Top 10 ways your current 2022 Medicare plan can change in 2023

(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.