The standard monthly premium for Medicare Part B will decrease in 2023 to$164.90, a savings of $5.20 from 2022’s premium of $170.10. The Part B deductible will also decrease to $226.00, a savings of $7 form the 2022 deductible of $233. The change was precipitated by a May 2022 report from the Centers for Medicare and Medicaid Services (CMS) that recommended excess reserves in the Supplementary Medical Insurance Trust Fund (SMI) be passed on to Part B beneficiaries.
This savings will be offset, however, by an increase in the Part A deductible and coinsurance amounts. The Part A deductible will be $1,600.00 in 2023, an increase of $44 from $1,556 in 2022. Daily copays for days 61-90 in the hospital will go from $389 to $400, and copays for days 91-150 will increase from $778 to $800. The skilled nursing facility copay will increase from $194.50 to $200.00
If you have a Medicare Advantage Plan and want to get back into a Supplemental Plan without going through medical underwriting, Blue Shield is having an Underwriting Holiday from now until November 30, 2022. Why is this the perfect time to switch? Since the Underwriting Holiday overlaps with AEP (Medicare’s Annual Enrollment Period), you would be able to get a Stand-Alone Part D drug plan to go with your Supplemental plan (since supplemental plans don’t include drug coverage). From October 15 to December 7, you can sign up for a drug plan with an effective date of January 1, 2023.
People change plans for several reasons, but the main reason is to have more choice with their healthcare. Medicare supplemental plans have no networks and no referral restrictions. You just have to go to doctors who accept Medicare. Once you have been in a Medicare Advantage Plan for over a year, you have to fill out an application for a supplemental plan and answer medical questions if you want to move back to Original Medicare and get a medigap plan. You could be turned down for the plan due to pre-existing medical conditions. During an underwriting holiday, you wouldn’t have to answer health-related questions, and you would be guaranteed issue.
The plans being offered during the Underwriting Holiday are the popular G plans (comparable to the F plan which is no longer available to those eligible for Medicare after January 2020). The G plan covers Medicare Part A coinsurance and the Part A deductible, the Part B coinsurance (but not the Part B deductible), Part B excess charges, and foreign travel emergency coverage (up to plan limits). Plan G Extra and Inspire have added benefits like hearing and vision.
As Annual Enrollment for Medicare Advantage and Prescription Drug plans approaches, it is time for Medicare beneficiaries to take stock of their current plans to determine if a change would benefit them. Plan members should be receiving their Annual Notice of Changes in the mail to see what modifications (if any) are being made for 2023. But with the influx of new Medicare Advantage plans with myriad benefits, how do you choose the right one for you? Below is a checklist of items you want to consider when trying to make a decision if you are new to Medicare or just considering making a plan change.
1. Do you want a PPO or HMO plan? While most Medicare Advantage Plans are HMO’s, there has been an increase in the number of PPO’s being offered. HMO’s require you to go to network providers or you won’t be covered. PPO’s give you the option to go out of network, but you will pay more (in copays or coinsurance) if you do. PPO’s normally have a higher premium because they give you this choice, but it might be worth it if you want to have the benefit of seeing out-of-network doctors. Medicare Advantage Plan PPO’s should not be confused with Medicare Supplemental plans. Supplemental plans have no networks but do require you to go to doctors who take Medicare.
2. If you have a doctor or specialist you want to see, make sure they are in network for the plan you are considering. Don’t assume that every doctor in a practice is contracted with the plan. You can call the plan directly or look up the doctor online on the plan’s website to verify if they are in network. Remember, however, that a doctor may discontinue his contract with the plan at any time, which means you would have to find a new physician if this were to happen.
3. Do you have specific health issues you want addressed? Some plans are designated as CSNP’s or Chronic Special Needs Plans. These plans structure benefits to address certain illnesses like diabetes, certain heart conditions or end-stage renal disease.
