While we’ll have to wait until 2025 to see the majority of the changes, which include $2,000 annual caps on Medicare Part D out-of-pocket prescription drugs, it’s the perfect time for our experts to share four important things you need to know about Medicare right now as you can begin enrolling for benefits starting on October 15.
1. Make a plan to sign up (and don’t forget to do it)
It may sound obvious, but not everyone remembers to sign up for Medicare, says Bobbi Rebell, a certified financial planner and author of Launching Financial Grownups. “You want to make sure to make this a priority,” she says, because there can be penalties if you fail to sign up during the seven-month initial enrollment period. Before you pick your plan, research what your preferred policy covers (and what it doesn’t) by spending time on medicare.gov and exploring how it might be different coverage from what you once had. “If you were previously on corporate health insurance or the Affordable Care Act, you may find some surprises since Medicare isn’t the same,” she says.
2. Telehealth will still be an option
While telehealth benefits were operating under emergency rule during the pandemic, those benefits will continue during 2023, says Ari Parker, co-founder and lead Medicare adviser at Chapter, which helps seniors find the best plans across every insurance carrier and every plan option. “This is significant, as more than two in five Medicare customers have accessed telehealth since 2020,” Parker says. “There were a lot of virtual appointments.”
3. Coverage for vaccines and insulin is continuing
It’s important to note: Vaccines will continue to be covered, and this is especially important when it comes to the shingles vaccine, a two-part regimen, something 3.6 million Medicare beneficiaries received in 2020. “It’s really pricey and costs almost $200 per administration, so the fact that it’s covered under Medicare Part D is very helpful,” Parker says. In addition, insulin costs will be capped at $35 per month in the coming year.
4. Consider the three Ps
When you’re in enrollment mode, think of Medicare from the perspective of these three Ps—providers, prescriptions and priority, says Parker, whose first book, It’s Not That Complicated: The Three Medicare Decisions to Protect Your Health & Money, was published last month. “The Ps are a great way to frame your decisions,” Parker says. “Each one should be taken into account when you’re seeking the coverage that’s best for you.” Despite the fact that the airwaves are flooded with adds for “free” plans, Medicare isn’t free. That’s why making sure your provider is in your plan and that your prescriptions are covered is pretty straightforward, Parker says. “But I use the word ‘priority’ to focus on how important it is to figure out how you will cover the 20 percent Medicare doesn’t cover.” For most Medicare recipients, this means two choices: One is Medigap, which is Medicare Supplement Insurance that helps fill “gaps” in original Medicare and is sold by private companies. This is an important supplement for such expenses as co-payments, co-insurance and deductibles. The other option is a Medicare Advantage plan (sometimes called Part C), offered by Medicare-approved private companies. These plans are another way to get your Medicare Part A and Part B coverage (most also include Part D drug coverage), but you will need to stay in network. These plans also set a limit on what you’ll have to pay out-of-pocket each year for covered services.
