Changes to Medicare in 2023 That You Need to Know


Exciting changes are afoot for 2023, and I can’t wait to share them with you. Whatever your political leanings, if you are one of over 60 million Americans in the Medicare system, there is no denying that the passage of the Inflation Reduction Act will bring predictability to your prescription costs. Here are the big takeaways:


Insulin costs will be capped at $35/month beginning in 2023. Costs of insulin have been steadily increasing and according to the Kaiser Family Foundation, Part D enrollees spent $1 billion out of pocket on insulin in 2020, more than four times the amount spent in 2007. This new monthly cap is a sigh of relief to the millions of diabetics within the Medicare system.


You’ve probably heard of the “doughnut hole” in the current Part D programs, where Medicare covers expensive medications for a period of time before the retiree falls into the hole and has to pay out of pocket before Medicare kicks back in as catastrophic coverage. Retirees can spend tens of thousands of dollars on expensive chemotherapy drugs and rheumatoid arthritis drugs for example. But no more - annual out of pocket prescription costs will be capped at $2,000/year beginning in 2025. Game changer.


The US Government will finally be able to use its weight to negotiate prescription drug prices on behalf of Medicare recipients. It starts slowly, with 10 pricey drugs being negotiated in 2026, and goes on to add another 15 drugs in both 2027 and 2028, and then yet another 20 drugs in 2029. The ramp-up is slow, but this change will make Medicare a more cost-effective health insurance plan for both the government and its recipients.





Lastly, vaccines of all types will be free for Medicare recipients. No more delaying on those pneumonia or shingles vaccines!


Now, let’s switch gears and talk about Medicare Advantage Plans. Remember that Advantage plans are all-inclusive plans that have very low monthly premiums and then you pay a co-pay when you visit the doctor or hospital. The 2 big knocks were high maximum out of pockets and limited ability to be covered beyond your local network. Before you say “not interested”, you should take a fresh look. Insurance companies are rolling out 2023 Advantage plans that include significant dental, vision and eyeglass coverage, hearing aid coverage, and in some plans a $200 quarterly payout for over-the-counter pharmacy items. And I’m not done yet: the maximum out of pocket for those co-pays is dropping to $3,200 in 2023 and then down to $2,000 in 2024. No more worrying that a hospital stay could drain your savings with high co-pays. Most importantly, plans are putting into writing that you can see any network provider while traveling in the US and the copay will be the same.


This is game changer stuff, people. When you add up the cost of your total health costs under traditional Medicare: the supplement premium, the prescription premium, the out of pocket for dental, vision, hearing aids, OTC needs, and then stack it up against an Advantage plan that covers all of that, you’re in for a pleasant surprise.


To learn more, reach out to myself or Rick Austin, who is an independent Medicare insurance professional providing our clients with Medicare expertise for the last 8 years. He is known for his no-nonsense approach to finding the best Medicare deal out there, and his easy-going friendly personality actually makes Medicare planning fun. He is a wealth of information and can help you parse through the minutia and find the right plan for you. Email him at raustin@marshwealth.com.



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