Robert Wagner Insurance October 2022 Newsletter

The Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts.

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

Beginning in 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.   Read more >

The Medicare Annual Election Period runs from October 15th to December 7th, 2022. During AEP, you can make changes to your Medicare health and drug plans. These changes will be effective beginning on the first day of the new year. You may choose to make changes because your plan no longer suits you or will cost more in the upcoming year.

If you have a health plan through Covered California or direct from the health plan beginning November 1st through December 31st you can make plan changes which will be effective on January 1st.

Open enrollment will continue through January 31st with changes effective February 1, 2023.

Effective 10/1/2022 CMS requires that all Medicare Advantage and Prescription Drug Plan calls be recorded. This includes all inbound and outbound phone calls.

A disclaimer stating that the call is being recorded must be given at the beginning of the call and must include acknowledgement. 

If we speak by phone concerning your Medicare Advantage or Drug plan the call will be recorded because of this Medicare mandate. 

Most of the changes to Part D such as the $2000 Out of Pocket Cap and the limit on premium increases will not take effect until 2024, 2025 and 2026.

The cap on insulin copays started in 2022 is expanded in 2023 as well as some additional vaccines to be covered by Part B.

Negotiated drug prices will begin in 2026 with an initial maximum of ten high cost and highly utilized drugs.  Read more >

Many seniors have avoided the popular Medicare Advantage plans because they wanted to avoid the constraints of an HMO. This year's open enrollment demands a second look. In 2023 there will be several new Medicare Advantage PPO plans to choose from, some with a national PPO network, a built-in dental allowance, and included Part D coverage. 

If the cost of your current Medicare Supplement and Part D drug plan are stretching the budget one of the low premium Medicare Advantage PPO plans may be the answer. Give me a call or email for more information.

The Medicare Part B Premium Giveback is a popular selling point for certain Medicare Advantage plans. Why wouldn’t it be? It’s effectively paying for a designated portion or all of your Part B premium, which could save you a good bit of money each month. Even though the Part B Giveback may be popular, it’s not perfect and there may be circumstances where another type of plan may be more preferable. That may sound crazy but bear with us. We’re going to look at why a Part B Giveback is beneficial and when it may not be the best value for you.

The Benefits

If you’re healthy and don’t use your coverage often, the reduction in your Part B premium can really be worth it. Let’s examine the best-case scenario:

You have a Medicare plan that pays the entire Part B premium for you ($170.10 in 2022). That’s over $2,000 you’re receiving back into your Social Security check due to the Giveback each year. If you’re not using your Medicare plan much outside of fully covered regular checkups, this could either cover the entirety of your medical and prescription costs for the year or go into savings for a rainy day. It’s important to keep in mind that is the best-case scenario. Most Part B Givebacks don’t offer an amount that covers the entirety of the Part B premium. They generally fall between $30 and $100. That’s certainly not an insignificant amount of money, but it does mean you’ll still be paying at least a portion of the Part B premium.

Also, the Giveback may not cover a service you need more often, meaning you end up spending more out-of-pocket due to a lack of coverage. This may be worth it if the amount you spend out-of-pocket is less than what you receive from the giveback, but unless it’s a sizable difference, you’re running the risk of having a more expensive plan while effectively missing out on the benefit of the giveback.

Let’s say that one of the plans offered a $50 per month Giveback, but this was matched with a $10 office visit and $35 specialist visit charge. If your current health circumstances cause you to see multiple specialists monthly, the costs of this plan may quickly outweigh the value of the Part B Premium Giveback.

The Bottom Line

Ultimately, the Part B Premium Giveback can represent a solid value for you, but it should not be the defining decider for you. When you’re exploring your options, you should consider the Giveback a happy bonus, because you still need to be satisfied with the plan you signed up for. At the same time, as mentioned previously, if your Giveback benefit doesn’t cover the services you need, you may end up paying more out-of-pocket than you would have if you had signed up for a non-Giveback plan. So, when choosing a Medicare plan, there are a number of factors to consider, but the chief considerations should be:

1. Does the plan cover your needs sufficiently?
2. Does the network cover the health care and service providers you need?
3. Are the costs, like premiums and deductibles, affordable to you?

The U.S. Food and Drug Administration (FDA) made an announcement that’s music to many consumers’ ears. They finalized a new ruling anticipated to increase access and affordability for hearing aids.

These essential tools for many have long received spotty coverage under Medicare and other forms of insurance, leaving consumers to either save up or make do

without. Now, many more Americans should be able to access hearing aids without breaking the bank.

All facts and figures can be found in the FDA’s press release on the finalized ruling, unless specifically linked elsewhere.

When Will Over-the-Counter Hearing Aids Be Available?

Not all hearing aids will suddenly become available over the counter, however. This ruling creates a new category of hearing aid identified as over-the-counter (OTC) that will still follow standards to maintain safety and effectiveness. The FDA hopes that this new category will spur competition and innovation to further drive down costs. The effective date for this ruling is October 16, 2022, or 60 days after its publication in the Federal Register   Read more >>

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