4. Are you on MediCal as well as Medicare? There are DSNP’s or Dual-eligible Special Needs Plans that coordinate benefits with Medicare and MediCal to make it easier to access doctors and benefits. They may include extra benefits like vision, hearing, dental, transportation and telehealth services.
5. If you take certain medications, make sure they are in the formulary of the plan. Each plan has a unique formulary, or list of medications that they cover. Be sure and check this list to ascertain your meds will be covered. Some plans are part of the Senior Savings Model in which they cap the price of insulin at around $35. While you and your doctor can appeal to the plan to cover a medication that is not in the formulary, there is no guarantee that they will cover it.
6. If you are new to Medicare, you may choose an Advantage Plan and find that this type of plan is not right for you. If you cancel the plan within the first twelve months (from the effective date), you will have guaranteed issue rights to switch to a Supplemental plan, which means you can get a Supplemental plan without going through underwriting or answering medical questions. If you wait longer than the twelve-month period, you would be subject to underwriting and could be turned down for a Supplemental plan.
Medicare is a complicated topic, so if you are confused, an experienced broker can help answer your questions and address your concerns. A local broker will be familiar with the plans available in your area, the physician networks contracted with the plans, and can help narrow down your choices based on your specific needs.
The proposed White House Budget for 2023 has some key healthcare considerations the Biden administration has long wanted to address. Paramount among them is a five-year $81.7 billion investment in pandemic preparedness. The focus would be in research of vaccines and treatments for biological threats like COVID-19. Prevention and technology to combat new illnesses that might arise in the future are also targeted for increased funding.
Investment in research to combat cancer is also a high priority for President Biden who hopes to reduce the cancer death rate by 50% over the next 25 years. The Cancer Moonshot Initiative, which was implemented during the Obama Administration by then Vice-President Biden, is a coalition seeking vaccine-based immunotherapy treatments against cancer.
Mental health, suicide prevention, and reducing HIV/AIDs infections are also issues President Biden wishes to address in the 2023 budget. Funding would be allocated to bolster community clinics offering mental healthcare services and increase workers in the mental healthcare industry. Nearly $850 million would go to Health and Human Services to increase accessibility to pre-exposure prophylaxis (PrEP) to decrease the transmission of HIV/AIDS. Funding would also be used to add more community providers for underserved populations.
Long COVID (sometimes called Long Haul COVID) could become a disability under the Biden Administration, making the condition eligible for protections under the Americans with Disabilities Act, the Rehabilitation Act of 1973 and the Patient Protection and Affordable Care Act. These Acts prevent discrimination and provide resources to those affected by disabilities. Long Haul COVID symptoms can include fatigue, brain fog, headache, cough, dizziness and depression, as well as other conditions that adversely affect a person’s ability to function.
A doctor’s assessment would likely be necessary to document a person’s limitations due to the long-term effects of COVID in order to be deemed disabled according to the department of Health and Human Services. Eating, sleeping, speaking and working are examples of some of the major disruptions of life activities that would be looked at to determine disability status.
The Biden Administration has asked for input in clarifying how the law banning surprise medical billing would address non-emergency care from out-of-network providers. Should a specialist be allowed to refuse to treat someone unless he/she can balance bill the individual without putting pressure on the patient to waive their protections? The law implements a “notice and consent” process which must be in-acted when a provider wishes to balance bill an individual seeking treatment. How to accomplish this without undermining the insurance network model, which purportedly holds down costs, is at question.
The No Surprise Act (NSA) was part of the COVID-19 relief package voted into law by Congress last December. Going into effect in January of 2022, the NSA prohibits providers from billing patients more than in-network cost-sharing. It applies to situations where patients cannot choose in-network providers like emergency care and certain nonurgent circumstances where a network provider is not available.
The law also holds providers responsible for keeping provider directories up to date and accessible to their members. If a patient can show that they received outdated information on whether a provider was in-network prior to an appointment, they will have to pay the in-network cost-sharing amount only.
