Changes are in store for Medicare enrollees in 2023, some of which apply to Medicare Advantage and Medicare Part D, the plans that beneficiaries can update during the annual open enrollment period which begins Oct. 15.
Through Dec. 7, eligible individuals also can switch from Original Medicare to Medicare Advantage; from Medicare Advantage to Original Medicare; from one Medicare Part D prescription drug plan to another; and enroll in a Medicare Part D plan if they did not enroll when they first were eligible for Medicare.
Overall, the changes will be welcome news for the estimated 31.8 million Americans the Centers for Medicare & Medicaid Services expect to enroll in the federal health insurance program for those 65 and older.
CMS released the 2023 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in late September. There are many options and many rules, which makes Medicare a challenge to navigate.
The Tampa Bay Times’ Medicare Guide breaks down the various parts of Medicare and offers charts for plan comparison to help beneficiaries, who have a wide array of choices this year. Here are some points to consider at the outset.
Last year, premiums for Medicare Part B, which covers both medically necessary services and preventive services, rose close to 15%, the largest increase in history. In 2023, for the first time in more than a decade, Part B premiums are slated to drop, decreasing from $170.10 to $164.90 per month. Additionally, the annual deductible for all Medicare Part B beneficiaries will drop from $233 to $226.
While Medicare Part A, which provides coverage for hospital inpatient care, skilled nursing facilities, hospice, and home health care, is free for most people, the premium does increase each year. In 2023, the Medicare Part A deductible will be $1,600 for each benefit period, a $44 increase over last year.
Meanwhile, the number of plan choices continues to increase both nationally and locally. The 4.9 million Floridians enrolled in Medicare will be able to choose from 627 Medicare Advantage plans compared to 583 plans in 2022.
Every Floridian eligible for Medicare will have access to a Medicare Advantage plan with a $0 monthly premium even as the average monthly plan premium increases from $8.86 to $9.41.
Through the CMS Innovation Center’s Value-Based Insurance Design Model, 201 plans will offer Medicare Advantage enrollees throughout the state additional options – up from 163 in 2022 – including reductions in cost sharing for certain covered benefits, such as eliminated Medicare Part D cost sharing; rewards and incentives programs related to healthy behavior; and customized benefits that address social determinants of health, such as food insecurity and social isolation, for enrollees who receive low-income subsidies and/or chronically ill enrollees.
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Additionally, Floridians with Medicare can select from among 23 standalone Medicare prescription drug plans with a lower premium than what they paid in 2022. Monthly premiums for standalone prescription drug plans in 2023 will range from $8.40 to $170.10.
The deductible for Part D coverage will be $505 for the year. The initial coverage limit will increase to $4,660, and the out-of-pocket threshold will increase to $7,400.
Unlike Original Medicare, which does not have a cap on out-of-pocket costs, Medicare Advantage plans are required to cap enrollees’ out-of-pocket costs for Part A and Part B services. The cap does not include the cost of prescription drugs, since those are covered under Medicare Part D, even when it’s integrated with a Medicare Advantage plan.
For several years, the cap was $6,700, although most plans have had out-of-pocket caps below that level. For 2021 and 2022, the maximum out-of-pocket limit for Medicare Advantage plans increased to $7,550 (plus out-of-pocket costs for prescription drugs). For 2023, the cap is increasing to $8,300, but most plans will continue to have out-of-pocket caps below the government’s maximum.
The Inflation Reduction Act will start to benefit Medicare Part D enrollees in 2023. Recommended vaccines covered under Part D no longer will have cost sharing; they’ll be free. Additionally, all Part D plans will provide all of their covered insulin products with copays of no more than $35 per month, essentially extending the existing optional Senior Savings Model to all Part D plans, including Medicare Advantage plans with integrated Part D coverage.
All the providers who offered Medicare Advantage and standalone Medicare prescription drug plans in Hernando, Hillsborough, Pasco and Pinellas counties are returning with similar or enhanced plans for 2023.
Cigna, which earlier this year announced a 22% growth in its geographic footprint, is expanding into 106 new counties nationwide, including several in Florida. The company will offer a $0 premium plan in each county, and most customers will pay the same or lower premiums compared to last year. Benefits include caregiver, companion and social support programs and broader financial wellness incentives.
“By leveraging the full capabilities of our enterprise, Cigna is able to offer Medicare Advantage customers a range of affordable, personalized plans,” said Aparna Abburi, president of Medicare and CareAllies for the company. “We take a thoughtful and targeted approach to our Medicare Advantage footprint, adding new markets where we have strong provider partnerships that will ensure our customers get quality care.”
