In May of 2022, the Centers for Medicare and Medicaid Services (CMS) released its final rule regarding both Medicare Advantage and Part D prescription drug programs. This guide will explore the 8 most important things to know about the 2023 Medicare Part D and Medicare Advantage rule change.

2023 Medicare Part D Rule Change

2023 Medicare Part D Rule Change – Key Takeaways

  1. The rule will provide Medicare Advantage beneficiaries with better access to essential healthcare services during emergencies and disasters (like the COVID-19 pandemic).
  2. The rule will also reduce out-of-pocket costs for prescription drugs beginning in 2023, by forcing Part D plans to pass on some of their negotiated savings.
  3. CMS expects that the rule change will not significantly change MA benefits or premiums. However, Medicare Part B premiums will increase in 2023 as usual.

Here are the 5 most important things to know about the new rule:

1.) Plan D Beneficiaries Should See Lower Costs at the Prescription Counter

Beginning January 1st, 2023, CMS will require Part D plans to apply the same price concessions they get from negotiating with network pharmacies to the point-of-sale consumer. This should bring out-of-pocket costs down for all Part D beneficiaries, while also improving prescription price transparency.

2.) Oversight of Third-Party Marketing Organizations will be Strengthened

The new rule will strengthen protections against confusing or misleading activities by third-party marketers. This will help protect Medicare Advantage and Part D consumers from being duped into a bad or overly expensive plan. CMS will also enforce the inclusion of a multi-language insert in all documents that informs beneficiaries about interpreter services.

3.) Improves Medicare Advantage Coverage Obligations During Disasters and Emergencies

Medicare Advantage plans will now have to comply with special requirements when there is an emergency or disaster declaration. These requirements could include waiving referral requirements, and offering coverage for non-contracted providers.

4.) New, Heightened Requirements for Part D and MA Companies

CMS will add past performance, network adequacy, and medical loss ratio reporting requirements for all Part D and Medicare Advantage companies. These requirements are designed to stop under-equipped or poorly-performing companies from expanding into new contracts and service areas.

In addition to these requirements, CMS will be adding new or improved rating systems to both MA and Part D companies.

5.) Added ‘Enrollee Input’ and ‘Social Determinant’ Requirements for SNP and D-SNP Plans

Dual Special Needs Plans (D-SNPs) will be required to establish at least one enrollee advisory committee for each state that they’re in. New social determinants, like food security, housing stability, and access to transportation will now be factored into Health Risk Assessments (HRAs).

More 2023 Medicare Part D Questions Answered

Q: What will Medicare cost in 2023?

A: Medicare costs are announced towards the end of the calendar year. 2023 Medicare costs have not been officially announced yet. In 2022, Medicare Part B standard premium increased by $21.60. The annual deductible increased by $30.

Q: Will Medicare Part B go up in 2023?

A: The 2023 Medicare Part B premium is predicted to increase by between $18 and $23. The Part B annual deductible is predicted to increase by about $30. These numbers are estimates based on previous years’ increases; The official 2023 Medicare prices have not been released yet.

Q: Where Can I Read the Final CMS 2023 Medicare Part D Rule?

A: Click here to visit CMS.gov to read the full CMS rule change fact sheet.

Q: Will Prescription Drugs be More Expensive in 2023?

A: The CMS Part D rule change takes effect on January 1st, 2023.   

If You’re Worried About 2023 Medicare Part D Costs, We Can Help

Medicare costs go up every year; That’s just the reality. But it doesn’t change the fact that you are the person who is in charge of your healthcare, and no one else. If you feel like you’re paying too much, or maybe your needs have simply changed, you can take action to get lower rates, better coverage, and sometimes both.

Before you make any changes to your plan, schedule a free consult with a Personal Benefits Manager like myself. Our job is to make things easier, faster, and more affordable, and we’ll be at your side for as long as you have your plan.

And stay tuned to the MediGap Advisors blog. We’ll be posting 2023 Medicare prices right when they are announced.