Many people are reluctant to change their Medicare Part D or Medicare Advantage
plan coverage year-to-year. However, millions of Medicare beneficiaries will
see significant changes in their 2023 Medicare costs and coverage.
If you are staying with your current 2022 Medicare plan into next year, please
be sure to review your plan’s
Annual Notice of Change (
) letter and use the list below to help you look for important changes
that might impact your 2023 coverage.
(1) Your 2022
Medicare plan may no longer be offered in 2023.
Over
1.44
million people are currently
enrolled in a 2022 Medicare Advantage plan (
MA or
MAPD) or Medicare Part D plan (
PDP) that will no longer be
available in 2023. These 1.4 million people
will lose their 2022 Medicare plan coverage in 2023 - unless they enroll into
another Medicare plan.
As examples, the counties seeing the largest
number of terminated 2023 Medicare Advantage plans are:
Los Angeles,
CA losing 37 plans and
Orange County, CA losing 30 plans. You
can
click here to read more in our article about Medicare plans being
discontinued in 2023.
(2) You may be automatically reassigned to a different 2023 Medicare plan.
Over
1.47 million people,
1.26 million enrolled in 2022 Medicare
Advantage plan and an additional
200,000 people enrolled in a 2022
stand-alone Medicare Part D plan, will be automatically “
crosswalked” or merged into a different 2023 Medicare plan - with
changes to their plan cost and coverage. For example, the 196,000 members of the 2022 Cigna Essential Rx (
PDP) will
be
automatically
reassigned to the 2023 Cigna Extra Rx (PDP). You can
click here
to read more about Medicare plan mergers or consolidations.
(3) Your monthly 2023 Medicare Part D
premium may be increasing.
Almost 2.7 million Medicare beneficiaries will see their monthly 2023
Medicare Part D premium increase 20% or more - and over
280,000 people currently
enrolled in a 2022 Part D plan will see their plan
premium double in 2023. The good news is about 3.5 million people
will see a 2023 premium decrease of
1% to 79%.
You can
click here
to see examples of 2022 Medicare Part D plans that are
increasing 2023 premiums. Please
keep in mind that, in addition to lower-premium Part D plans, there may be
low- or $0 premium Medicare Advantage plans (MAPDs) available in your
area.
(4) Your plan’s Initial Deductible
may increase.
The
2023 standard
Medicare Part D deductible
will increase to $505, up from the 2022 standard deductible of $480 – affecting
14 million people. Over
909,000 Medicare beneficiaries are
enrolled in a Part D plan having an even larger initial deductible increase of
$45 or more. You can
click here to
read more about initial deductible changes and examples
of Medicare Part D plan’s increasing their 2023 initial deductible.
(5) Your 2023
Medicare plan’s Initial Coverage Limit (ICL) may change.
All stand-alone 2023 Medicare
Part D plans use the standard
Initial Coverage Limit (ICL) of $4,660. However, some 2023 Medicare Advantage plans
offer an ICL other than the standard – ranging from $4,355 to $11,000
. Your drug plan’s ICL sets the boundary between your Medicare Part
D plan's Initial Coverage Phase and the
Donut Hole or Coverage Gap. The ICL is measured by the total retail value
of your prescription drug purchases. You can
click here
to read more about 2023 Medicare Advantage plans that have
an increased or decreased Initial
Coverage Limit.
(6) Your 2023 Medicare drug plan’s
formulary or drug list will change.
Although 2023 Medicare prescription drug plans will always be adding, moving,
and removing medications,
based on our
analysis, over
3.8
million Medicare beneficiaries currently enrolled in a stand-alone 2022 Medicare
Part D plan will see at least
100 more medications added to their 2023
formulary.
Important: Remember that a larger
formulary does not necessarily mean that the Medicare drug plan will cover all
of your medications. So please, check to
make sure your medications are
affordably
covered by your chosen 2023 Medicare Part D plan.
(7) Your 2023
Medicare plan’s prescription drug cost-sharing may change.
Medicare plans can change their fixed copayments from year-to-year (such as
raising Tier 1 drugs to a $5 co-pay) – or plans may increase the co-insurance
percentage (
for example, instead of a fixed 35% co-insurance, you will pay 50%
for Tier 4 drugs in 2023). And some Medicare
drug plans may change between co-insurance (percent of retail price) to
copayment as a cost-sharing model.
You can
click here
to see an example of how the
SilverScript
SmartSaver (PDP) will change from a $46
co-pay to 25% co-insurance for Tier 3 Preferred Brands (meaning, you will save
money in 2023 if your Tier 3 drugs have a retail cost under $184) – this change
will affect almost
1.5 million current
plan members.
(8) Your Medicare plan’s cost-sharing
can vary significantly between “preferred” and “standard” network pharmacies.
