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How are Medicare benefits changing for 2023?

Changes for 2023 include premium and deductible increases for Part A, lower rates for Part B, and better Part D coverage due to the Inflation Reduction Act

Louise Norris // October 15, 2022

Reviewed by our health policy panel.

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Q: How will Medicare prescription drug costs change for 2023? A: There are several changes for 2023, including free vaccines under Part D, a $35 cap on monthly insulin costs, and changes to the Part D deductible and coverage thresholds.

Is Original Medicare coverage enough?

Is Original Medicare coverage enough?

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Key takeaways

Q: What are the changes to Medicare benefits for 2023?

A: There will be several changes for Medicare enrollees in 2023. Some of them apply to Medicare Advantage and Medicare Part D, which are the plans that beneficiaries can change during the annual fall enrollment period that runs from October 15 to December 7. (Here’s our overview of everything you need to know about the annual enrollment period.)

Or call 866-472-0949 (TTY 771) to speak to a licensed insurance agent
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But there are also changes to Original Medicare cost-sharing and premiums, the high-income brackets, and more.

Did the Medicare Part B standard premium increase for 2023?

The standard premium for Medicare Part B is $170.10/month in 2022, but it’s decreasing to $164.90/month in 2023. This is the first year-over-year decrease since 2012. Medicare Part B spending was lower than expected in 2022, leaving a surplus that is being used to decrease premiums for 2023.

This is partly due to Medicare’s lower-than-expected spending on Aduhelm, the new Alzheimer’s drug that drove a significant portion of the Part B rate increase in 2022. (The standard Part B premium increased by nearly $22/month in 2022 — it had been $148.50/month in 2021 — which was the largest dollar increase in the program’s history.)

For 2023, the Social Security COLA is 8.7%, which is the largest it’s been in decades. And unlike 2022, when a chunk of seniors’ COLA had to be used to cover the additional Part B premiums (Part B premiums are deducted from Social Security checks), the Part B premium is decreasing in 2023. So the COLA will be fully available for retirees to use to cover other living expenses, which have increased sharply in 2022.

(If a Social Security recipient’s COLA isn’t enough to cover the full premium increase for Part B, that person’s Part B premium can only increase by the amount of the COLA. That’s because Part B premiums are withheld from Social Security checks, and net checks can’t decline from one year to the next. That was not an issue in 2022, however, due to the size of the COLA, and will not be an issue in 2023 due to the large COLA and lack of a Part B rate increase.)


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How much is the Part B deductible for 2023?

The Part B deductible for 2022 is $233, and it’s decreasing to $226 in 2023. This is the first time the Part B deductible has decreased since 2012.

Some enrollees have supplemental coverage that pays their Part B deductible. This includes Medicaid, employer-sponsored plans, and Medigap plans C and F. But since the beginning of 2020, Medigap plans C and F have no longer been available to newly-eligible enrollees (people can keep them if they already have them, and people who were already eligible for Medicare prior to 2020 can continue to purchase them). The ban on the sale of Medigap plans that cover the Part B deductible for new enrollees was part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It’s an effort to curb utilization by ensuring that enrollees incur some out-of-pocket costs when they receive medical care.

Many Medicare Advantage plans have low copays and deductibles that don’t necessarily increase in lockstep with the Part B deductible, so their benefits designs have had different fluctuations over the last few years. (Medicare Advantage enrollees pay the Part B premium plus the Advantage plan premium if the plan has a separate premium — many do not, so the enrollees just pay the Part B premium. Medicare Advantage plans wrap Part A, Part B, usually Part D, and various supplemental coverage together into one plan, with out-of-pocket costs that are different from Original Medicare.)

Part A premiums, deductible, and coinsurance

Medicare Part A covers hospitalization costs. Part A has out-of-pocket costs when enrollees need hospital care, although most enrollees do not pay a premium for Part A. But you’ll have to pay a premium for Part A if you don’t have 40 quarters of work history (or a spouse with 40 quarters of work history).

Are Part A premiums increasing in 2023?