One of the largest relief packages in U.S. history, the American Rescue Plan Act of 2021, gives about $34 billion to aid Americans in buying health insurance. The provisions in the bill do expire in two years, however, there may be a push by Democrats down the road to make them permanent.
Among the biggest winners in President Biden’s $1.9 trillion COVID relief package are those who buy health insurance on the federal marketplace exchanges, which in California is Covered California. The bill includes a provision that caps what an insured would pay for premiums on the exchange to 8.5 percent of income. It also provides for those who find themselves unemployed due the pandemic, allowing them to buy health insurance on the exchanges even though they are receiving unemployment benefits, which typically excludes them from getting subsidies.
Another key aspect of the bill addresses those who are on COBRA, the program that allows workers to buy coverage offered by their former employer. The bill would pay 100 percent of the COBRA premiums from April 1, 2021 to September 30, 2021. The bill also includes incentives for states that did not expand Medicaid to do so, allowing more people to qualify for help from the federal aid program.
As the Biden Administration works with FEMA to open 100 COVID vaccination sites across the United States, there is still much confusion over who is eligible to get the vaccine and where they go to schedule an appointment. The two federal sites in California that have already opened are located at Oakland-Alameda Colosseum in the Bay area and California State University in Los Angeles.
As well as these county sites, appointments can be made at certain Albertsons, Rite Aid, Ralphs and Pavilions pharmacies. Blue Shield and Kaiser Permanente have been contracted with the state to help manage the vaccine rollout. Those who are eligible currently, according to state guidelines, are those in phase 1A (healthcare workers and long-term care residents) and 1B (those 65 and older, agricultural and food workers, educators and emergency service personnel). The next phase, which includes those 16 to 64 with high-risk underlying conditions is scheduled to open on March 15.
With the cost of insulin nearly tripling over the past decade, many Americans with diabetes face difficult decisions when it comes to their health – whether to limit or stop taking their insulin because of the staggering cost. Seniors on fixed incomes may be even more vulnerable to the dire consequences of not being able to afford their medications.
In an effort to address the growing problem, the Centers for Medicare and Medicaid have implemented the Senior Savings Model for Part D Drug plans starting in January 2021. This new model limits copays in the deductible, initial and coverage gap phases for certain brands of insulin to a maximum of $35 per 30-day supply. The cost could even be less, depending on the medication. These rules apply to both stand-alone Part D drug plans and those imbedded in Advantage plans. Plans do not have to participate in the new model, and there are a limited number of plans that have opted into the new program.
In California, the stand-alone Part D plans that have agreed to participate are as follows: AARP Medicare Rx Preferred, Cigna Secure-Extra Rx, Express Scripts Medicare Choice, Express Scripts Medicare Saver, Humana Premier Rx, Mutual of Omaha Rx Premier, WellCare Medicare Rx Value Plus, WellCare Value Script, WellCare Wellness Rx. Advantage plans participating in the Senior Savings Model vary by county.
With domestic violence on the rise during the pandemic, Covered California has added a new Qualifying Life Event (QLE) for victims to get health coverage outside of open enrollment. Victims of domestic abuse or spousal abandonment may qualify for a special enrollment period at which time they may apply for coverage or remove themselves and/or dependents from existing coverage to enroll in a new health plan.
While a QLE is not needed to terminate coverage, if the consumer is the primary on the insurance or the spouse of the primary, he or she may remove the abuser and/or dependents from the plan. If not a spouse or registered domestic partner, the abused can remove only themselves from the plan but not dependents. Once removed from the plan, they may then apply for coverage under the single or head of household tax filing status. A CPA should be consulted about the tax ramifications reported on their returns once new coverage is selected.
Open Enrollment begins on November 1, 2020 and goes through January 31, 2021. (Not to be confused with Medicare’s Annual Enrollment Period which goes from October 15 to December 7.) During Open Enrollment, you may sign up for new coverage, change or renew current coverage or sign up for Medi-Cal (although you can apply for Medi-Cal at any time during the year).