Medicare Open Enrollment kicked off on October 15th. It’s the one enrollment period you don’t want to miss if you’re a current Medicare member. Over the next seven weeks, you can make changes to your health benefits for 2023. Now’s the time to take a look at your coverage, see what’s working and what isn’t, and find the coverage you need for the next year.
Is it worth it to take a look? The short answer is yes.
Here are four good reasons to take advantage of the Medicare Open Enrollment Period this year.
#1) You might save money.
The Medicare Part B premium is dropping for 2023, going from $170.10 a month in 2022 to $164.90 a month next year. This is unusual, and there’s a reason for it. Last year, the monthly premium for Part B jumped a whopping $20+ a month, going from $148.50 in 2021 to $170.10 a month in 2022. That’s because Medicare expected a lot of people to try out the new Alzheimer’s drug, Aduhelm, so they adjusted the Part B premium to accommodate a steep increase in spending.
But the Centers for Medicare and Medicaid Services (CMS) ultimately decided not to cover Aduhelm on a broad basis, even though it’s FDA-approved, which meant fewer Medicare members could access it. It also meant Medicare collected more in premiums than they needed for 2022. Instead of adjusting premiums mid-year, they decided to course correct for 2023.
As a result, the Part B premium in 2023 is slightly lower, even if somewhat artificially so. This lower premium might sound nice, but consider that the Part B premium in 2021 was $148.50. It’s still a $15 jump from just two years ago.
The Part B annual deductible is also decreasing in 2023, to $226 (down from $233 in 2022). But the Part B deductible was $203 in 2021, which means it’s still $23 higher than it was two years ago.
As a whole, costs for Original Medicare continue to climb.
Comparing your options for Medicare Advantage might help you save money. Because while you’ll still pay for your Part B premium with most Medicare Advantage plans, these plans typically come with added benefits and lower cost sharing.
Medicare Advantage plans also continue to see an overall trend downward in price. In 2023, the average cost of a Medicare Advantage plan is about $18, according to CMS. Our own analysis of CMS state data for 2023 puts that average at just over $19. Either way, it’s lower than the 2021 average by about $3 to $5 a month.
Part D plans are also expected to cost less in 2023. The Centers for Medicare and Medicaid Services anticipates the average Part D drug plan to cost about $31.50 a month next year.
#2) Benefits are getting even broader for Medicare Advantage plans.
Medicare Advantage (MA) plans are popular among seniors, representing nearly half (45%) of overall Medicare enrollment as of 2022. More than 29 million people chose Advantage over traditional Medicare this year. It won’t be long before MA plans represent the majority of enrollment.
You’ve probably seen plenty of advertisements for these plans, especially this time of year. As the private alternative to traditional Medicare, Advantage plans are sold by individual companies. They also come with a wide array of benefits. By law, MA plans have to cover at least the same benefits as Medicare Part A and Part B. Beyond that, they can cover a whole host of other benefits. That might include routine dental and vision care, hearing aids, telehealth, meal delivery, gym memberships and more.
Notably, most (but not all) Medicare Advantage plans cover prescription drugs, a key benefit that Original Medicare doesn’t cover on its own.
But private Medicare plans also have leeway in covering other benefits, some that may seem odd at first glance. That’s because there’s been a push in recent years for private Medicare plans to address so-called social determinants of health. These are things that affect your health and/or wellbeing but might not be strictly medical in nature, like an in-home air purifier that helps people with asthma breathe better.
Not every MA plan covers these kinds of benefits, which may be described as “innovative” benefits, but an increasing number do. In 2022, each state had an average of about 21 plans offering innovative benefits, though it varied widely by state. Next year, that average jumps to 29 plans based on our analysis of CMS state data.
The top five states for plans with innovative benefits are Florida (210), Texas (77), California (66), New York (60) and Louisiana and Virginia (both with 51 each). At the bottom of the list, Wyoming, Vermont and the District of Columbia each have just three plans with innovative benefits in 2023.
Where you live will determine how many plans you have access to, so it’s always a good idea to take a look during open enrollment. You may find broader coverage than you had in 2022.
#3) People with ESRD have a new option in 2023.
Not everyone with Medicare is 65 or older. Some are eligible because of a disability. If you have end-stage renal disease (ESRD), then you can enroll in Medicare regardless of age. But coverage isn’t permanent. People with ESRD lose eligibility for Medicare if they’ve gone 36 with a successful kidney transplant. That changes, somewhat, for coverage in 2023.
Starting this month (October) for coverage that takes effect in 2023, people who were only eligible for Medicare based on ESRD and who’ve undergone a successful kidney transplant can now enroll in a limited version of Part B. This is for people who would otherwise lose Medicare coverage because it’s been 36 months post-kidney transplant. This new, limited Part B coverage only covers immunosuppressive drugs. And in 2023, the premium for this limited coverage is $97.10 a month.
If you’re in this situation, you can call Social Security with a special phone number created just for this purpose: 1-877-465-0355
Without access to this coverage, kidney transplant recipients are on the hook for the full cost of immunosuppressive drugs – assuming they don’t have other forms of health insurance – so it could be a good benefit for you if you need it. Just keep in mind that this new benefit is not full Medicare Part B coverage. It only covers immunosuppressive drugs for people who are 36 months post-kidney transplant.
You’ll also still need to meet the annual Part B deductible ($226 in 2023) before benefits start. And you’ll be subject to the 20% cost sharing under Part B as well. Higher-income enrollees will also pay a premium surcharge. Check with Social Security for more details on this plan.
If you need this coverage for 2023, enroll by December 31st for coverage starting January 1st.
#4) All Part D plans have to cap insulin costs now.
CMS launched the Part D Senior Savings Model in 2021 based on guidelines under the Trump administration. This program allowed Part D plans to cap insulin costs at $35 a month. As of 2022, about a third of Part D plans were participating in this model, according to an analysis from the Kaiser Family Foundation.
Thanks to the Inflation Reduction Act (IRA), signed into law by President Biden this year, more seniors will have access to more plans with lower insulin costs. That’s because the IRA caps insulin costs for all Part D plans, including Medicare Advantage plans with a Part D drug benefit. So if you need insulin, this may open up more plan options for you in 2023.
Note that this doesn’t mean that every Part D plan has to cover every type of insulin. Private plans can still decide which forms of insulin they’ll cover. But the forms they do cover will now have a $35 cap. Check a drug plan’s formulary carefully to make sure it covers the medication you need.
Kaiser Family Foundation found that a lot of Part D plans rank insulin as a tier 3 drug, a pricier classification. If you take insulin, this new regulation for 2023 could help trim your out-of-pocket costs under Medicare.
Bottom line? It’s time to review your options.
Even if you like your current Medicare coverage – whether that’s through Original Medicare or a private Medicare Advantage plan – there are upsides to seeing what else is out there. You may save money and find a plan with broader benefits, including coverage for things that aren’t typically considered “healthcare.”
But we get it. Carving time out of your schedule to look at your health benefits isn’t exactly thrilling. And with so many ads coming at you from all sides, you might not even know where to start. Plus, if you like your current coverage, it can be tempting to just let it renew for 2023.
But this is a potentially costly mistake. It never hurts to compare what’s available to what you have now, even if it’s just to confirm that what you have is what works best for you.
Open Enrollment ends December 7th. To see what’s available in your area, start here (link opens to an independent shopping site).