Medicare Coverage FAQs for 2023

Having a quick and easy guide to your Medicare coverage changes for 2023 is a way to get helpful information without reading exhausting articles. Below we have come up with some commonly asked questions. There are references within the FAQs to assist with finding more information if needed.

When is the enrollment period?

The Medicare enrollment period goes from October 1 to December 7, 2022. Your new coverage will begin on January 1, 2023. From January 1 to March 31, you can change your Medicare Advantage plan, and it will go into effect the first of the following month.

What is Medicare Advantage?

Medicare Advantage is a pre-approved plan from a private company that offers coverage. They include Medicare Part A, Part B, and Part D. You may be limited to providers in that company’s network and may need pre-approval for certain procedures or prescriptions. These plans often have lower out-of-pocket costs and may provide additional benefits.

What is Original Medicare?

Original Medicare includes Part A and B. You can choose to also get Part D (prescription) coverage. You can also add supplemental insurance called Medigap. To get Medicare coverage, you must sign up for either Original Medicare or Medicare Advantage.

Is there a price or coverage difference between Original Medicare and Medicare Advantage?

Yes. With Original Medicare, you can go to any doctor or hospital that takes Medicare in the U.S. Medicare Advantage is limited to those within their insurance network. Original Medicare typically has a coinsurance of 20% after you meet your deductible. Out-of-pocket costs for those on Medicare Advantage will differ according to your selected plan.

What is a premium, and how do I know what my premium is in 2023?

A premium is your monthly payment for Medicare. Most people don’t have to pay a premium for Part A. In 2023, premiums will be $164.90 a month but may be higher if you are in a higher income bracket. A late enrollment penalty of 10% is added if you could have signed up for Part B coverage and did not. This is not applicable if you qualify for a special enrollment period. Part D premiums will vary on which plan you have selected.

What does a Medicare Part D program cost in 2023?

The estimated monthly premium for a Medicare Part-D stand-alone plan is $43. This increased from 2022 when the monthly premium was $39. This is approximately a 10% increase.

What is a special enrollment period?

After the initial enrollment period, you may be able to enroll in Part B or Part A under certain circumstances. Examples include moving or losing insurance coverage. To see the full list of special circumstances, view them at Medicare.gov.

What will my vaccination coverage be in 2023?

In 2022, certain vaccines were not covered, even if they were recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). In 2023, Medicare Part D must cover these recommended vaccines without cost-sharing. This will include the covered vaccines (COVID, flu, pneumonia, hepatitis B) as well as tetanus, diphtheria, pertussis, and shingles. COVID vaccines, boosters, or additional doses are covered in 2023.

What is the Inflation Reduction Act?

The Inflation Reduction Act is a law that was signed by President Joe Biden in August of 2022. It allows Medicare to negotiate for lower drug prices and puts caps on certain limits or out-of-pocket spending. We will begin to see the benefits of the Act in 2023, with several changes taking place over the next few years. In 2024 we will see low-income assistance expansion, and each consecutive year more prescriptions will be negotiated for lower costs.

What about insulin coverage?

Thanks to the Inflation Reduction Act, insulin copay costs will be capped at $35 a month. This will take effect on January 1 for insulin covered under Medicare Part D and July 1 for recipients who have insulin coverage as part of durable medical equipment under Medicare Part B.

What is my medical equipment coverage under Medicare?

Medicare will pay for any medically necessary durable medical equipment. This includes items like wheelchairs, oxygen, walkers, or hospital beds. They must be ordered from a Medicare-enrolled doctor and may need to be rented. When obtaining equipment from a supplier, make sure they are participating and accept assignments- meaning they can only charge the coinsurance and deductible.

Is telehealth offered?

Telehealth is available for those on Medicare using audio and video communication. This will last during the COVID-19 public health emergency and five months after. Afterward, you must be at a doctor’s office or medical facility in a rural area to continue telehealth services.

What isn’t covered by Medicare Part A and Part B?

Original Medicare does not include dentures, eye exams for prescription glasses, long-term care, cosmetic surgery, massage therapy, or hearing aids. You may not have to pay for these if you have other coverage, such as Medicaid or a Medicare Advantage plan that offers additional benefits.

To stay up to date on Medicare information, check the Medicare website and news links. They also have chats and plan comparisons. Medicare can seem intimidating, but with the use of valuable resources, you can establish which plan or benefits are most useful to you and your family going into the new year.