After pledging earlier this year to identify $1 billion in cost savings to invest in its Medicare Advantage program, Humana has expanded this year into 260 new counties with the goal of serving an additional 4.6 million Medicare-eligible individuals across the country.
Touting its focus on combining the benefits of Original Medicare with additional options such as dental, vision, hearing and prescription drugs, Humana is promoting a flexible allowance for these items that will help members pay out-of-pocket expenses.
“When you sum up what Humana is offering this year, it’s as simple as this: Our members spoke, and we listened,” said George Renaudin, Medicare president for Humana. “We conducted extensive research to ensure our changes align with consumer wants and needs. This research resulted in investments focused on what consumers want, like dental coverage, which is consistently a No. 1 priority in supplemental benefits for our members.”
Aetna, a CVS Health company, is debuting more affordable medical and prescription drug coverage and expanded money-saving benefits that support members’ well-being. New Medicare Advantage plan options include those designed with veterans in mind.
“In addition to the health challenges that typically come with getting older, we recognize the heavy financial strain on older adults and people with disabilities who often live on fixed incomes,” said Christopher Ciano, president of Aetna Medicare.
“To help lower their health care costs, we expanded our Aetna Medicare Solutions portfolio of products to include improved prescription drug coverage that will save members money, more essential benefits that make a meaningful difference in members’ lives, and plans that fit their unique needs and budget. "
How Medicare works
Part A and Part B generally are the most popular programs and tend to offer the most free services for individuals who qualify.
Part A covers inpatient hospital care, nursing home care, hospice care and home health care. These services usually are free, which means there’s no premium to pay.
Part B covers two types of services: those that are medically necessary, such as outpatient hospital care, doctor bills, physical therapy and more; and preventive services and detection of illnesses at an early stage when treatment is likely to work best.
Part B is optional and costs most people a monthly premium, which is projected to decrease in 2023 from $170.10 per month to $164.90. The premium is higher for some, depending on income. The premium is a bit lower for those who choose to have the premium deducted from their Social Security check.
Unless you are still on an employer’s health plan, it makes sense to sign up for Part B when you first become eligible for Medicare regardless of how healthy you are. You will face a penalty if you decide you need this coverage later – up to 10% for each year you could have had Part B but didn’t sign up for it, a penalty that will last for as long as you have Part B.
Part C refers to Medicare Advantage plans. These plans, subsidized by taxpayers, are managed by private insurance companies through either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Individuals choose medical providers from a predetermined list. The plans offer bundles that include Part A, Part B, and usually a prescription drug program (Part D).
Medicare Advantage plans will continue to offer a wide range of supplemental benefits in 2023, including eyewear, hearing aids, both preventive and comprehensive dental benefits, access to meals, over-the-counter items, fitness benefits and worldwide emergency/urgent coverage.
The Medicare Advantage enrollment process varies slightly by plan, but in all cases, you must be enrolled in Medicare Part A and Part B. If you enroll in a Medicare Advantage plan during the annual enrollment period and later change your mind, you can drop the plan and go back to Original Medicare (Parts A and B) during the Medicare Annual Disenrollment Period, which begins Jan. 1. If you don’t disenroll during this period, you must keep your plan for the rest of the year unless you qualify for a Special Enrollment.
It’s important to note that Part A and Part B services under Original Medicare come with deductibles and co-pays. These costs can be covered by buying private Medicare supplement policies known as Medigap. Premiums tend to be high, but the extra coverage can be worth it in the event of catastrophic illness.
Medicare Part D plans help pay for prescription drugs and protect you from high prescription drug costs. If you are eligible for Medicare Parts A or B, you are generally also eligible for Medicare Part D.
While all Part D plans are required to cover certain common types of drugs, the specific prescription drugs covered by a Medicare Part D plan vary by plan type and insurance carrier. Every plan has its own list of covered medications, called a formulary. Before enrolling, you should review each Medicare Part D plan’s formulary to understand which of your drugs are covered. The drugs you take may not be covered in every Medicare Part D formulary.
The Affordable Care Act closed the donut hole in Medicare Part D, so there is no longer a “hole” for brand-name or generic drugs. Enrollees in standard Part D plans pay 25% of the cost after meeting their deductible until they reach the catastrophic coverage threshold. Prior to 2010, enrollees paid their deductible, then 25% of the costs until they reached the donut hole, then they were responsible for 100% of the costs until they reached the catastrophic coverage threshold.
That amount gradually declined over the next several years, and the donut hole closed one year early in 2019 instead of 2020 for brand-name drugs. The donut hole is still relevant, however, in terms of how drug costs are counted toward reaching the catastrophic coverage threshold, and in terms of who covers the costs of the drugs – the drug manufacturer or the enrollee’s Part D plan.