Roughly 1% of Medicare Part A enrollees pay premiums; the rest get it for free based on their work history or a spouse’s work history. Part A premiums have trended upwards over time and they’re increasing again for 2023.

For 2023, the Part A premium for people with 30+ (but less than 40) quarters of work history will be $278/month, up from $274/month in 2022. And for people with fewer than 30 quarters of work history, the premium for Part A will be $506/month in 2023, up from $499/month in 2022.

Is the Medicare Part A deductible increasing for 2023?

Part A has a deductible that applies to each benefit period (rather than a calendar year deductible like Part B or private insurance plans). The deductible generally increases each year. It will be $1,600 in 2023, up from $1,556 in 2022. The deductible applies to all Part A enrollees, although many enrollees have supplemental coverage that pays all or part of the Part A deductible.

How much is the Medicare Part A coinsurance for 2023?

The Part A deductible covers the enrollee’s first 60 inpatient days during a benefit period. If the person needs additional inpatient coverage during that same benefit period, there’s a daily coinsurance charge. For 2023, it will be $400 per day for the 61st through 90th day of inpatient care (up from $389 per day in 2022). The coinsurance for lifetime reserve days is $800 per day in 2022, up from $778 per day in 2022.

Today's Medicare Poll

medicare-poll

Did you take advantage of the Medicare Advantage Open Enrollment Period?

No, I did not make any changes during the MAOEP.
70.5%
Yes, I switched to a different Medicare Advantage plan.
23.1%
Yes, I switched to Original Medicare.
6.4%
For care received in skilled nursing facilities, the first 20 days are covered with the Part A deductible that was paid for the inpatient hospital stay that preceded the stay in the skilled nursing facility. (Medicare only covers skilled nursing facility care if the patient had an inpatient hospital stay of at least three days before being transferred to a skilled nursing facility, although this requirement has been waived for people affected by the COVID pandemic.) But there’s a coinsurance that applies to days 21 through 100 in a skilled nursing facility. In 2023, it will be $200 per day, up from $194.50 per day in 2022.

Can I still buy Medigap Plans C and F?

As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap plans C and F (including the high-deductible Plan F) are no longer available for purchase by people who become newly-eligible for Medicare on or after January 1, 2020. People who became Medicare-eligible prior to 2020 can keep Plan C or F if they already have it, or apply for those plans at a later date, including for 2023 coverage.

(Medical underwriting applies in most states if you’re switching from one Medigap plan to another after your initial enrollment window ends, but some states have guaranteed-issue Medigap plans even after the initial enrollment period has ended.)

Time to sign up for Medicare?Medigap Plans C and F cover the Part B deductible ($226 in 2023) in full. But other Medigap plans require enrollees to pay the Part B deductible themselves. The idea behind the change is to discourage overutilization of services by ensuring that enrollees have to pay at least something when they receive outpatient care, as opposed to having all costs covered by a combination of Medicare Part B and a Medigap plan.

Because the high-deductible Plan F was discontinued for newly-eligible enrollees as of 2020, there is a high-deductible Plan G available instead.

Will there be inflation adjustments for Medicare beneficiaries in high-income brackets in 2023?

Yes. The threshold for high-income surcharges (and each of the income brackets) is increasing for 2023, although the premiums that people pay for Part B are decreasing, and that includes people who pay the high-income surcharge.

Medicare beneficiaries with high incomes pay more for Part B and Part D. But what exactly does “high income” mean? The high-income brackets were introduced in 2007 for Part B and in 2011 for Part D, and for several years they started at an income of $85,000 ($170,000 for a married couple).

But the income brackets began to be adjusted for inflation as of 2020. For 2023, the threshold where the surcharge starts to be added is increasing again, to $97,000 for a single person and $194,000 for a married couple, up from $91,000 and $184,000, respectively, in 2022. The significant increase for 2023 is due to the fairly high inflation we’ve seen in 2022. (Note that the surcharge in 2023 will be based on income tax returns from 2021, since those are the most recent tax returns on file when 2023 begins; there’s an appeals process you can use if your income has changed since then).

