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Updates

Below you will find the latest Medicare facts and figures.

2023 Updates to Medicare for You: A Smart Person’s Guide

Original Medicare Costs

UPDATED FACT: The Part B deductible is $505. 

SECTIONS WHERE IT APPEARS IN THE BOOK:

  • Shopping for Coverage: Questions and Answers about a Medicare Advantage Plan
  • Shopping for Coverage: Questions and Answers about a Medigap Policy
  • Living with Medicare: Part B, Medical Insurance

UPDATED FACT: The Part A hospital deductible is $1,600 per benefit period.

SECTIONS WHERE IT APPEARS IN THE BOOK:

  • The Parts and Paths of Medicare: Medicare Costs and the Need for Additional Coverage 
  • Living with Medicare: Part A, Hospital Insurance
  • Living with Medicare: Questions and Answers about Part A and Part B Services

UPDATED FACT: Extended hospitalization copayment is $400 for days 61–90 in a benefit period, and $800 per day for days 90–150 (lifetime reserve days). 

SECTIONS WHERE IT APPEARS IN THE BOOK:

  • The Parts and Paths of Medicare: Medicare Costs and the Need for Additional Coverage
  • Living with Medicare: Part A, Hospital Insurance
  • iving with Medicare: Questions and Answers about Part A and Part B Services

UPDATED FACT: The skilled nursing facility (SNF) copayment is $200 for days 21–100.

SECTIONS WHERE IT APPEARS IN THE BOOK:

  • The Parts and Paths of Medicare: Medicare Costs and the Need for Additional Coverage 
  • Living with Medicare: Part A, Hospital Insurance

Part D, Prescription Drug Coverage

UPDATED FACTS:

  1. The standard Part D deductible is $505.
  2. The threshold to enter the next stage, Coverage Gap (donut hole), is $4,660.
  3. Once your true (total) out-of-pocket costs (what you’ve paid in the Coverage Gap) reach $7,400, it’s on to the last payment stage, Catastrophic Coverage.
  4. In Catastrophic Coverage, you pay the greater of 5 percent or a set copayment for generic and brand-name drugs ($4.15 and $10.35).

SECTION WHERE THEY APPEAR IN THE BOOK:

  • Living with Medicare: Part D, Prescription Drug Coverage 

Medigap Policies (Medicare Supplement Insurance)

UPDATED FACT: Medigap policies in 47 states are standardized by 10 letters. Each letter represents a package of benefits and costs. Massachusetts, Minnesota, and Wisconsin have their own models, but the policies work the same way.

SECTION WHERE IT APPEARS:

  • The Paths and Parts of Medicare: Original Medicare Path 

UPDATED FACT: The deductible for high-deductible Plan G is $2,700.

SECTION WHERE IT APPEARS:

  • Shopping for Coverage: Shopping for a Medigap Policy 

Medicare Advantage Plans

UPDATED FACT: The maximum out-of-pocket limit in 2023 at $8,300 for in-network care and $12,480. 

SECTIONS WHERE IT APPEARS:

  • The Parts and Paths of Medicare: Questions and Answers about the Medicare Paths 
  • Living with Medicare: Questions and Answers about Your Medicare Path 

UPDATED FACT: The maximum deductible for a Medical Savings Account (MSA) plan is $15,750.

SECTION WHERE IT APPEARS:

  • Shopping for Coverage: Shopping for a Medicare Advantage Plan 

Medicare Premiums

UPDATED FACT: The Part B premium is $164.90.

SECTIONS WHERE IT APPEARS:

  • The Parts and Paths of Medicare: The Three Parts of Medicare and Costs Overview 
  • The Parts and Paths of Medicare: Federal Employees Health Benefits (FEHB) Plans 
  • Medicare Premiums: Premiums for Medicare Coverage 
  • Medicare Premiums: Questions and Answers about Medicare Premiums 

UPDATED FACT: Those who do not qualify for premium-free Part A and have earned 30 credits will pay $278 a month. Those with fewer than 30 credits will pay $506.

