CMS Updates Medicare Enrollment and Eligibility Rules
On
October 28, 2022, the Centers for Medicare & Medicaid Services (CMS) issued
a final rule effective on January 1, 2023, updating Medicare enrollment and
eligibility rules to expand coverage for people with Medicare and advance
health equity. Among the changes,
Medicare coverage now becomes effective the month after enrollment for
individuals signing up in the last three months of their Initial Election
Period, or in the General Election Period, thereby reducing potential gaps in
coverage.
The
rule also expands access through Medicare special enrollment periods (SEPs) and
allows eligible beneficiaries to receive Medicare Part B coverage without a
late enrollment penalty. Examples of new
SEPs created by this rule are SEPs for eligible individuals who miss an
enrollment opportunity because:
- They were
impacted by a disaster or government-declared emergency;
- Their
employer or health plan materially misrepresented information related to
timely enrollment in Medicare Part B;
- They were
incarcerated; and
- Their
Medicaid coverage was terminated after the COVID-19 Public Health
Emergency (PHE)s ends or on or after January 1, 2023 (whichever is
earlier).
These changes are related to Original Medicare A/B eligibility
only. They do not apply to Medicare
Advantage. The effective dates and SEPs
for Medicare Advantage remain unchanged.
The
final rule also establishes a new immunosuppressive drug benefit that extends
vital Medicare immunosuppressive drug coverage to individuals who have had a
kidney transplant and otherwise would lose Medicare coverage.
To view the final rule, refer to this link:
2023 Medicare Part A Premium, Deductible, and Coinsurance Amounts
Medicare Part A covers inpatient hospital, skilled nursing
facility, and some home health care services.
About 99 percent of Medicare beneficiaries qualify for premium-free Part
A due to having at least 40 quarters of their own Medicare-covered employment
(or the work history of a spouse), or two years having passed from initial eligibility
for Social Security Disability benefits.
Enrollees aged 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities must pay premium for Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate of $278 in 2023 (increase of $4 from 2022). Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium of $506 a month in 2023 (up $7 from 2022).
The Medicare Part A inpatient hospital deductible that
beneficiaries pay if admitted to the hospital is $1,600 in 2023 (increase of
$44 from 2022). The Part A inpatient
hospital deductible covers beneficiaries’ share of costs for the first 60 days
of Medicare-covered inpatient hospital care in a benefit period. In 2023, beneficiaries must pay a coinsurance
amount of $400 per day for the 61st through 90th day
of a hospitalization (increase of $11 from 2022) in a benefit period and $800
per day for lifetime reserve days (increase of $22 from 2022). For skilled nursing facilities, the daily
coinsurance for days 21 through 100 of extended care services in a benefit
period is $200.00 in 2023 (up $5.50 from 2022).
2023 Medicare Part B Premium and Deductible Amounts
Medicare Part B covers physician services, outpatient hospital
services, certain home health services, durable medical equipment, and certain
other medical and health services not covered by Medicare Part A. General tax revenues, along with premiums
paid by Medicare beneficiaries, fund the Part B program.
There is a special rule for Social Security recipients, called the
“hold harmless rule,” that ensures that Social Security benefits will not
decline from one year to the next because of an increase in the Medicare Part B
premium. Whether this rule comes into
play in any year depends on the amount of Cost of Living Adjustment (COLA) and
the Medicare Part B premium increase.
The hold harmless rule applies in 2023 for those people who had been
paying the standard Part B premium, and their Medicare Part B premium increased
but the Social Security COLA amount was not large enough to cover the
increase. Those who are subject to the
2023 hold harmless rule pay less than the $164.90 standard Part B premium. All others pay the 2023 not held harmless
premium, which is determined based on the Modified Adjusted Gross Income (MAGI)
as reported on the individual’s 2021 tax return.
The standard monthly premium for Medicare Part B enrollees is
$164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. In most years (unlike 2023), the Medicare
Part B premium rises. Medicare Part B
enrollees will pay the standard $164.90 Part B premium amount in 2023 unless:
- You
have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium
amount.)
- Your
modified adjusted gross income as reported on your IRS tax return from 2
years ago is above a certain amount. If so, you’ll pay the standard premium
amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your
premium.