For 2023, the Part B premium for high-income beneficiaries ranges from $230.80/month to $560.50/month, depending on income (this is a decrease from 2022, when the premiums for high-income beneficiaries ranged from $238.10/month to $578.30/month in 2022).

As part of the Medicare payment solution that Congress enacted in 2015 to solve the “doc fix” problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees. These new brackets took effect in 2018, bumping some high-income enrollees into higher premium brackets.

And starting in 2019, a new income bracket was added on the high end, further increasing Part B premiums for enrollees with very high incomes. Rather than lumping everyone with income above $160,000 ($320,000 for a married couple) into one bracket at the top of the scale, there’s now a bracket for enrollees with an income of $500,000 or more ($750,000 or more for a married couple).

People in this category will pay $560.30/month for Part B in 2023. The income level for that top bracket — income of $500,000+ for a single individual or $750,000 for a couple — has remained unchanged since 2020. But the thresholds for each of the other brackets has increased each year (starting with the lowest bracket increasing from $85,000 to $87,000 in 2020, and so on; a similar adjustment has applied at each level except the highest one).

How are Medicare Advantage premiums changing for 2023?

According to CMS, the average Medicare Advantage (Medicare Part C) premiums is expected to be about $18/month in 2023 (in addition to the cost of Part B), which is down from $19.52/month in 2022 and $23/month in 2020. Average Advantage premiums have been declining for the last several years.

(Note that Medicare Advantage premiums are in addition to Part B premiums. People who enroll in Medicare Advantage pay their Part B premium and whatever the premium is for their Medicare Advantage plan, and the private insurer wraps all of the coverage into one plan.)

The average premiums described above account for all Medicare Advantage plans, including those that don’t have integrated Part D coverage. And the overall average is driven down due to the fact that the majority of Advantage enrollees actually have no premiums other than the cost of Part B (ie, they’re in “zero premium” Advantage plans). If we only consider the Advantage premiums for plans that do include Part D and that do have a premium in addition to the cost of Part B, the average premium is quite a bit higher ($58/month, for people with Advantage plans that integrate Part D and have a monthly premium).

More than 29 million people had Medicare Advantage plans in 2022. Enrollment in these plans has been steadily growing for more than 15 years, and CMS expects that to continue in 2023, with enrollment projected to reach 31.8 million people. The total number of Medicare beneficiaries has been steadily growing as well, but the growth in Medicare Advantage enrollment has far outpaced overall Medicare enrollment growth. In 2004, just 13% of Medicare beneficiaries had Medicare Advantage plans. That had grown to more than 46% by 2022.

Kidney transplant recipients can use Part B immunosuppressive drug coverage for life

Historically, Medicare coverage for kidney transplant recipients has only lasted for 36 months after the transplant. But as of 2023, that’s no longer the case. After 36 months, kidney transplant recipients will be able to continue to have limited Medicare Part B coverage for immunosuppressive drugs. This won’t be full Medicare Part B, but it will cover the medications that transplant recipients must take for the rest of their lives in order to prevent their bodies from rejecting the transplanted kidney.

As of 2023, the cost for Part B that only covers immunosuppressive drugs is $97.10/month (it’s higher for people with income above $97,000 for a single individual, or $194,000 for a couple). Once the person turns 65, or becomes eligible for Medicare based on a disability, they can transition back to full Medicare coverage.

People with ESRD can join Medicare Advantage plans

Under longstanding rules, Medicare Advantage plans used to be unavailable to people with end-stage renal disease (ESRD) unless there was an ESRD Special Needs Plan available in their area. But starting in 2021, Medicare Advantage plans are guaranteed issue for all Medicare beneficiaries, including those with ESRD. This is a result of the 21st Century Cures Act, which now gives people with ESRD access to any Medicare Advantage plan in their area.

