7 Ways Medicare Coverage Is Changing in 2023

Woman taking medicine
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Like many other health insurance plans, Medicare can change annually. Beneficiaries may see a different premium, deductible, and coverage rate each January.

However, there are more changes than usual for 2023, thanks to the 2022 Inflation Reduction Act. The federal law includes significant overhauls of several Medicare provisions.

Here’s what’s changing for Medicare in 2023.

1. Lower Part B premiums and deductibles

Doctor talking to older patient in his office

While inflation appears to be pushing the cost of everything higher, retirees will have at least one lower expense this year. The premium and deductible rates for Medicare Part B — which typically cover outpatient care, such as physician services — both dropped for 2023. The new rates are as follows:

  • Medicare Part B standard premiums: The standard premium — which is the amount most beneficiaries pay — is $164.90 per month, down from $170.10 for 2022.
  • Medicare Part B is deductible: The deductible is how much the person has to pay out of pocket before their insurance coverage begins. For 2023, the Medicare Part B deductible is $226 per year, down from $233 in 2022.

This change was not due to the Inflation Reduction Act. Rather, it is the result of lower spending than projected by the Medicare program in 2022.

2. Higher Part D coverage gap threshold

a man is upset because of the high prices of prescription drugs

Medicare Part D plans cover prescription drugs, but there are limits to how much this plan will cover each year. Once a person reaches that threshold, they enter what is known as the coverage gap (also referred to as a “doughnut hole”) and must pay as much as 25% of the cost of the covered branded and generic prescriptions.

In 2022, the threshold for entering the coverage gap is $4,430, but for 2023, that number increases to $4,660.

To learn more, visit the “Costs in the coverage gap” webpage on Medicare.gov, the federal government’s official Medicare website.

3. Lower the cost of insulin

Woman on insulin
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Nearly a third of seniors have either diagnosed or undiagnosed diabetes, according to the American Diabetes Association. For those on insulin, the costs can add up quickly.

However, help has arrived for Medicare beneficiaries. By 2023, Medicare Part D plans cannot charge more than $35 per month for covered insulin. What’s more, plans can’t charge a deductible for insulin.

Under the terms of the Inflation Reduction Act, the changes go into effect on January 1, 2023. Then, on July 1, 2023, a similar price cap will be applied to insulin used in traditional insulin pumps.

4. More vaccine coverage

Recently vaccinated women
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The Inflation Reduction Act also eliminated cost-sharing for adult vaccines recommended starting in 2023. That means Medicare recipients will pay nothing this year to receive the immunizations recommended by the government’s Immunization Practices Advisory Committee.

Currently, more than two dozen vaccines are on the recommended list, and that includes the following:

  • Influenza
  • COVID-19
  • Shingles
  • Hepatitis B
  • Measles, mumps and rubella

5. Expanded coverage of immunosuppressants after kidney transplantation

A black female doctor prescribes pills for an older black male patient

Some people have Medicare coverage simply because they have end-stage kidney disease — one of the few situations in which a person can qualify for Medicare before age 65. In such cases, the patient’s Medicare coverage ends 36 months after a successful kidney transplant.

Starting in 2023, these people will have the option of continuing their coverage for immunosuppressive drugs – which help prevent the body from rejecting a kidney transplant – beyond that 36 months. This new option is only available to those who have no other health coverage, and there is a premium for the benefits.

6. New start date for initial Medicare coverage

Medicare registration

Older Americans newly eligible for Medicare can enroll during the initial enrollment period which lasts from three months before the month they turn 65, through the month of their birthday and then three months after their birthday. Previously, if you signed up for three months after your birthday month, you had to wait two to three months for coverage to begin.

That changes in 2023. Starting this year, if you enroll in Medicare within three months after the month of your 65th birthday, your coverage will begin the following month.

7. Special registration period for additional situations

House in the flood
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If someone misses their initial Medicare enrollment period, they usually have to wait until the next general enrollment period, which can result in a penalty. Only in limited circumstances, such as in the case of displacement or loss of other insurance coverage, can someone who miss their original enrollment period register during the special enrollment period and thereby avoid the penalty.

But starting in 2023, seniors may be able to enroll during the special enrollment period if other exceptional circumstances cause them to miss the initial enrollment period.

These circumstances include the following:

  • Natural disaster or emergency
  • Detention
  • Loss of Medicaid coverage

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