Published by: Medicare.gov

People with Medicare Part D (drug coverage) can get even more covered vaccines, including RSV, shingles, whooping cough, and more to help keep them healthy in the new year.

Medicare also covers many preventive and screening services. These services can help keep you from getting sick and can help find health problems early when treatment is most likely to work best. Talk to your doctor about which ones might be right for you.

If you have Original Medicare (Part A and Part B), log into your secure Medicare account to see a personalized list of current and upcoming preventive services. If you don’t already have an account, signing up is free and easy.

If you’re in a Medicare Advantage Plan, contact your plan for a list of covered preventive services. MA Plans must cover all the same preventive services as Original Medicare, and some may offer additional services.

The post Take charge of your health in the new year! appeared first on C-Medisolutions.

Published by: AARP

Some of the biggest changes to Medicare in years take effect in 2023, with more than 65 million Americans paying lower premiums and deductibles and about to feel the effects of landmark legislation designed to bring down the runaway cost of prescription drugs.

Here’s a closer look at the biggest changes coming to Medicare in 2023.

For most Medicare beneficiaries, Part B premiums are deducted directly from their monthly Social Security payments. With Social Security’s cost-of-living adjustment (COLA) increasing benefits by 8.7 percent in 2023, Americans who are enrolled in both programs will see more money in their pockets each month.

The higher monthly charges paid by 7 percent of Medicare beneficiaries with high incomes also will decline in 2023. Part B beneficiaries with annual incomes greater than $97,000 will pay more than the standard premium — exactly how much more will depend on their income. For example, someone filing an individual tax return whose income is between $97,000 and $123,000 will pay $230.80 a month for Part B. Premiums for high-income beneficiaries start at $238.10 in 2022.

Enrollment in Medicare Advantage (MA), the private health insurance alternative to original Medicare, is likely to continue growing in 2023. Experts expect half of all Medicare enrollees to select an MA plan for the new year. Most Medicare enrollees must pay the Part B premium whether they have original Medicare or an MA plan. Some of these private plans do offer a “giveback” benefit in which the insurer covers part or all of a member’s Part B monthly premium.

Deductibles also going down

The annual Part B deductible for 2023 is decreasing to $226, a $7 decline from 2022 and the first drop in a decade.

Annual deductibles in Medicare Advantage plans and stand-alone Part D prescription drug plans vary by what plan you pick and where you live. The government does set a limit on Part D deductibles. That limit is $505 for 2023, compared with $480 in 2022.

Part A costs increasing

A fixed cost in Medicare that is going up is the Part A deductible. While most Medicare enrollees do not pay a monthly premium for Part A, which covers inpatient hospitals, skilled nursing facilities, hospice, and some home healthcare services, a deductible is charged for each hospital stay.

For 2023, the Part A deductible will be $1,600 per stay, an increase of $44 from 2022. For those people who have not worked long enough to qualify for premium-free Part A, the monthly premium will also rise. The full Part A premium will be $506 a month in 2023, a $7 increase. Whether a beneficiary must pay the full Part A premium depends on their or their spouse’s work history. Beneficiaries with Medicare Advantage plans should check with their plan for hospital charges.

Insulin copays capped

Under the Inflation Reduction Act of 2022, which includes several provisions to lower the prices of prescription drugs for Medicare beneficiaries, beginning in 2023 copays for a 30-day supply of any insulin that a Medicare drug plan covers will be capped at $35. Enrollees won’t have to pay more than $35 even if they have not yet met their annual Part D deductible. Note that not every plan covers every type of insulin.

Free vaccines

Also under the new law, vaccines recommended for adults by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) will be available to Medicare recipients with prescription drug coverage free of charge.

Drugmakers face penalties for high price hikes

Another provision of the new law that will be fully effective in 2023 requires pharmaceutical manufacturers to pay a rebate to Medicare if they raise the prices of their drugs more than the rate of general inflation.

Beginnings of price negotiations

By Sept. 1, Medicare will announce the first 10 Part D drugs that under the new law will begin a first-ever process in which Medicare will negotiate prices with drugmakers, Seshamani said, and that “will have a huge impact for providing more affordability for drugs for people with Medicare.”