Many people with ESRD will find that Original Medicare plus a Medigap plan and Medicare Part D plan is still the most economical option overall, in terms of the coverage provided. But in some states, people under 65 cannot enroll in guaranteed-issue Medigap plans, or can do so only with exorbitantly high premiums. And some of the states that do protect access to Medigap for most beneficiaries under 65 do not extend those protections to people with ESRD. Without supplemental coverage, there is no cap on out-of-pocket costs under Original Medicare.

Medicare Advantage plans do have a cap on out-of-pocket costs, as described below. So for ESRD beneficiaries who cannot obtain an affordable Medigap plan, a Medicare Advantage plan could be a viable solution, as long as the person’s doctors and hospitals are in-network with the plan.

Is the Medicare Advantage out-of-pocket maximum changing for 2023?

Medicare Advantage plans are required to cap enrollees’ out-of-pocket costs for Part A and Part B services (unlike Original Medicare, which does not have a cap on out-of-pocket costs). The cap does not include the cost of prescription drugs, since those are covered under Medicare Part D (even when it’s integrated with a Medicare Advantage plan).

For several years, the cap was $6,700, although most plans have had out-of-pocket caps below that level. For 2021 and 2022, the maximum out-of-pocket limit for Medicare Advantage plans increased to $7,550 (plus out-of-pocket costs for prescription drugs). For 2023, the cap is increasing to $8,300. But most Advantage plans will continue to have out-of-pocket caps below the government’s maximum.

How is Medicare Part D prescription drug coverage changing for 2023?

Average Part D premiums are projected to be $31.50/month in 2023, down from $32.08 in 2022. But as is always the case, there will be numerous options available, with a wide range of premiums.

For stand-alone Part D prescription drug coverage, the maximum allowable deductible for standard Part D plans is $480 in 2022, up from $445 in 2021. This will increase to $505 in 2023.

And the out-of-pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023, up from $7,050 in 2022 (note that this is a combination of drug manufacturer discounts and the enrollee’s costs; actual out-of-pocket costs for the enrollee will be around $3,100 when the catastrophic coverage level is reached).

The copay amounts for people who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brand-name drugs. Beneficiaries with higher-cost drugs will continue to pay 5% of the cost during the catastrophic coverage phase (it’s the greater of the copay or the 5%). But cost-sharing in the catastrophic coverage phase will cease altogether as of 2024, thanks to the Inflation Reduction Act.

The Inflation Reduction Act will also start to benefit Medicare Part D enrollees right away in 2023. Recommended vaccines covered under Part D will no longer have cost-sharing (ie, they’ll be free). And all Part D plans will have to provide all of their covered insulin products with copays of no more than $35/month (this essentially extends the existing optional Senior Savings Model to all Part D plans, including Medicare Advantage plans with integrated Part D coverage).

The Affordable Care Act “closed” the donut hole in Medicare Part D, so there is no longer a “hole” for brand-name or generic drugs: Enrollees in standard Part D plans pay 25% of the cost (after meeting their deductible) until they reach the catastrophic coverage threshold. Prior to 2010, enrollees paid their deductible, then 25% of the costs until they reached the donut hole, then they were responsible for 100% of the costs until they reached the catastrophic coverage threshold.

That amount gradually declined over the next several years, and the donut hole closed one year early — in 2019, instead of 2020 — for brand-name drugs.

The donut hole is still relevant, however, in terms of how drug costs are counted towards reaching the catastrophic coverage threshold, and in terms of who covers the costs of the drugs (ie, the drug manufacturer or the enrollee’s Part D plan). Here’s more about how that all works.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Louis S DeLisle
2 years ago

Can my medicare benefits pay for a Y membership?

Maurie Backman
2 years ago

Some Medicare Advantage plans will pay for fitness classes or a gym membership, so it’s worth seeing if you qualify for that coverage. If you have original Medicare though, you usually won’t get coverage for a Y membership or anything that falls under the gym/fitness category.

