital copy here: 2023 Medicare & You Handbook.

This handbook outlines many of the changes discussed in this article.

Conclusion

Medicare is always making changes, and it’s important to understand how your out-of-pocket costs may increase. The good news is Medicare continues to expand coverage, and 2023 is no exception.

If you need Medicare help, call our office at 217-423-8000 to schedule an appointment with a licensed insurance agent.