While navigating Medicare rules and regulations can be challenging and, in some instances, costly, recently enacted legislation offers important enhancements and potential cost savings for Medicare beneficiaries starting this year.
Both the Inflation Reduction Act, which was signed into law last summer, and the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, which became law in 2020, have provisions taking effect in 2023 that can positively impact those receiving Medicare. From quicker access to coverage to savings on insulin for diabetics and free vaccines, here’s a rundown of what to expect.
Improvements from the BENES Act
The key provisions of the BENES Act seek to better connect eligible individuals with Medicare coverage by reducing administrative complexities. A major component of delivering on these provisions involves eliminating the waiting period for enrollees across different enrollment periods beginning January 2023.
- Initial Enrollment Period (IEP): Enrollees who sign up during their Initial Enrollment Period in the month of, or one of the three months following their 65th birthday, will be covered the first day of the following month. Previously this would have taken up to three months to kick in.
- General Enrollment Period (GEP): For individuals signing up during the General Enrollment Period, coverage will now begin the first day of the month following the month of enrollment rather than July 1st.
In addition, those who meet exceptional circumstances, as established by the Secretary of the Department of Health and Human Services, will be afforded a Special Enrollment Period (SEP), something previously only available to those with Medicare Advantage plans or Part D Prescription Drug coverage. With the new regulations, a Special Enrollment Period has been established for individuals:
- Impacted by an emergency or disaster as declared by a federal, state, or local government;
- Who received misinformation about coverage eligibility from their employer, health plan provider, agent, or broker;
- Formerly incarcerated;
- Missing coverage due to termination of Medicaid eligibility; and,
- Meeting other exceptional circumstances as reviewed on a case-by-case basis.
Inflation Reduction Act enhancements
The Inflation Reduction Act (IRA) sets forth several provisions to generate savings on prescription drugs and limit costs associated with Medicare. In addition to the provisions set to be implemented over the next few years, a handful of key changes have gone into effect as of 2023. One such provision requires pharmaceutical companies to pay rebates to Medicare when the costs of drugs outpace inflation. While not providing direct relief to Medicare beneficiaries, these rebates will go to the Medicare Supplementary Medical Insurance (SMI) trust fund, which helps to cover the costs of Medicare Part B and Part D.
A well-publicized and celebrated component of the Inflation Reduction Act places a limit of $35 on monthly cost sharing of insulin products covered under Part D and insulin covered by Part B. Previously costs could fluctuate drastically depending on plan coverage, forcing some Americans to pay hundreds of dollars per year for medication. The spending cap on insulin through Part D Prescription Drug coverage went into effect January 1st, while the cost for insulin covered under Part B will be capped starting July 1st.
Finally, for beneficiaries with Medicare Part D coverage seeking vaccinations, all All Committee on Immunization Practices (ACIP) recommended vaccines, including shingles and Tdap, are now covered in full. Experts hope this coverage adjustment will help increase vaccine utilization, particularly among vaccines such as Shingrix. Despite the risk of contracting shingles – and serious complications as a result – increasing with age, the shingles vaccine typically has low participation among Medicare beneficiaries.
Looking beyond 2023
While Medicare beneficiaries should take note of the several important changes occurring this year, additional provisions will be rolling out through the next few years. We will continue monitoring updates as they come up and will report on changes beneficiaries should be aware of. If you have any questions on these changes or any other Medicare-related topics, reach out to one of our Licensed Insurance Agents at Aevo Insurance Services or to Medicare directly.