A standard plan’s maximum deductible will increase to $505 in 2023, and the threshold for entering the catastrophic coverage phase (where out-of-pocket spending decreases significantly) will increase to $7,400. But the Inflation Reduction Act will ensure that Part D enrollees no longer have to pay for covered vaccines and will have access to insulin for no more than $35 per month.
The star ratings
Star ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans. Individuals can compare perceived quality through the star ratings, along with other information, such as cost and coverage, on the online Medicare Plan Finder tool available on Medicare.gov.
CMS changed the methodology for the 2023 star ratings and removed guardrails that protected plans during the height of the pandemic. In all, 57 contracts earned five stars, down significantly from 74 last year. There were 67 contracts that earned 4.5 stars, down from 96 last year; 136 that earned four stars compared to 152 last year; 116 that earned 3.5 stars compared to 122 last year; and 90 that earned three stars, up from 25 last year.
Original Medicare or Medicare Advantage?
Coverage: Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities but does not cover benefits like eye exams, most dental care, and routine exams. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it.
Medicare Advantage plans must cover all the medically necessary services that Original Medicare covers. Most plans offer extra benefits that Original Medicare doesn’t cover, such as some routine exams and vision, hearing, and dental services. Medicare drug coverage (Part D) is included in most plans. In some cases, you must get a service or supply approved ahead of time for the plan to cover it.
Doctor and hospital choice: Original Medicare allows you to see any doctor or hospital that takes Medicare, anywhere in the United States. In most cases, you don’t need a referral to see a specialist.
Medicare Advantage plans in many cases require you to use doctors and other providers who are in the plan’s network, at least for non-emergency care. Some plans offer non-emergency coverage out of network but typically at a higher cost. You may need to get a referral to see a specialist.
Cost: For Part B-covered services, Original Medicare usually requires you to pay 20% of the Medicare-approved amount after you meet your deductible; this is called your co-insurance. You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). There is no yearly limit to what you pay out of pocket unless you have supplemental coverage such as Medicare Supplement Insurance (Medigap).
With Medicare Advantage, out-of-pocket costs vary; plans have different costs for certain services. You pay the monthly Part B premium and may also have to pay the plan’s premium. Plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). Plans have a yearly limit on what you pay out of pocket for services that Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year.
The Centers for Medicare & Medicaid Services provides information as well as an updated Medicare Plan Finder at https://www.medicare.gov/ to allow people with Medicare to compare their personalized options for health and drug coverage. Additionally, a toll-free line – 1-800-MEDICARE – is available 24 hours a day, seven days a week, to provide help in English and Spanish with language support in more than 200 other languages. Medicare enrollees also can contact their State Health Insurance Assistance Programs (https://www.shiphelp.org/) for one-on-one assistance.
To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs. The MSPs help pay Medicare premiums and may also pay Medicare deductibles, co-insurance and copayments if people meet eligibility conditions. Individuals interested in learning more can visit: https://www.medicare.gov/your-medicare-costs/get-help-payingcosts/medicare-savings-programs. Or you can call the Social Security Administration toll-free at 1-800-772-1213.
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Tampa Bay Times 2023 Medicare Guide
Everything Florida seniors need to know to get ready for Medicare enrollment is available at tampabay.com/medicare.
• COMPARE MEDICARE PLANS: The Times has assembled a chart to help Tampa Bay residents shop for the best 2022 coverage in Pinellas, Hillsborough, Pasco and Hernando counties.
• COMPARE PRESCRIPTION PLANS: This chart shows the plans available in Florida under Medicare’s Part D program for prescription drugs.
• FINDING HELP: Serving Health Insurance Needs of Elders, or SHINE, is a state program that connects with seniors online or by phone to help them navigate the Medicare benefits. Call 1-800-963-5337 or visit floridashine.org.
• COVID SHOTS SAVED SENIORS’ LIVES: Primary immunizations were associated with up to 680,000 fewer COVID hospitalizations and between 330,000 to 370,000 fewer related deaths among Medicare beneficiaries in 2021
• MILLIONS WILL SAVE IN MEDICARE FEES: The rare 3% decrease in monthly premiums will be coupled with a historically high cost-of-living increase in Social Security benefits.
• BILLIONS IN BENEFITS UNUSED: Millions of older adults are having trouble making ends meet, especially during these inflationary times. Yet many don’t realize help is available, and some notable programs that offer financial assistance are unused.
• LIFE IS A BALANCING ACT, UNTIL YOU FALL: Maintaining good health is key to a longer life.
• 9 TIPS TO STAY HEALTHY AS YOU AGE: Ideas for staying healthy longer.