The Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, recently issued several new regulations that will impact Medicare beneficiaries. These new regulations include changes to Part B and Part D premiums, shifts to Medicare Advantage plans, and adjustments to telehealth and audiology coverages.
Table of Contents
Overall Cost Changes to Medicare
Part A premium
$278 or $506
Part A deductible
Part A coinsurance: Days 61-90 of hospitalization
$389 per day
$400 per day
Part A coinsurance: Lifetime reserve days of hospitalization
$778 per day
$800 per day
Part A coinsurance: Days 21-100 of extended care services in a skilled nursing facility
$194.50 per day
$200 per day
Part B premium
Part B deductible
Part D premium*
Part D maximum deductible*
Increases in Medicare Part A Costs
Part A premiums to increase to $278 for 2023
Though most Medicare beneficiaries are eligible for premium-free Part A, those who have premium-paid Part A will see a $4 increase from 2022’s $274 premium to 2023’s $278 premium. However, those who must pay the full Part A premium — such as Medicare beneficiaries under 65 years old or those who have not paid enough into their Social Security benefits through employment — will pay $506 for Part A.
Part A deductibles to increase to $1,600 for 2023
The annual deductible for Medicare Part B is $1,600 for 2023, a $44-dollar decrease from the deductible of $1,556 in 2022. This means beneficiaries will have to pay more before they may access their Medicare benefits for Part A coverages, like hospital stays and care in a Skilled Nursing Facility.
Part A coinsurance to increase for 2023
Coinsurance amounts for Part A for specific healthcare services are set to increase in 2023:
Coinsurance for days 61-90 of hospitalization
$389 per day
$400 per day
Coinsurance for lifetime reserve days of hospitalization
$778 per day
$800 per day
Coinsurance for days 21-100 of extended care services in a skilled nursing facility
$194.50 per day
$200 per day
Decreases in Medicare Part B Costs
Part B premiums decrease to $164.90 for 2023
CMS announced it will incorporate savings from Aduhelm price cuts into the 2023 Part B premium rate, leading to an overall Medicare Part B premium decrease from $170.10 in 2022 to $164.90 in 2023.
Aduhelm, a drug for the treatment of Alzheimer’s disease, drove a large part of Medicare Part B’s 14.5% premium increase from 2021 to 2022. The 2022 premium reflected the original projected cost of covering Aduhelm for all beneficiaries. By the time Aduhelm’s manufacturer halved the projected cost of the drug in late 2021, it was too late to adjust the 2022 premium to reflect this update in pricing. In addition, CMS reduced overall coverage of the drug, further driving down Part B premiums for 2023.
Part B deductibles decrease to $226 for 2023
The annual deductible for Medicare Part B is $226 for 2023, a $7-dollar decrease from the deductible of $233 in 2022. This will allow beneficiaries to access their Medicare benefits slightly quicker for Part B coverages, like diagnostic lab tests, preventative care, and access to durable medical equipment.
Decreases in Medicare Part D Costs
Part D average premiums projected to decrease to $31.50 for 2023
Medicare Part D is a prescription drug health plan that is optional for Medicare beneficiaries and offered through private insurance companies approved by Medicare. Many Medicare Advantage plans also include Part D, or beneficiaries can purchase Part D as a stand-alone plan. As such, insurers set Part D premiums.
However, CMS regulates these private plans and announced that the average monthly premium for Medicare Part D coverage will be $31.50 in 2023. This average is a decrease from 2022’s average monthly premium of $32.08, though ultimately, your Part D premium will vary based on the insurer.
Drug prices to potentially decrease throughout 2023
Beginning January 1, 2024, CMS will require Part D plans to apply price concessions when calculating cost sharing. This new requirement will reduce beneficiary cost-sharing expenses because factoring in price concessions will lower drug prices.
Cost sharing generally includes a beneficiary’s out-of-pocket costs for healthcare services or drugs, including deductibles, coinsurance, and copayments. However, it does not include premiums or the cost of non-covered services.
Price concessions for drugs are rebates that a Part D health plan receives from the drug manufacturer, which lowers the cost of the drug for the insurer.
