2023 brought several changes to Original Medicare – most of them positive!
This article will go over the most significant changes that are new in Medicare for 2023, focusing on changes in cost, benefits, and enrollment rules. So you’ll be able to avoid surprises, take advantage of expanded benefits and enrollment privileges for 2023, and get the most out of your Medicare benefits.
And, of course, if you have any questions about your Medicare or Medigap benefits, you can contact a Personal Benefits Manager at Medigap Advisors at any time.
Here’s what you need to know about Medicare changes for 2023.
Medicare Cost Changes in 2023
Congress and the Center for Medicare and Medicaid Services have made several changes in the cost structure for Original Medicare, which consists of Medicare Part A (hospital insurance) and Part B (physicians coverage).
PART A Changes
The Part A Deductible Is Going Up
Medicare Part A covers hospitalization. If you are hospitalized, you are responsible for the Part A deductible, which is the amount you or your insurance must pay before Medicare Part A itself begins to pay benefits.
As of 2023, the Medicare Part A deductible goes up by $44 to $1,600. That’s per benefit period, not per year.
If you have a good Medicare supplement (Medigap) policy, like a Plan F, G, or N, you don’t have to worry about your Medicare Part A deductible. Your Medigap plan covers your Part A deductible and copays in their entirety.
If you just have Original Medicare, then you’ll face a slightly higher deductible per incident. If you’re discharged from the hospital, and then rehospitalized again for the same thing within a 60 days benefit period, you don’t have to pay another deductible.
But if you’re hospitalized for a different reason, or hospitalized for the same reason after 60 days, then you’d have a new deductible of $1,600.
Part A Co-pays Are Going Up, Too
Under Medicare Part A, there are no co-pays for hospital stays for the first 60 days.
As of 2023, for days 61-90, you will have a Medicare Part A copay of $400 per day. That’s a slight increase compared to 2022.
For day 91-150, you will have an $800 copayment each day while using your 60 lifetime reserve days.
After 150 days, unless you have a Medigap policy or some other payer, such as the VA, you’ll pay all hospitalization costs.
Obviously, this can add up fast. But owning a good Medigap insurance policy can protect you against these potentially devastating costs for hospital stays.
Skilled Nursing Care Copays are Going Up, Too
Medicare provides limited coverage of up to 100 days for skilled nursing and rehab care after a qualifying hospitalization of three days or more.
Under Part A, there is no copay for the first 20 days.
As of 2023, the copay for Medicare-approved skilled nursing care is $200 for days 21 through 100.
The Medicare skilled nursing care benefit only covers acute rehab care after a hospitalization. It doesn’t include long-term custodial care for chronic conditions that aren’t expected to improve.
Most Medigap plans cover the entire skilled nursing care copay, but not all of them.
If you aren’t sure what your plan covers, contact a Personal Benefits Manager to go over your situation and make sure you’re in the best plan.
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Part B Changes
Where Medicare Part A covers charges that happen in the hospital, Medicare Part B covers charges that occur outside of hospitalization. These benefits include physician charges, durable medical equipment, lab and diagnostic fees, imagery, and up to 3 pints of blood.
For Medicare Part B, we have some good news: this year, your monthly premium for Medicare Part B falls from $170.10 to $164.94.
Your Part B premium falls from $170.10 to $164,94.
Many readers won’t have to worry about paying the premium: it’s normally deducted from your Social Security check. But if you aren’t taking Social Security benefits, you’ll get a bill every quarter.
Part B premiums are deducted from your Social Security Check. If you aren’t drawing Social Security, you’ll get a quarterly bill.
More good news: as of 2023, your Part B deductible is falling from $233 to $226.
Medigap Plan F covers your Part B deductible. But that plan is no longer available to new enrollees.
Part B also has a co-insurance requirement of 20%, which is unchanged from the prior year.
Unless you have a Medigap policy, you will need to pay 20% of the cost of covered services under Part B, and Medicare will cover the remaining 80%.