Lou Smith
2 years ago
Reply to  Maurie Backman

Paying extra to get fitness classes or gym membership is not wise. You can join Planet Fitness for about $10. a month. Advantage plans have extra costs that regular Medicare does not have,

Hearher
2 years ago
Reply to  Lou Smith

It depends where you live as to what plan you get, but I can say 100% without a doubt that an Advantage plan has lower costs than Original Medicare. Medicare has no out of pocket maximum which means you will have to pay that 20% until kingdom come. On an advantage plan often there are no deductibles and you have an out of pocket maximum to protect you.

Jan
2 months ago
Reply to  Hearher

However in Advantage plans you are restricted the the insurance company’s participating doctors and geographical area. Specialists out of the area are not included, right?

Linda Spennato
2 months ago
Reply to  Jan

Most quality Drs will not accept advantage plans because they pay them less. My friend had back surgery and her Dr told her he would not have done surgery if she had an advantage plan. Also, if you travel out of your state and need a Dr….forget about receiving help.

Linda Nichols
2 years ago
Reply to  Maurie Backman

I have Original medicare and includes Silver Sneakers which gets me in FREE to many gyms and rec centers.

Dorothy
6 months ago
Reply to  Linda Nichols

How is silver sneakers included?

Admin
6 months ago
Reply to  Dorothy

Dorothy, here’s an overview of how Silver Sneakers works: https://www.medicareresources.org/glossary/silver-sneakers/

Diane
2 years ago

How can we find out about nurse visits,PT, aides, etc?

Admin
2 years ago
Reply to  Diane

Diane, here are a couple of articles that I think will help:

Hope that helps!

Larry T Iten
2 years ago
Reply to  Diane

The Part D donut hole became a cliff. Don’t they keep up with the news. I went off the cliff in early February now I can no longer afford prescriptions. If I can’t afford prescriptions why do health care and for that matter why have Medicare? I cannot afford insulin so I will go into a coma and die soon anyway. We can all thank the fascists for this. Keep watching Fox News people. Your own self interests are not important compared to the next Tax Cut For The Rich And Powerful Number 69 since 1981.

Jeff
2 years ago
Reply to  Larry T Iten

Ask your physician about prescribing under 340B. Insulin then costs about $9/vial.

Lou Hoch
2 years ago
Reply to  Diane

how do I find out the names of health care service companies in my area that offer home aid services to patients who spent onlyone..or.two nights in a hospital? Is there a medicare listing of companies offering these services to patientss NOT classified as home bound.?

Josh Schultz
2 years ago
Reply to  Lou Hoch

Hi Lou, I am sure you’ll be able to find a company willing to provide those services to you, at least under normal circumstances (COVID-19 has made things harder for people seeking care). The question is whether Medicare will pay for the care. Due to COVID-19, Medicare has loosened its definition of homebound to include people with COVID-19 who need to stay at home. More information about Medicare coverage of home health and skilled care is here: https://www.medicareresources.org/faqs/how-much-in-home-care-will-medicare-cover/

Jay
2 years ago

I had a high income in 2019 due to sale of a rental house and property. Next year my income will be greatly reduced. What form or letter needs to be submitted so future medicare tax is based on my normal income and not 2019 inflated income?

Maurie Backman
2 years ago
Reply to  Jay

The Social Security Administration (SSA) determines if you owe a surcharge on Part B premiums based on the income from your tax return two years prior, so your tax return from 2019 will dictate whether you owe more money in 2021. You can request an appeal (also known as a reconsideration) within 60 days of being notified that you’re being charged extra using this form: https://www.ssa.gov/forms/ssa-561-u2.pdf

Arthur Orofino
2 years ago

I am on Medicare and Medicaid what is my advantage with your program ?? Birth date 01-22-1928 In good shape a little Afib

CATRYNA WHITE
2 years ago

Big friggin deal. So our Part B premium went up from $135.50 to $144.60, with a cost of living raise of 1.6%. When all is said and done, after doing the math, the cost of living raise ended up being .9%; not even 1%. These @[email protected]$ should not even be collecting a premium on Part B. Talk about rip off!

Julia Isham
2 years ago

Is it true that Medicare only pays for 100 days of hospital stay per lifetime?