As in past years, about
98% of all 2023 stand-alone Medicare prescription drug plans (PDPs)
will use different cost-sharing for preferred vs. standard network pharmacies. As an example, the
California
SilverScript Choice (PDP) will
have a co-payment of $2 for a Tier 1 medication at preferred network pharmacies
and, for the same Tier 1 drug, a $6 co-pay when purchased at a standard network
pharmacy. You can
click here to see more examples of standard and preferred
pharmacy cost-sharing. And, you can
contact your plan’s Member Service department to find preferred pharmacies in
your area using the toll-free telephone number found on your Member ID card.
(9) Your 2023
Medicare Advantage plan’s Maximum Out-of-Pocket (MOOP) spending limit may
change.
The Medicare Advantage plan MOOP threshold limits how much you will spend on
co-payments and co-insurance for in-network, eligible Medicare Part A and Part
B coverage. A Medicare Advantage plan’s MOOP limit can change
every year and ranges from $299 to $8,300 -- with most 2023 Medicare Advantage plans
having a MOOP under $6,001 – with 26% of 2023 Medicare Advantage plans having a
MOOP at, or below, $3,650. On
the higher end, 30% of 2023 Medicare Advantage plans will have a MOOP between
$6,001 and $8,300. (Medicare Advantage plans designed for
low-income beneficiaries have no MOOP.)
About 1.4 million Medicare Advantage plan
members will see an increase in their in-network MOOP in 2023. The MOOP increase can range from $50 to
$4,850. You can
click here
to learn more about the maximum out-of-pocket limits and
increase for 2023 Medicare Advantage plans.
(10) Your 2023 Medicare plan may have added new features and coverage.
All 2023 Medicare Part D plans will offer insulin at a $35 or less co-pay: Based on the newly-passed
Inflation
Reduction Act, all 2023 stand-alone Medicare Part D
prescription drug plans and Medicare Advantage plans with drug coverage (MAPDs)
will offer all insulin found on the plan’s formulary for a co-pay of $35 (or
less) through all phases of Part D coverage (with insulin costs possibility
reduced further in the Catastrophic Coverage phase). We show the text such as:
“
all covered insulin pay $35 or less” in our Medicare Part D Plan Finder
(
https://PDP-Finder.com) and our Medicare Advantage Plan Finder (
https://MA-Finder.com). You can then
click the “
Browse
Formulary” link to check the plan’s formulary for the
types of insulin covered.
All 2023 Medicare Part D plans will offer Part D vaccines at a $0 co-pay: Also based on the
Inflation
Reduction Act, all 2023 stand-alone Medicare Part D
prescription drug plans and Medicare Advantage plans with drug coverage (MAPDs)
will offer $0 cost sharing for vaccines that are recommended by the Advisory
Committee on Immunization Practices (
ACIP), such as Shingles and Pneumonia vaccines.
Medicare Part B Premium Giveback: More 2023 Medicare Advantage plans are now offering a Medicare
Part B premium Giveback feature – where you will receive a partial (or full)
refund of your Part B premiums. Part B
Giveback amounts for 2023 can range from $2 to $170.10. Unfortunately, Medicare Advantage plans
offering a Part B Giveback are not available everywhere, but you
can use the
Giveback filter in our Medicare
Advantage Plan Finder (
https://MA-Finder.com) to see the plans available and Part B Giveback
amounts.
Supplemental Benefits: More 2023 Medicare
Advantage plans are expanding supplemental healthcare benefits (dental, hearing
aid, eye care, OTC drugs, and fitness benefits) and non-health related benefits
(limited meals, non-healthcare transportation). You can find a list of supplemental benefits at the bottom of our
Medicare Advantage plan detail pages. Begin by viewing all Medicare Advantage plans in your area (for example:
https://MA-Finder.com/15238) and then click on the plan name and then scroll down
the page to see the list of Supplemental Benefits. You can then telephone the plan (the
toll-free number for Member Services is found at the top of the page) and ask
for more details about the benefits.
The Bottom Line to our Top 10 List . . .
If you decide to stay with your current 2022 Medicare Part D or Medicare
Advantage plan into 2023 – AND you understand how your Medicare plan is
changing –
you do not need to do anything – you will be automatically re-enrolled into
your Medicare plan along with any changes your plan is making for 2023.
If your 2022 Medicare plan is being terminated in 2023 - and you are not merged
or “crosswalked” to another 2023 Medicare plan - you may be without Medicare
plan coverage on January 1st.
The Good News: You still have
plenty of time to review your 2023 Medicare plan options during the annual Open
Enrollment Period (AEP) that continues through December 7th. For more information, Medicare beneficiaries
can telephone Medicare at 1-800-633-4227 and speak with a Medicare
representative.
Need a fast way to see how your 2022 Medicare Advantage or Medicare Part D
plan is changing in 2023?
Our
PDP-Compare and
MA-Compare tools allow you to compare changes in all
stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare
Advantage plans (MAs or MAPDs) across the country.
Our
comparison tools show changes in monthly premiums and plan designs,
as well as changes in cost-sharing rates for different drug tiers. Both PDP-Compare and MA-Compare also show the
Medicare plans that will be discontinued, merged, or added in 2023. MA-Compare includes links to the health
coverage details for all 2022 and 2023 Medicare Advantage plans.