Medicare is Changing: What You Need to Know
We understand the importance of staying informed about the latest changes in the Medicare system. Recently, new legislation has been enacted, and with the official end of the COVID public health emergency, several changes are taking effect. These changes are a mixed bag—some are beneficial to beneficiaries, while others might cause confusion. Here's what you need to know:
1. Insulin Price Caps
Starting this year, Medicare beneficiaries will have a copay of no more than $35 for a 30-day supply of any insulin listed in their Part D plan’s covered drugs. This cap applies even if the beneficiary hasn't yet reached his/her Part D deductible. However, it's crucial to note that this cap will not apply to insulin not listed in the beneficiary’s Part D plan’s “formulary” of covered drugs.
2. No More Lengthy Enrollment Delays
In the past, new enrollees had to wait months for their Medicare coverage to begin if they missed their Initial Enrollment Period. Starting January 1, 2023, when you enroll during the General Enrollment Period, Medicare coverage begins on the first of the month following the month of enrollment. However, it's still best to sign up for Medicare as soon as you are eligible to avoid late-enrollment penalties.
3. Part B Premiums and Deductibles Fell Slightly in 2023
Medicare monthly premiums and annual deductibles rise most years, but beneficiaries might be surprised to learn that the Part B standard premium dropped by around $5 a month in 2023 to $164.90/month, and the annual Part B deductible was reduced by $7. However, this cost reduction is an exception, not a new trend.
4. Part D Out-of-Pocket Cost Caps Are Coming
Starting in 2024, the 5% coinsurance in Part D’s catastrophic coverage phase will be eliminated, and starting in 2025, Part D out-of-pocket prescription drug costs will be capped at $2,000. This change is excellent news for anyone who requires very expensive drugs in the future.
5. Vaccines No Longer Require a Copay
Starting this year, vaccines are covered without any copays for Medicare beneficiaries, regardless of whether they’re covered under Part B or Part D. However, the vaccine must be recommended by the Advisory Committee on Immunization Practices (ACIP).
6. Expanded Telemedicine Coverage Will Continue
Medicare has traditionally covered “telemedicine” only under very specific circumstances. However, the Consolidated Appropriations Act passed in the final days of 2022 extended the flexible pandemic-era telehealth coverage rules until the end of 2024.
7. Dental Coverage Has Expanded—But Only Slightly
Even though Medicare’s coverage of dental procedures has expanded this year, the majority of dental visits still are not covered. The recent change improves coverage for only dental procedures that are integral to the success of certain non-dental medical procedures.
At Summit, we're committed to helping you navigate these changes and understand how they impact your coverage. Contact us today for personalized advice and guidance.