Cost-sharing expenses for drugs under a Part D plan do not currently account for price concessions. Mandating those prices to be set with expected price concessions applied should lower copays, coinsurance, and other cost-sharing expenses for beneficiaries.
Shifts to Medicare Advantage Plans
Medicare advantage plans must offer easier access to care during emergencies and disasters
Medicare Advantage plans are required to cover out-of-network services and waive provider referral requirements during a declared disaster or emergency, such as COVID-19. CMS expanded this requirement, mandating that Medicare Advantage plans ensure access to covered services throughout the entirety of a disaster or emergency period. This coverage term includes situations where the end date is unclear and the emergency period renews several times.
More criteria for medicare advantage providers to meet
CMS enacted new criteria for Medicare Advantage plans to meet. Though private insurance companies offer Medicare Advantage plans, they follow Medicare-set regulations. Two new criteria are network adequacy requirements and quality benchmarks for expanding an existing plan’s service area.
Insurers hoping to offer Medicare Advantage plans must demonstrate to CMS that their plans have a sufficient network of providers to care for beneficiaries. In other words, networks must include enough physicians, specialists, and facilities to reasonably cater to those enrolled in the plan.
CMS will provide insurers with information regarding their network adequacy before or in early 2023, which could help insurers mitigate issues with their network providers ahead of time.
Marketing and Communications
CMS plans to increase its oversight of all marketing materials about Medicare Advantage plans to eliminate misleading information and confusion.
Quality Benchmarks for Expansion Requests
CMS will begin factoring in a Medicare Advantage plan‘s quality rating, financial history, and compliance history when evaluating applications for expanding a plan’s service area. Plans that fall short of expectations for care will be denied an opportunity to increase their coverage.
Shifts to Telehealth Coverages
Telehealth includes services received from a healthcare provider without being in the doctor’s office, such as if you get care from your doctor over the phone or the internet.
Before COVID-19, Medicare covered some telehealth services, such as virtual and telephone office visits and some health screenings. However, these benefits only applied to beneficiaries in specific settings, like those living in rural areas.
New changes to telehealth coverage will see the ending of some telehealth benefits as well as the expansion of others.
Temporary expansion to telehealth coverages set to end in 2023
During the COVID-19 emergency, the federal government temporarily expanded coverage of telehealth services, such as occupational and talk-based therapy delivered through audio-only telephone services. The expanded coverage also allowed telehealth services to be received in the beneficiary’s home.
However, these expanded coverages will wind down as of October 13, 2022, coinciding with the federal end date of the COVID-19 public health emergency. A 151-day extension period will begin before the telehealth expansions expire to allow for a transition period.
Temporary new services added to medicare telehealth services list
CMS’ list of covered telehealth services includes a Category 3 list, which are the services that CMS will cover temporarily during a public health emergency, including COVID-19. Recently, CMS proposed adding 54 codes to its Category 3 telehealth list, further increasing the number of services that beneficiaries would have access to during an emergency.
The proposed service additions are:
- Electronic analysis of implanted neurostimulator pulse generators and/or transmitters
- Ventilator management
- Ophthalmologic services
- Audiologic services
- Speech therapy
- Cognition care
- Adaptive behavior treatment
- Behavior identification assessment
- Behavioral health care
If approved, coverage of these services will expire on December 31, 2023.
Coverage for Audio-only Telehealth Services to End
Audio-only telehealth refers to services provided using audio-only technology, like a phone. As such, it does not include services delivered with video. CMS will permanently expand audio-only telehealth coverage to include mental and behavioral health services for patients unwilling to use video-conferencing telehealth services.
At the end of the 151-day waiting period after October 15, 2022, Medicare will no longer cover other audio-only services.
Medicare To Cover One Non-referral Audiology Appointment per Year
Audiology services are hearing and balance assessments provided. Medicare beneficiaries historically needed an approved physician’s referral to seek care from an audiologist.
CMS is proposing to remove the physician referral requirement for certain audiology services, such as examinations for hearing aid prescriptions. CMS proposes to allow audiologists to bill for this service without a referral once every 12 months.