7 Ways Medicare Coverage Is Changing in 2023

Like many other health insurance plans, Medicare is subject to change each year. Beneficiaries might see different premiums, deductibles and coverage levels each January.

However, there are more changes than usual for 2023, thanks to the Inflation Reduction Act of 2022. The federal law included a significant overhaul of some Medicare provisions.

Here’s a look at what’s changing for Medicare in 2023.

1. Lower Part B premiums and deductibles

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

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

These changes aren’t because of the Inflation Reduction Act, though. Instead, they are the result of lower-than-projected spending by the Medicare program in 2022.

2. A higher Part D coverage gap threshold

Medicare Part D plans cover prescription drugs, but there is a limit to how much these plans will cover each year. Once someone reaches that threshold, they enter what is known as the coverage gap (also referred to as the “donut hole”) and need to pay as much as 25% of the cost of covered brand-name and generic prescriptions.

In 2022, the threshold for entering the coverage gap was $4,430, but for 2023, that amount increased to $4,660.

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

3. Lower insulin costs

Nearly one-third of seniors have diagnosed or undiagnosed diabetes, according to the American Diabetes Association. For those who use insulin, the cost can quickly add up.

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

A provision of the Inflation Reduction Act, those changes took effect on Jan. 1, 2023. Then, on July 1, 2023, similar price caps will be placed on insulin used in traditional insulin pumps.

4. More vaccine coverage

The Inflation Reduction Act also eliminates cost-sharing for recommended adult vaccines starting in 2023. That means Medicare beneficiaries won’t pay anything this year to receive immunizations recommended by the government’s Advisory Committee on Immunization Practices.

Currently, more than two dozen vaccines are on the recommended list, and they include the following:

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

5. Extended immunosuppressant coverage after kidney transplants

Some people have Medicare coverage only because they have end-stage renal 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 individuals will have the option to continue their coverage for immunosuppressive drugs — which help prevent the body from rejecting a transplanted kidney — past those 36 months. This new option is only available to those who don’t have other health coverage, and there is a premium for the benefit.

6. New start dates for initial Medicare coverage

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

That changed in 2023. As of this year, if you enroll in Medicare in the three months after the month of your 65th birthday, your coverage will start the very next month.

7. Special enrollment periods for additional situations

If someone misses their initial Medicare enrollment period, they typically have to wait until the next general enrollment period, which can result in penalties. Only in limited situations, such as in the case of a move or a loss of other insurance coverage, can someone who misses their initial enrollment period sign up during a special enrollment period and thus avoid those penalties.

But starting in 2023, seniors may be able to enroll during a special enrollment period if there are other exceptional circumstances that caused them to miss their initial enrollment period.

These circumstances include the following:

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