Medicare Advantage (MA) plans are a popular option for many Medicare beneficiaries who want more benefits and lower costs than original Medicare. MA plans are offered by private insurance companies that contract with Medicare to provide all the services covered by Part A and Part B, plus some extra benefits such as vision, dental, and hearing care. MA plans also include Part D prescription drug coverage, which is optional under original Medicare.
If you are interested in enrolling in an MA plan or switching from your current plan, you should be aware of some important changes that will take effect in 2023. These changes may affect the availability, affordability, and quality of MA plans in your area. Here are some of the key updates that you should know:
- More help with insulin costs. If you have diabetes and need insulin, you may be able to save money by choosing an MA plan that participates in the Part D Senior Savings Model. This is a new initiative by the Centers for Medicare & Medicaid Services (CMS) that aims to lower the out-of-pocket costs of insulin for MA enrollees. Under this model, participating MA plans will offer a maximum copay of $35 for a 30-day supply of insulin, regardless of the drug tier or coverage phase. According to CMS, this could save enrollees an average of $446 per year on insulin costs . This model will also encourage MA plans to offer more choices and lower prices for other prescription drugs, such as brand-name and specialty drugs .
- Better access to essential health care services during emergencies and disasters. If you face an emergency or disaster situation, such as a hurricane, wildfire, or pandemic, you will have more flexibility and protection when accessing health care services under your MA plan. CMS has announced that MA plans will be required to cover medically necessary services at any Medicare-certified facility during a declared emergency or disaster, regardless of network status or prior authorization requirements . This means that you will be able to receive timely and appropriate care without worrying about additional barriers or costs. This rule will also apply to telehealth services, which have become more widely used and accepted during the COVID-19 pandemic .
- Ability to enroll in any MA plan if you have end-stage renal disease (ESRD). If you have ESRD, which is a severe kidney condition that requires dialysis or a transplant, you will have more options when choosing an MA plan. Previously, ESRD patients were restricted to enrolling in certain types of MA plans, such as Special Needs Plans (SNPs) or Chronic Condition Special Needs Plans (C-SNPs). Starting in 2023, ESRD patients will have the same enrollment options as other Medicare beneficiaries, which may increase their access to more comprehensive and coordinated care . However, ESRD patients should still compare the costs and benefits of different MA plans carefully, as some plans may charge higher premiums or copays for ESRD-related services .
These are some of the key updates of MA plans in 2023 that may benefit you as a current or potential enrollee. For more information on these and other changes, please refer to the following sources:
If you are ready to enroll in an MA plan or switch from your current plan, you can use the Medicare Plan Finder tool at https://www.medicare.gov/plan-compare/ to compare the plans available in your area. You can also call 1-800-MEDICARE (1-800-633-4227) or contact your local State Health Insurance Assistance Program (SHIP) for free personalized counseling and assistance.