Medicare Prescription Drug Plans for 2023 and Part D Drug Coverage

Big changes in Medicare prescription drug plans for 2023 include monthly premium costs, coverage plan options, covered drugs, and additional benefits like vaccines. Insulin costs are seeing a cap on payments, and we expect to see more options with coverage or Advantage plans.

Key takeaways:
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    Substantial changes are expected for Medicare prescription drug plans in 2023.
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    Major changes include monthly premium costs, coverage plan options, prescription coverage, and vaccine benefits.
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    Comparing plans allows you the opportunity to understand the benefits for you and your family.

Enrollment is open until December 7th of 2022, and Medicare Advantage plans will likely see more participants enrolling this upcoming year.

Medicare drug coverage is an optional benefit to those on Medicare to assist with prescription costs. To obtain this coverage, you need to join a Medicare-approved plan. These will vary in cost and may cover different drugs, which would be available on a formulary. A formulary will list the coverage details for each drug category (like antidepressants, anticonvulsants, etc.) and what prescriptions are covered under your plan.

Medicare Part D

Part D is a voluntary drug benefit that is obtained through private plans that have a contract with the government. Recipients can choose a stand-alone coverage plan or a Medicare Advantage plan that will include prescription drugs, according to their formulary. If you opt out of coverage, you may pay a late enrollment penalty. There are also Fee-for-Service plans offered and savings accounts.

For insight into how commonly this is used, 49 million of the 65 million Medicare enrollees also participate in a Part D plan. Those with Part D will pay a monthly premium, which will change in 2023. Premiums are adjusted based on income. Some recipients will pay premiums to the plan directly, while others may have it taken out of their Social Security checks. In 2023, the average rate for a Medicare Part D plan will go from $32.08 in 2022 to $31.50 per month.

Cost sharing

In 2023, recipients can continue to face higher cost-sharing prices for brands and non-preferred drugs instead of generics. Cost sharing is the amount you pay out of pocket that is also shared with your coverage. This can include deductibles, coinsurance, or copayments. It does not include premiums or the cost of non-covered services. Medium cost sharing in 2023 will be $1 or $5 on generics, $44 for preferred brands, and 25% coinsurance for specialty drugs. Preferred brands are seeing an increase from 2022 of two dollars.

Insulin cap

Those with Medicare Part D and Advantage plans will also have a cap on specific insulin products at $35 for one month’s supply. This may not necessarily change your plan since some were offered before. Part D deductibles won’t apply to insulin products. The cap for insulin will begin on January 1st, 2023. It may also cover specific insulin products, such as those listed on the plan’s formulary. If you take insulin, look at the formulary to see if this cap applies.

Vaccinations

Not all vaccinations will be covered for free in 2022. In 2023, we will see this change due to the Inflation Reduction Act. Beginning in 2023, vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) must be covered. This includes Tdap (tetanus, diphtheria, pertussis) and shingles. Current vaccinations will remain covered, including COVID, flu, pneumonia, and hepatitis B.

Donut hole discount

There will be a 75% donut hole discount on brand-name drugs purchased while in the donut hole. The donut hole is expected to be eliminated in 2025. Until then, there are adjustments made to plans to assist with costs. The donut hole refers to the coverage gap after you exceed your coverage limit. In 2023, the coverage limit will be $4,660. After you spend your out-of-pocket limit, you will enter Catastrophic Coverage. The Out-of-pocket limit in 2023 will be $7,400. The donut hole does not apply to those eligible for the Extra Help or Low-Income Subsidy programs.

Open enrollment

Open enrollment for Medicare began in October of 2022 and will continue until December 7th, 2022. This is the best time to compare plans and see what is best for you and your family. You can compare Medicare, Medicare Advantage, and Part D drug plans. Drug plans and coverage can change annually, so it’s best to be prepared and see what may change for you in the coming year.

Increase in plans

In 2023 we will see an increase in stand-alone drug plans offered to those on Medicare. There will be a 5% increase from 2022 for a total of 801 different plans. To see which ones are offered in your area, look on the Medicare.gov website and enter your zip code for 2023. You can also select the plan type you are looking for, such as Medicare Advantage, Part D, or Medigap only.

Knowing your options for prescription drug coverage can save you money and the hassle of guesswork. Using the Medicare website, you can compare plans in your area to see what works best for you and your family. Staying up-to-date on annual changes can assist in knowing what benefits have changed and what services or prescriptions will now be covered. If you’d like to learn more, check the Medicare website, where you can utilize a chat or contact a representative.

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