SECTION WHERE IT APPEARS:

  • Medicare Premiums: Premiums for Medicare Coverage 

UPDATED FACT: The premiums for stand-alone Part D drug plan start as low as $1.60 in a few areas and go up to $100 or more.

SECTION WHERE IT APPEARS:

  • Living with Medicare: Part D, Prescription Drug Coverage 

IRMAA (Income-related Monthly Adjustment Amount)

UPDATED FACTS:

  1. For those enrolling in Medicare Part B in 2023, Social Security reviews their 2021 tax records.
  2. The IRMAA thresholds are as follows $194,000 for a married individual filing a joint return (both spouses will have to pay any adjustments), $97,000 for a single filer, and $97,000 for a married individual filing a separate return.

SECTION WHERE THEY APPEAR:

  • Medicare Premiums: IRMAA
2023 IRMAA Income Brackets

Late Enrollment Penalties

UPDATED FACTS:

  • The Part B late enrollment penalty is 10 percent of the standard Part B premium for every year (a full 12 months) enrollment is delayed. In 2023, the penalty amount was $16.49 (10 percent of $174.90. Three years late enrolling in Part B added $49.20 to the monthly premium.
  • The Part D late enrollment penalty amount is $0.327 (1 percent of $32.74) for each month without drug coverage.
  • Part A late enrollment penalty amount in 2023 for those who have 30–39 credits is $27.80 and $50.60 for those with fewer than 30 credits. 

SECTION WHERE IT APPEARS:

  • Determine Your Timing: Questions and Answers about the IEP

Skilled Nursing Facility

UPDATED FACT: During the COVID pandemic, Medicare temporarily waived the requirement for a three-day prior hospitalization for coverage of a SNF stay. This waiver provided temporary emergency coverage of SNF services without a qualifying hospital stay. This waiver has been extended multiple times and is now set to expire on April 11, 2023.

SECTION WHERE IT APPEARS:

  • Living with Medicare: Skilled Nursing Facility (SNF) Stays

New in 2023

Here is a list of the most significant changes for 2023: 

  • Effective January 1, 2023, copayments for Part D insulin (the kind that is injected) are capped at $35 a month. Those who use an insulin pump will pay no more than $35 for insulin, effective July 1.
  • Part D vaccines will not be subject to a deductible and there will be no copayment. The best way to get these vaccinations is to visit a pharmacy that’s in your Part D drug plan’s network.
  • A law that took effect in 2022 requires insurance agents, brokers, and other third-party marketing organizations (like the ones that sponsor TV ads) to record all calls with beneficiaries in their entirety, including the enrollment process. They must disclose that their information will go to an agent for future contact, and they may be transferred to an agent who can enroll them in a plan. 
  • As of January 1, 2023, the Centers for Medicare and Medicaid Services must approve all television ads in advance and review ads already on air to ensure they meet all marketing requirements.

There are more changes coming in the next couple of years, like the $2,000 cap on Part D drug costs. Watch for updates. 

Clarification

UPDATE: The second example under Specific Circumstances does not belong in this chapter. Glenn had a stroke and required care that could not be provided in his home. The facility he wanted was not in any network. He qualifies for a special enrollment period to get a Medicare Advantage Special Needs Plan. 

SECTION WHERE IT APPEARS:

  • The Paths and Parts of Medicare: Changing from the Medicare Advantage Path to the Original Medicare Path.

Clarification

UPDATE: Medicare Advantage plans must provide the same Part A and Part B services that Original Medicare covers, but plans can set the rules and determine how to operate. There are three coverage rules of consequence: networks, referrals, and prior authorization. 

SECTION WHERE IT APPEARS:

  • The Paths and Parts of Medicare: Medicare Advantage Path

Clarification

UPDATE: The IEP, seven months surrounding your 65th birthday, is a time to pay attention to Medicare.

Once you turn 64, use one of these worksheets to identify your  IEP. Then, during this time, study your situation and determine what, if anything, you need to do about Medicare. 

SECTION WHERE IT APPEARS:

  • Appendix: Initial Enrollment  Period (IEP) Worksheets