- You
are protected by the "hold harmless" rule discussed above.
Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. These income-related monthly adjustment amounts affect less than 10 percent of people with Medicare Part B. The 2023 Part B premiums based on MAGI from the 2021 tax return are shown in the following table:
|
Beneficiaries who file individual tax
returns with income: |
Beneficiaries who file joint tax
returns with income: |
2023 Part B premium not held harmless |
Premium level |
|
Less than or equal to $97,000 |
Less than or equal to $194,000 |
$164.90 |
Standard |
|
Greater than $97,000 and less than or
equal to $123,000 |
Greater than $194,000 and less than or
equal to $246,000 |
$230.80 |
1.4 x standard |
|
Greater than $123,000 and less than or
equal to $153,000 |
Greater than $246,000 and less than or
equal to $306,000 |
$329.70 |
2.0 x standard |
|
Greater than $153,000 and less than or
equal to $183,000 |
Greater than $306,000 and less than or
equal to $366,000 |
$428.60 |
2.6 x standard |
|
Greater than $183,000 and less than
$500,000 |
Greater than $366,000 and less than
$750,000 |
$527.50 |
3.2 x standard |
|
Greater than or equal to $500,000 |
Greater than or equal to $750,000 |
$560.50 |
3.4 x standard |
Medicare Part B has an annual deductible of $226 in 2023 (down $7
from 2022), then Medicare beneficiaries are responsible for 20% of the
Medicare-approved amount for services.
2023 Medicare Part D Premiums
Since 2011, Medicare beneficiaries’ Part D premiums have been based on income. In addition to any Part D plan premium, there is an income-related monthly adjustment amount (IRMAA) impacting less than 10% percent of people with Medicare Part D. Part D premiums vary from plan to plan (note when Part D benefits are included in a Part C Medicare Advantage plan, there may not be any premium). Roughly two-thirds of beneficiaries pay premiums directly to the plan, while the remaining beneficiaries have their premiums deducted from their Social Security benefit checks. Regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. The 2023 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:
|
Beneficiaries who file
individual tax returns with income: |
Beneficiaries who file
joint tax returns with income: |
2023 Part D base premium* |
IRMAA |
|
Less than or equal to
$97,000 |
Less than or equal to
$194,000 |
Plan premium |
$0 |
|
Greater than $97,000 and
less than or equal to $123,000 |
Greater than $194,000 and
less than or equal to $246,000 |
Plan premium |
$12.20 |
|
Greater than $123,000 and
less than or equal to $153,000 |
Greater than $246,000 and
less than or equal to $306,000 |
Plan premium |
$31.50 |
|
Greater than $153,000 and
less than or equal to $183,000 |
Greater than $306,000 and
less than or equal to $366,000 |
Plan premium |
$50.70 |
|
Greater than $183,000 and
less than $500,000 |
Greater than $366,000 and
less than $750,000 |
Plan premium |
$70.00 |
|
Greater than or equal to
$500,000 |
Greater than or equal to
$750,000 |
Plan premium |
$76.40 |
New for 2023 -- Immunosuppressive
drug benefit
If you only have
Medicare because of End Stage Renal Disease (ESRD), your Medicare coverage,
including immunosuppressive drug coverage, ends 36 months after a successful
kidney transplant. Medicare offers a benefit that helps you pay for your
immunosuppressive drugs if you don't have certain types of other health
coverage (like a group health plan, TRICARE, or Medicaid that covers
immunosuppressive drugs). This new
benefit only covers your immunosuppressive drugs and no other items or
services. It isn’t a substitute for full
health coverage. You can sign up for
this benefit anytime as long as you had Medicare because of ESRD at the time of
your kidney transplant. To sign up,
call Social Security at 1-800-772-1213. TTY
users can call 1-800-325-0788.
Note: You’ll pay a monthly premium of $97.10 (or higher based on your income) and $226 deductible for this benefit in 2023. Once you've met the deductible, you'll pay 20% of the Medicare-approved amount for immunosuppressive drugs. If you have limited income and resources, you may be able to get help from your state to pay for this benefit.
Until next time,
Andrew Herman