S. Fet
11 months ago
Reply to  Julia Isham

Medicare will only pay for 100 lifetime inpatient hospital days, but if you do not get admitted to an inpatient healthcare facility for 60 days, those days will reset back to zero. Patients who spend prolonged periods of time in hospitals or are recurrent patients frequently will hit their lifetime maximum. Same goes with skilled nursing benefits. They will reset after 60 days of not utilizing the benefit.

Deb
2 years ago

My 62 year old brother retired in May. He receives ss benefits. He just had an amputation yesterday. Will he qualify for Medicare and will they pick up the last 90 days?

Charlene
8 months ago
Reply to  Deb

I have a similar problem. I need to know if Medicare will cover my health needs even though I am only 62,.

Pat Messina
2 years ago

I am on Medicare…I am also diabetic, my copay for my prescription doubled from $40 to $90. I thought that insulin costs were going to go down. What happened?

2 years ago
Reply to  Pat Messina

The reduction in out-of-pocket costs for insulin is coming in 2021: https://www.medicareresources.org/blog/2020/05/27/medicare-heads-up-may-27-2020/#insulin You’ll want to carefully shop during the upcoming open enrollment period (October 15 to December 7) to see exactly how each Part D plan available in your area would cover your prescriptions. If you make a plan change during open enrollment, it will take effect in January and you’ll start to see the new benefits when you fill prescriptions starting in 2021.

2 years ago

What will the 2021 Medicare Part B premium for someone whose income is around 20,000 from SSDI?

Eric C. Karch
2 years ago

A lot of money for an 80% insurance plan.

Mary C Baker
2 years ago
Reply to  Louise Norris

The problem is that the COLA dollars added to your check are then wiped back out by premiums and deductibles that are always increasing. The cost of living has increased so very much more than 1.3 this year. Grocery stores and all sorts of companies are raising prices so much that it makes it hard to get what you need and still survive. It just gets tougher and tougher each year. I have Part G and Aetna and feel like each year my spouse and I are sinking just from the increases in premiums and deductibles.

Vince
2 years ago

When will the actual high income brackets for 2021 ($88k/$176K?) and the actual medicare premiums be announced?
Can the lowest bracket ever go below $85k/$170k due to deflation?

Editor
2 years ago
Reply to  Vince

We don’t know when the premiums will be announced. The income based surcharges will be announced with them when premiums are released. The lowest bracket is unlikely to decrease.

Rick
2 years ago

Is this a typo? In “October 2021, the federal government enacted a short-term spending bill that includes a provision to limit the Part B Premium increase for 2021”
Will the Part B premiums increase for 2021?The standard premium for Medicare Part B is $144.60/month in 2020, and it had been projected to increase to $153.30/month in 2021. But in October 2021, the federal government enacted a short-term spending bill that includes a provision to limit the Part B premium increase for 2021. Under the terms of the spending bill, the increase for 2021 will be limited to 25 percent of what it would otherwise have been.

Editor
2 years ago
Reply to  Rick

Hi Rick,

What is the typo you think you see?

Josh

Lisa
2 years ago
Reply to  Josh Schultz

The reference to 2021 should be 2020, I believe.

Crowd Scientist
2 years ago

Medicare Advantage plans are generally managed care plans that confine members to county-specific “networks” of hospitals and physicians. These are sometimes called Risk HMOs because the carrier, which is paid a capitation fee by Medicare to assume full responsibility (risk) for providing the full scope of Medicare covered services to the member. Some Medicare Advantage Pans have “thin” networks, which means there are relatively few physicians that accept new patients and few hospital options. What happens if, during the 2021 COVID-19 pandemic, the in-network hospitals run out of available beds? In a hypothetical community like Ocala, FL with 3 hospitals, a Medicare Advantage Plan is not required to pay very much, if anything, for out-of-network hospitalization. If you have traditional Medicare and need ICU care, but all 3 hospitals’ ICU beds are full, Medicare will still cover the costs of medical and hospital care in another hospital in Dade, Broward, Palm Beach or any other county because there are no networks. Being confined to in a Medicare Advantage Plan could be a lot like being stuck on the Diamond Princess Cruise Ship, waiting for permission to dock as you become increasing hypoxic.