Enrollment access improved

Beginning in January, as long as people eligible for Medicare enroll during official enrollment periods, they won’t have to wait for their coverage to take effect. Also under a new federal regulation, more special enrollment windows have been established, including for people who, through no fault of their own, didn’t sign up when they were first eligible.

The post Biggest Medicare Changes for 2023 appeared first on C-Medisolutions.

Medicare should cover alcoholism and substance use disorder treatment for a parent if:

• Their provider states that their services are medically necessary
• They receive services from a Medicare-approved provider or facility
• And, their provider sets up their plan of care

Medicare covers treatment in both inpatient and outpatient settings. Here are just a few examples of the services that Medicare covers:

• Psychotherapy
• Opioid treatment program (OTP) services
• Patient education regarding diagnosis and treatment
• Post-hospitalization follow-up

Part A should cover their care if they are hospitalized and needs substance use disorder treatment. If they are in an inpatient psychiatric hospital, keep in mind that Medicare only covers a total of 190 lifetime days. Once their limit has been reached, though, Medicare may cover care at a general hospital. A plan’s cost-sharing rules for an inpatient hospital stay should apply.

Part B should cover outpatient substance use disorder care they receive from a clinic, hospital outpatient department, or opioid treatment program. Original Medicare covers these services at 80% of the Medicare-approved amount. As long as they receive the service from a participating provider, they will pay a 20% coinsurance after meeting their Part B deductible. Visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to find participating providers. If they are enrolled in a Medicare Advantage Plan, contact their plan for information about costs, coverage, and in-network providers for substance use disorder treatment.

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Medicare covers both inpatient and outpatient mental health care. And Medicare prescription drug plans cover medications used to treat mental health conditions, but be sure to check the formulary to ensure the brands and dosages you take are included.

 Medicare Part B covers outpatient mental health care, including the following services:

• Individual and group therapy
• Substance use disorder treatment
• Tests to make sure you are getting the right care
• Occupational therapy
• Activity therapies, such as art, dance, or music therapy
• Training and education (such as training on how to inject a needed medication or education about your condition)
• Family counseling to help with your treatment
• Laboratory tests
• Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
• An annual depression screening

 Be sure to ask any provider you see if they take your Medicare insurance before you begin receiving services. If they don’t, you will likely be responsible for the full cost of the care. Psychiatrists are more likely than any other type of physician to opt out of Medicare, meaning Medicare will not cover any of the cost of the care from those doctors. Additionally, not all non-medical providers (like psychologists or clinical social workers) are Medicare-certified. If you need a list of providers near you who accept Medicare, you can go to www.medicare.gov/care-compare. 

 Medicare Part A covers inpatient mental health care that you receive in either a psychiatric hospital (a hospital that only treats mental health patients) or a general hospital. Your provider should determine which hospital setting you need.

If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care in your lifetime. If you have used your lifetime days but need additional mental health care, Medicare may cover your care at a general hospital.

 Medicare Part D covers most prescription drugs used to treat mental health conditions. You may have Part D coverage through a Medicare Advantage Plan or through a stand-alone Part D plan. All Part D plans must cover at least two drugs from most drug categories and must cover all drugs available in certain categories, including antidepressants and antipsychotic medications.

The post What mental health care does Medicare cover? appeared first on C-Medisolutions.

All Medicare Advantage Plans must set an annual limit on your out-of-pocket costs, known as the maximum out-of-pocket (MOOP). This limit is high but it may protect you from excessive costs if you need a lot of care or expensive treatments. After reaching your MOOP, you will not owe cost-sharing for Part A or Part B covered services for the remainder of the year. Some plans may also apply the MOOP to supplemental benefits, such as vision, hearing, or dental.

The out-of-pocket costs that help you reach your MOOP include all cost-sharing (deductibles, coinsurance, and copayments) for Part A and Part B covered services that you receive from in-network providers. Part D cost-sharing does not count toward your plan’s MOOP.

In 2023, the MOOP for Medicare Advantage Plans is $8,300, but plans may set lower limits. If you are in a plan that covers services you receive from out-of-network providers, such as a PPO, your plan will set two annual limits on your out-of-pocket costs. One limit is for in-network costs and the other is for combined in-network and out-of-network costs.

Call your plan directly if you have questions about your annual out-of-pocket limit.

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