Our January webinars were dedicated to understanding the recent legislative changes that are going to begin taking place in 2023. Healthcare and insurance in this country has long been costly and sometimes restrictive, but there is certainly some relief on the horizon, particularly for individuals who purchase their own health insurance and those on Medicare or Medicaid programs.
WHO, WHAT, WHEN, HOW….
CMS and Medicare
Costs related to Medicare have all gone down – Part B premium to $164.90 from $170.10.
Part B deductible to $226 from $233.
Medicare’s high-income surcharge (IRMAA) brackets have changed, and the surcharges have been reduced for 2023.
Don’t forget that the surcharge is based on 2021 income for 2023, so if your income has been reduced since then permanently, you can file a Form SSA-44 requesting that it be exempted due to a Life Changing Event (like retiring and losing that income, having a one-time capital gain in recent years or other qualifying events).
Higher Social Security benefits take effect following the inflation-bloated 8.7 COLA (cost of living adjustment in 2022.
Individuals and Private Health Insurance
Good news for individuals - the Federal tax subsidies have been extended through 2025.
Also, the Family Glitch has been closed up – which allows employees to qualify for a subsidized health plan on the Marketplace even if their employer offers coverage, if they meet the new affordability test.
Beneficiary Enrollment Notification and Eligibility Simplification Act (BENES) Up until this year, if a person failed to sign up for Medicare in their Initial Enrollment Period (IEP), 3 months before, your birthday month and 3 months later, there are late-enrollment penalties that last a lifetime and there are delays in when the coverage starts.
And when people who failed to get Medicare during their initial enrollment period, and let’s face it, is easier than you think to miss it, have to wait until the General Enrollment Period (GEP) which is during the first quarter of every year.
Beginning January 1, 2023, Medicare coverage will start the first day of the month after enrollment if you apply during the three months after your 65th birthday month.
Beginning January 1, 2023, Medicare coverage will start the first day of the month after enrollment during the first quarter under GEP.
The Inflation Protection Act of 2022 (IPA) This piece of legislation has a broad range of benefits for seniors beginning Jan. 1 2023 with a staggered timeline for implementation:
2023
Insulin cost sharing reduced to $35/month for each insulin you take.
If you use an insulin pump that is covered under Medicare Part B then effective July 1, 2023 the insulin is also covered under Part B (no charge after your deductible is met).
If you use an insulin product you can add, drop or change your Part D coverage one time between now and Dec 31, 2023 and your true-out-of-pocket (TrOOP) will carry over.
Medicare will begin negotiating drug prices with manufacturers for implementation in 2026.
All Part D vaccinations are covered 100% with no deductible.
2024
Eligibility for Low Income Subsidy (LIS) will expand to 150% of FPL.
Out of pocket cap for drug costs in catastrophic phase and eliminates the 5% coinsurance.
2025
Adds a $2000 out-of-pocket cap in Part D and other drug benefit changes,
2026-2029
Implements negotiated prices for certain high-cost drugs, beginning with 10 Medicare Part D drugs and increasing to 20 more by 2029. Negotiations begin in 2023, are finalized and will publish these rates in the fall of 2024 and become effective in January 2026.