Editor
2 years ago

Medicare Advantage plans would have to cover care at other Medicare hospitals when the in-network hospitals have no beds.

Sandy Webster
2 years ago

Will Medicare cover walkers and bedside commodes in 2021?

mary vedborg
1 year ago

Will medicare cover more accupuncture in 2021? It currently cover only low back, but I read that it would be covering neck and upperback as well in 2021.

Editor
1 year ago
Reply to  mary vedborg

Medicare currently covers up to 12 acupuncture visits in 90 days for chronic lower back pain: https://www.medicare.gov/coverage/acupuncture

Patricia A. Johnston
1 year ago

Why does Medicare no longer cover my regular Armour Thyroid prescription? I am now 83 years old. I have taken it since I was 18 years old. Is it because of my age? Is it no longer suitable at my age? Or is there some way I can get coverage?

CarolGiacona
1 year ago

Is Medicare covering testing ULTA sound carries in the neck and electrocardiogram?

julia
1 year ago

if I don’t enroll on Medicare part “B” at 65 because i’m still working do i have to pay a penalty if i enroll at the later time

Joey Walthall
1 year ago

Does Medicare cover Shingle shot?

Tanya Feke, MD
11 months ago
Reply to  Joey Walthall

Medicare Part B covers many vaccines but the shingles shot is not one of them. For that, you will need to turn to Medicare Part D or a Medicare Advantage plan that has prescription drug benefits, i.e., an MAPD plan. These plans do cover the shingles vaccine but that does not mean they will be free. Many plans will require you to pay a copay or coinsurance. Your deductible may also apply.

At this time, there is only one shingles vaccine available in the United States. Shingrix is a two-dose vaccine with doses given 2 to 6 months apart. GlaxoSmithKline, the pharmaceutical company which makes the vaccine, reports that the list price is $162.01 for each dose, $324.02 for the complete series. This is the cost of the vaccine only and does not include any charges that a medical office or pharmacy may charge for injecting you with the vaccine. On average, the company reported that people on Medicare pay less than $50 out of pocket for each dose.

Veronica Hand
11 months ago

I just opened my bill from Anthem for 2022 and found my plan D went from $26.10 to $92.00 per month, is there no cap on % increase for renewals? Are we stuck with this increase for a full year now?

Tanya Feke, MD
11 months ago
Reply to  Veronica Hand

Unfortunately, there is no cap on how much a Part D plan can charge for premiums. Rates can go up and some even go down from year to year. This is one of the reasons it is so important to check the Annual Notice of Change that your plan sends out each year in September. This notice addresses any price or coverage changes your plan will have starting on January 1.

The Medical Annual Enrollment Period (October 15 – December 7), aka Medicare Open Enrollment, is your opportunity to shop around for the Part D plan that will best meet your needs in the new year. This can be a confusing time for many people and you are not alone if you didn’t compare your current plan with other plans this year. https://www.medicareresources.org/survey-post/nearly-three-quarters-of-readers-feel-overwhelmed-by-part-d-options/

Now that Annual Enrollment is over, you may be caught paying these higher premiums through the end of 2022. The only way to change your Part D plan before the next Medicare Annual Enrollment is to qualify for a Part D Special Enrollment Period. This can happen if you are on Medicaid, if you enroll in a Program of All-Inclusive Care for the Elderly (PACE), you are admitted to (or leave) a long-term nursing home or hospital, you move out of your plan’s service area, or you become eligible for the Extra Help program. https://www.medicareresources.org/faqs/how-do-i-qualify-for-medicares-extra-help-program/

You can also change to a Five-Star Part D plan in your area, if there is one available. You can do this anytime from December 8 to November 30 the next year. https://www.medicareresources.org/glossary/medicare-star-rating

Keep in mind this outlines many options for Part D Special Enrollment but is not a complete list.

binky
10 months ago

if my income has decreased do my part d premiums decrease

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