A Break for Higher Income Medicare Beneficiaries
Premiums for Medicare Parts B and D (prescription drugs) are based on your income. If you make over a certain amount of income, you will need to pay higher premiums.
As of 2023, the income thresholds that trigger increased premiums under IRMAA rules have increased from $91,000 for single filers to $97,000. For couples filing jointly, the income threshold has increased from $182,000 per year to $194,000.
The more you earn, the higher your potential Part B and Part D premiums.
Changes for Diabetics
Effective 2023, Medicare beneficiaries who use insulin have their insulin prices capped at not more than $35 for each one-month supply. Also, insulin medications are not subject to a Part D deductible.
Also, beginning July 1st, Part B-covered insulin cost sharing is also capped at $35 per month.
Improved coverage for vaccinations/immunizations
Part D-covered vaccines are now available with zero out-of-pocket costs to beneficiaries. This applies to the shingles vaccine, and many others.
2023 brings several welcome changes to Medicare enrollment rules, as well.
Prior to this year, those who waited to enroll in Medicare until the last three months of their seven-month initial enrollment period (IEP) had to wait up to three months before they were eligible for Medicare benefits.
As of 2023, however, that waiting period is mostly eliminated. Coverage is effective on the first day of the month after the month you enroll for months four through seven of your initial enrollment period.
Also, effective 2023, people who missed their open enrollment period and therefore waited until the January 1-March 31 General Enrollment Period to sign up for Medicare get a similar break: instead of having to wait until July 1st for coverage, your Medicare coverage will commence the first day of the month after you enroll.
Effective 2023, the government also established new Special Enrollment Periods (SEPs) for Part B and premium Part A for those who experience an exceptional circumstance. These may make it possible to enroll in Medicare outside of the initial and general enrollment periods penalty-free, if you are subject to extenuating circumstances beyond your control.
Possible qualifying special circumstances include:
- Being impacted by disaster or declared local, state, or federal emergency
- Receiving bad or faulty information from a health plan or employer that caused you to delay Medicare enrollment
- Being released from incarceration
The Social Security Administration can now grant a special enrollment period to other individuals on a case-by-case basis. However, the new SEP will only be granted if your delay in enrolling in Medicare was due to unusual circumstances beyond your control. The Social Security Administration will not grant a special enrollment period because you forgot or were ignorant of the law.
That’s why it’s a good idea to stay in close touch with a Personal Benefits Manager who can help keep you up to date on Medicare enrollment requirements and deadlines.
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New Immunosuppressive Drug Benefit
Social Security is also rolling out a new benefit called the immunosuppressive drug benefit, or “Part B ID” for short.
This benefit brings coverage of certain immunosuppressive drugs for certain end-stage renal disease Medicare beneficiaries under Part B, instead of Part D.
The benefit is available to those whose end-stage renal disease (ESRD) benefits have expired 36 months after their transplant, and who do not have other health insurance that provides coverage for immunosuppressant drugs.
The Part B-ID program isn’t free: It has a monthly premium of $97.10 as of 2013.
Note: The B-ID program is not a substitute for prescription drug coverage. It only includes coverage for immunosuppressant drugs. It’s a great idea to look at a full-fledged Medicare Part D plan, or a Part C Medicare Advantage plan that includes a full range of prescription drug benefits.
As always, we’re here to help get you enrolled in the best plan or combination of plans for your situation, or just clear up any questions you may have.
For more information, contact a Medigap Advisors Personal Benefits Manager.
Explore the, MediGap Advisors Blog to learn more about all things Medicare.
Here are some additional articles on Medicare: The Medicare Playbook 2023 Update is Here: The Only Medicare Handbook You’ll Ever Need | How To Invest Your Medicare MSA Plan Money
Here are some additional pages related to this article: Medicare Supplement Plan G Information | Medicare Part D Rx Information
Christine Corsini is one of your Personal Benefits Managers at MediGap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.