By Barb Armijo
A historic change is on the horizon as Medicare open enrollment gets underway October 15 through December 7, marking the beginning of a cap on what Medicare recipients pay for their medicines each year. The cap will be fully implemented in 2025.
Beginning January 1, 2023, and for the first time in Medicare’s history, beneficiaries with Part D drug benefits will see reduced costs, including a limit on out-of-pocket payments for insulin and making vital vaccines free.
Previously, there were no limits on how much a person on Part D could pay for their medicines each year. The news has been well received by advocates who have wanted to lower costs for seniors. According to the AARP, 1.3 million enrollees spent more than $2,000 on prescription drugs in 2020, the latest year that data were available. The new cap on out-of-pocket costs will be $2,000 when it is fully implemented.
The Inflation Reduction Act, recently signed by President Joe Biden and effective in 2023, requires drug companies to pay rebates to enrollees if drug prices rise faster than inflation; limits copays for insulin to $35 per month; and reduces costs and improves coverage for adult vaccines for those who have Part D.
For a timeline detailing how the Prescription Drug Provisions in the Act will roll , visit https://www.kff.org/medicare/issue-brief/how-will-the-prescription-drug-provisions-in-the-inflation-reduction-act-affect-medicare-beneficiaries/.
Telehealth coverage, which started in 2020, will also continue to be part of Medicare and Medicare Advantage plans, as well as expanded dental, vision and prescription drug coverage.
Open enrollment is a good time to make changes or sign up for Medicare and Medicare Advantage plans. Anyone who is 65 years of age or older is eligible for the plans.
Beneficiaries can choose Original Medicare, supplemental drug coverage, or Medicare Advantage plans with more choices and flexibility in coverages. Beneficiaries should have received an Annual Notice of Change letter from their provider explaining any changes in their policy that take effect January 1, 2023.
Also, remember that if you didn’t enroll in Medicare when you were first eligible – during the first general enrollment period after you turn 65 – you cannot enroll during the fall open enrollment. You must wait until the next Medicare general enrollment period, January 1 to March 31, and coverage is effective beginning July 1, 2023.
The official Medicare and You Handbook 2023 provides extensive information and resources for existing and new Medicare enrollees. The handbook can be viewed or downloaded at https://www.medicare.gov/publications/10050-Medicare-and-You.pdf. For questions, seniors can also call 1-800-Medicare (1-800-633-4227), or visit medicare.gov.
New Mexico’s Medicare Resources
Janice Torrez, president of Blue Cross Blue Shield of New Mexico, said BCBSNM will have its largest ever service area and product expansion in its history in the state.
“What this means is that we have 421,000 people across 17 new counties that will have coverage and new products that they have not had in the past,” Torrez said. “We are now in every county except for four in New Mexico. This truly brings options to people in rural New Mexico who have not had these options in the past.”
BCBSNM plans allow greater choice and flexibility for enrollees, Torrez said. The plans and benefits are designed to meet the diverse needs of its members, including reducing out-of-pocket costs, continuing some plans with zero premiums over what they pay for Medicare.
“We want seniors in the community we serve to be able to have as much choice as they can in the most important aspect of their life – health care,” Torrez said. “Certainly, the affordability of prescription drugs is critical to our members. But so are having options for dental and vision care, and continuing our benefit of offering the SilverSneakers program to our seniors.”
SilverSneakers, available at no cost for adults 65-plus through select Medicare plans, provides free gym membership to seniors at area fitness centers, including at 1,000 gyms nationwide for travelers, as well as health workshops and seminars.
“BCBS is committed to encouraging good health in 2023,” Torrez said. “Our rewards and incentive programs, like SilverSneakers, is something we want to continue to offer to our members. They absolutely love that program.”
To get all information out to prospective and current members, BCBS will offer drop-in office hours from 9 a.m. to 5 p.m. weekdays from October 17 through December 7. Visit BCBSNM.com for more information.
Presbyterian is launching an altogether new Medicare Advantage plan called Presbyterian UltraFlex, which allows members to seek services from any Medicare-approved provider in the country. The New Mexico service area will include more counties than are currently served by its HMO plan. UltraFlex includes a debit card with $215 per quarter that can be used for over-the-counter items, eyewear, dental services and hearing aids.
“We have a new nationwide virtual network that will support our UltraFlex members with 24/7 virtual appointments, a personal care advisor, behavioral and mental health, local referrals to specialists and a range of digital tools,” said Presbyterian Health Plan vice president of sales and marketing Brian Brown. “And we are expanding telehealth options so Medicare Advantage members can easily take advantage of care from the convenience of their homes.”
Also, members will now have the ability to access emergency and urgent care anywhere in the country, he said. That’s in addition to no-cost benefits, including basic dental, hearing exams and diabetic test supplies, as well as a flexible spending card.
The Medicare Advantage Plan that most members are on will continue to be a no-cost premium. The primary care provider copay of $5 has been eliminated, and specialist copays are reduced from $50 to $45.
To find out more about Presbyterian’s Medicare Advantage plans, visit www.phs.org. Enrollees can also call (505) 923-8458, request an information kit or attend one of many upcoming seminars listed at https://phs.swoogo.com/attend-a-seminar.
Optum, a local physician-led, multi-specialty medical group in Albuquerque and Rio Rancho, also offers help for seniors navigating the Medicare maze. Optum vice president for growth and strategy Mike Wallace said one of the most important things to remember about open enrollment is that recipients need to pay special attention to the Annual Notice of Change letters are typically mailed in late September.
“These letters tell enrollees about premium and co-pay changes that impact them,” Wallace said. “We encourage seniors to read those letters carefully, evaluate them, and then work with a broker to make sure they can get the best plan for them.”
Wallace offers these tips for seniors as they look at making changes to their Medicare and Medicare Advantage plans:
- Think about any significant health events that may come up next year and that may require more out-of-pocket costs than your current plan offers.
- Consider your dental and vision needs.
- Assess your financial situation, which can change year-to-year.
“But the best suggestion I offer is for seniors to not automatically take the plan with the lowest premium,” Wallace said. “Those zero-cost or low-cost premiums might not be best. In other words, one hospital visit will eliminate any savings you may have thought you were getting with a low-cost premium plan that didn’t cover your stay. It pays to take a good look at all the plans and make an informed decision with a reputable broker. Navigating Medicare plan options can be overwhelming.”
For more information about Optum, visit www.Optum.com or call 1-505-262-7000.
Lovelace Health System also provides help for seniors trying to figure out which Medicare insurance plans are best for them. This challenge is compounded by the fact that most health care providers do not accept all Medicare plans, and provider participation may change over time with Medicare plans that include a network of contracted health care providers.
“To help seniors understand these details, we offer MedicareOnDemand, a resource that connects them with Medicare brokers and experts who can help them,” Janelle Raborn, market leader for Lovelace Health System, said. “There are definitely a lot of things for seniors to consider, and we want to make sure they are well informed in making a decision on something as important as health care.”
MedicareOnDemand is a service by MedicareCompareUSA, a licensed independent insurance agency. Seniors can reach MedicareCompareUSA toll-free at (855) 756-7569, TTY 711, or online at https://medicareondemand.com/Lovelace/.