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Cap on insulin, more free vaccines: Changes in 2023 Medicare to know during enrollment period

CLEVELAND, Ohio — Now that the Medicare enrollment period has opened, there are two important things to remember. One, don’t take advice from faded-from-fame actors or athletes pitching Medicare hype on TV.

Two, don’t assume that last year’s plan will be a good fit for you in 2023. A cap on the price of insulin, expensive vaccines that will be available for free and decreased premium costs are among the changes coming to Medicare next year.

“This time of year, (seniors’) cell phones are lighting up; their texts are lighting up; their mailbox is full of paper and every TV station is advertising Medicare Advantage plans. Just try to turn off the noise,” said Christina Reeg, director of the Ohio Senior Health Insurance Information Program. The agency is funded by Medicare to provide objective, unbiased information about the federal insurance plan for people 65 and older.

“It’s very important, during this open enrollment period, that individuals review what they have, and then look closely at what’s being offered next year,” Reeg said.

Find out the latest information about Medicare coverage, and have your questions answered during The Plain Dealer and cleveland.com Guide to Medicare & Golden Retirement presented by Medical Mutual. The virtual free event is Thursday, Oct. 27, 4:30–6 pm Participants must preregister on the web page to receive a Zoom link for joining the event.

This workshop offers panels lead by Medicare experts who will explain plan options, how to choose the right plan for you, and insights on drug plan options. There will also be a moderated Q&A session.

One source of advice you should be wary of are TV ads that seem to be sponsored by the government, or feature celebrities. Often, the helplines mentioned in commercial transfer calls to large, out-of-state brokers trying to sell Medicare Advantage plans. Calling those help lines gives your phone number to scammers and can kick off a barrage of spam calls.

The open enrollment period — during which people already on Medicare can change plans — started Oct. 15. It runs through Wednesday, Dec. 7.

If you want to stay on your current Medicare plan, then do nothing during the enrollment period, and it will roll over automatically, Reeg said.

Seniors who are turning 65 and want to sign up for Medicare have a seven-month initial sign-up window — three months before their birth month, their birth month and three months after their birth month.

The Medicare changes coming in 2023 are due to Congress’ approval of the Inflation Reduction Act of 2022, which included measures to lower health-care costs.

Here are details about some of the major Medicare changes affecting most enrollees in 2023. Information comes from the Ohio Senior Health Insurance Information Program, the Western Reserve Area Agency on Aging, AARP and media reports.

More vaccines free in 2023

More vaccines will be free to Medicare recipients next year.

In the past, Medicare Part B has covered some vaccines — including those for flu, pneumonia, hepatitis B and COVID-19 initial shots and boosters — with zero out-of-pocket costs for the enrollee. Other vaccines were covered under Medicare Part D, the drug benefit, but with a high copay charge.

The change to zero copays for vaccines mostly affects the two-shot shingles vaccine, which currently costs Medicare Part D recipients less than $50 per dose.

Insulin will be capped at $35

Beginning next year, Americans with Medicare Part D prescription drug coverage will pay no more than $35 for a 30-day supply of insulin, even if they haven’t met their annual Part D deductible.

Currently, insulin injections cost between $10 and $1,300 in countries per month under Part D.

Medicare’s online Plan Finder tool does not reflect the $35 cap, because the law was passed too late to update the website, Reeg said. Insulin users should call the Ohio Senior Health Insurance Information Program or Medicare directly to get more details.

Starting July 1, Medicare enrollees using insulin pumps covered by Part B will not have to pay a deductible. Up until that date, they will still pay a 20% coinsurance after meeting deductible.

Medicare Part A costs go up

Most Medicare enrollees don’t pay a monthly fee for Medicare Part A, which provides hospital insurance, but they are charged a deductible for hospital stays. In 2023, the Part A hospital deductible will increase by $44, to $1,600.

Medicare Part B premium will decrease

The standard monthly premium for Medicare Part B will be reduced to $164.90 in 2023, down from $170.10 in 2022. The premium drop comes after a large increase in premiums — the amount paid for an insurance policy — in 2022. It was the largest increase in the program’s history.

“This is the first time in Medicare’s history that premium has gone down,” Reeg said. “Still, over $164 a month is a lot of money for many Medicare beneficiaries.”

Next year’s Part B premium will be lower because Medicare won’t be spending as much as originally expected on Aduhelm, the controversial Alzheimer’s drug. But next year’s premiums are still higher than they were years ago.

Medicare Part B provides medical insurance for doctor visits, outpatient services, medical equipment, transportation and more.

Every year, the Part B premium increases based off the cost of living, said Tommy York, director of business operations at the Western Reserve Area Agency on Aging, which advocates for older adults.

“This is the first year since 2012, where it actually is going to be decreasing,” York said. “It automatically gets paid out of your Social Security check.”

Medicare Part B deductible will be lowered

The annual Part B deductible for 2023 is slightly decreasing by $7, to $226.

A health insurance deductible is the amount of money paid out of pocket every year for eligible healthcare services before the insurance plan begins to cover the costs. The size of the deductible varies depending on the health insurance plan.

Changes won’t affect Medicare Advantage plans

These changes will not affect seniors on a Medicare Advantage plan, which is Medicare coverage from a private company. Those people will need to know the specific out-of-pocket costs for their particular plan in 2023.

Some Medicare Advantage Plans align their out-of-pocket costs with Medicare Part B. “But you’ve got over 100 (Medicare Advantage) plans in the Cleveland area. Each and every one of them has a different cost structure,” Reeg said.

Medicare Advantage is different from original Medicare, which includes Medicare Part A and Part B. Enrollees pay a deductible at the start of the year, as well as 20% of the cost of the Medicare-approved service, called coinsurance.

Avoid scams, protect personal information

During open enrollment season, many seniors are misled by marketing gimmicks, or fall victim to scams that puts personal information into the wrong hands. Here are tips for protecting yourself or a loved one:

  • Don’t answer calls, texts or emails from numbers or email addresses that you don’t recognize. Legitimate government agencies will not initiate contact by calling, texting or emailing you.
  • Do not give out your personal information, including your Medicare number, Social Security number or bank account information to anyone who initiates contact with you.

Here are websites that can help with Medicare issues:

AARP

Western Reserve Area Agency on Aging

Medicare Plan comparison tool

Medicare and You publication

https://www.medicare.gov/publications/10050-Medicare-and-You.pdf

Ohio Senior Health Insurance Information Program

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