By Hadley Gavin
America’s senior citizens nearing age 65 might be thinking, “what is Medicare, and why am I being bombarded by Medicare solicitations?” Medicare is health insurance for seniors 65 years and older and others who qualify due to disability benefits. Medicare Part A covers inpatient services, hospice, and skilled nursing. Medicare Part B covers outpatient services, such as doctors’ visits, durable medical equipment, x-rays, ambulance rides, and more. With the new year around the corner, here are some facts about Medicare in 2023.
New Medicare premiums and deductibles
You might be surprised that Medicare has premiums, deductibles, and coinsurance costs. Although you paid Medicare taxes through your paystubs at work, you are still responsible for your Medicare costs. But many of you might receive Part A with a $0 premium.
Here’s how – if you or your spouse have worked in the U.S. for at least ten years (equivalent to 40 quarters) and paid payroll taxes, Part A is $0 for you. If you don’t have the whole 40 quarters but at least 30, you will pay a pro-rated Part A premium of $278 per month. If you have less than 30 quarters, you will pay the total Part A premium of $506 per month.
If you become an inpatient at the hospital for over three consecutive days, you will pay the Part A deductible of $1,600 in 2023. Once you meet the deductible, Part A will cover your approved care for 60 days. After day 60, you will begin to pay a daily copay.
You will pay the Part B premium no matter how many quarters you have worked. In 2023, the standard Part B premium is $164.90 per month. You will pay this amount as long as you are enrolled in Part B! However, if you are in a high-income tax bracket, you will likely pay an income-related monthly adjustment amount (IRMAA) fee on top of your Part B premium.
Medicare Part B also has an annual deductible that you must meet before Part B starts covering 80% of your Medicare-approved services. In 2023, the yearly Part B deductible is $226. Once you meet this amount, Part B will cover 80% of your Medicare services, and you will pay the remaining 20% coinsurance.
Shingles vaccine coverage
Original Medicare Part A and Part B do not cover prescriptions you pick up at the pharmacy. You will need to purchase a Part D plan for drug coverage. But, Part D covers more than just medications; it also covers certain vaccinations, such as the Shingles vaccine.
In the past, you must first meet the Part D plan’s deductible before it pays its share for the shingles vaccine. In 2023, all Medicare Part D plans are required to cover the Shingles vaccine at 100%. Therefore, you would not have any out-of-pocket costs for this vaccine.
Immunosuppressant drug coverage
End-Stage Renal Disease (ESRD) is a condition where your kidneys stop working, and you would then undergo long-term dialysis or a kidney transplant. If you have a kidney transplant, you must take immunosuppressant medications for the rest of your life. Immunosuppressant drugs help reduce your body from rejecting your kidney transplants.
Although Medicare Part D covers medications you pick up at the pharmacy, immunosuppressant drugs will actually fall under Medicare Part B coverage. In 2023, there will be changes to this drug coverage!
Suppose you are under 65 and were on Medicare for 36 months. You can purchase Medicare Part B for immunosuppressant drug coverage if you do not have another form of insurance covering your medications. But Part B will only be drug coverage, and you will need to purchase additional insurance for medical coverage until you reach Medicare age (65 years old).
Changes to the General Enrollment Period
Did you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period? Don’t worry; you can apply for Medicare during the General Enrollment Period (GEP). The GEP begins on January 1 and ends on March 31 every year. Typically, when you use the GEP to apply for Medicare Part A and Part B, your coverage will become effective on July 1. But there will be some exciting changes in 2023!
Beginning in January 2023, if you apply for Medicare during the GEP, your Medicare coverage will start on the first of the following month. You will no longer have to wait until July for your Medicare coverage to become effective. However, please remember that if you apply for Medicare during the GEP and do not have proof of creditable coverage while you delayed Medicare, you will pay a late enrollment penalty.
Wrapping up
Some exciting changes are coming to Medicare in 2023! Contact a reputable Medicare broker for more information on Medicare costs, coverage, and enrollment periods, or visit Medicare.gov.
