Harmony Healthcare International (HHI) Blog

Open Enrollment (Annual) 2023

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The Medicare Annual Election Period is often referred to as the Open Enrollment Period, and it occurs from

 

October 15, 2022, through December 7, 2022.

 

During this period, current Medicare beneficiaries can make changes regarding

 

  • Medicare,
  • Medicare Advantage, and
  • Part D for calendar year 2023.

 

Beneficiaries can switch from Original (Traditional) Medicare to Medicare Advantage plans or vice versa during this period. They can also switch from one Medicare Advantage plan to another. Medicare premiums, deductibles, and coinsurance rates are adjusted every year at this time.

 

For the 2023 Plans, you can enroll between October 15, 2022 and December 7, 2022. If you turn 65 or become eligible for Medicare outside of the Annual Election Period, you have a seven (7) month window in which to enroll in the current year's plan and avoid any possible penalties.

 

Medicare Part A

 

(Hospital Insurance) covers hospital, skilled nursing facility, and some home health services. Most beneficiaries, about 99%, receive Part A insurance at no cost since they have at least 40 quarters of Medicare-covered employment. A premium is charged for this coverage if requirements such as the specified number of quarters of coverage (QCs) based on their earnings and the Federal Insurance Contributions Act (FICA) tax or the QCs of a spouse, parent, or child are not met.

 

  • The Medicare Part A deductible for 2023 is $1,600, an increase of $44 from 2022.

 

  • The coinsurance after the first 60 days of Medicare-covered inpatient hospitalization that applies to the 61st through 90th day of hospitalization is $400 per day (in a benefit period) and is $800 per day for lifetime reserve days.

 

  • In a skilled nursing facility, the 2023 daily coinsurance for days 21 through 100 is $200, an increase of $5.50 from $194.50 in 2022.

 

 

Medicare Part A Deductible & Coinsurance Amounts

 

2022

2023

In-patient hospital deductible

$1,556

$1,600

Daily hospital coinsurance for days 61-90

$389

$400

Daily hospital coinsurance for lifetime reserve days

$778

$800

Skilled nursing facility coinsurance for days 21-100

$194.50

$200

 

Medicare Part B

 

(Medical Insurance) covers physician services, outpatient hospital services, some home health services, durable medical equipment, and certain other services not covered by Part A.

 

  • The annual deductible is $226.00.

 

  • The standard monthly premium for Part B is $164.90 for 2023, a decrease of $5.20 from 2022.

 

  • The monthly premium increases based on a beneficiary’s income is shown in the following table.

 

Medicare Part B Premium

2033 Monthly Adjustments Based on Income

Individual Tax Returns with Income

Joint Tax Returns with Income

Monthly Adjustment Amount

Total Monthly Premium

< or = to $97,000

< or = to $194,000

$0.00

$164.90

> $97,000-$123,000

> $194,000-$246,000

$65.90

$230.80

> $123,000-$153,000

> $246,000-$306,000

$164.80

$329.70

> $153,000-$183,000

> $306,000-$366,000

$263.70

$428.60

> $183,000 & < $500,000

>$366,000 & < $750,000

$362.60

$527.50

> $500,000

> $750,000

$395.60

$560.50

 

Medicare Part C

 

Medicare Advantage Plans are offered by private Medicare-approved insurance companies that must follow the rules established by Medicare. Beneficiaries will have both their Part A and Part B coverage from their Medicare Advantage Plan plus prescription drug benefits, or other benefits may be included. Types of Medicare Advantage Plans include:

 

  • Health Maintenance Organizations (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee for Service (PFFS) plans
  • Medical Savings Account (MSA) plans
  • Special Needs Plans (SNP) plans

 

Medicare Advantage providers are paid a fixed amount for coverage each month from Medicare. The plans vary regarding requirements for accessing services such as referrals to specialists, and members pay certain out of pocket costs. Medicare Advantage plans frequently change their coverage, benefits, and policies, so examining the details every year is important. The maximum allowable out of pocket limit for Medicare Advantage Plans is increasing to $8,300 for 2023.

 

Medicare Part D

 

Prescription Drug Coverage plans for Original (Traditional) Medicare Part A beneficiaries assists with medication costs. The deductible you pay each year before the Part D plan pays its share varies with different plans.

 

  • The maximum deductible for 2023 is $505, an increase of $25 from 2022.

 

  • The out of pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023.

 

Medicare beneficiaries with Part D coverage (either a stand-alone Part D plan or when part of Medicare Advantage) have access to insulin with a copay of $35 a month starting in January 2023. This change is expected to be significant savings for individuals who are prescribed insulin. If your Medicare Part D Plan has a deductible this will not apply to covered insulin. Medicare beneficiaries who take insulin (about 3 million people) should be encouraged to have assistance when comparing plans. The Medicare Plan Finder will not display the changes to insulin cost sharing from the Inflation Reduction Act that became law on August 16, 2022 since plans had already submitted their annual Plan Bid Packages.

 

The Centers for Medicare & Medicaid Services (CMS) released the Medicare Advantage and Part D Star Ratings on October 6, 2022, to assist Medicare beneficiaries compare plans. Plans are rated on a one-to-five scale with information available on the Medicare Plan Finder and further performance data available at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData. During the pandemic, Medicare Advantage Plans overall quality ratings were protected from decreasing. Three measures were adjusted for COVID-19 impacts for the 2023 Medicare Advantage Star Ratings and the weight of consumer surveys was doubled. Medicare Advantage Plans declined for 2023 on all but 6 of the 23 non-drug related measures.

 

Harmony Healthcare International, Inc. (HHI) encourages all facilities to help residents understand their choices as they make important decisions about their health insurance. Resident’s confusion about insurance coverage can translate into innumerable problems, including diminished revenue and care options for the nursing facility. There can be a huge gap between reality and what a resident thinks their insurance plan will cover.

 

Harmony Healthcare International, Inc. (HHI) has resources to facilitate discussions with residents and their representatives and educate them regarding their Open Enrollment choices. HHI strongly recommends using reports from your software, the HHI tracking tool, and a step-by-step process to ensure that residents understand their choices and take advantage of the opportunity during Open Enrollment to make thoughtful decisions and changes.

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Topics: Medicare, Medicare Open Enrollment


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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