What Are the New Rules for Medicare for 2023?

Medicare implements new rules every year to benefit new and existing Medicare enrollees and to address any problems. But in 2023, some of the biggest changes occurred, particularly concerning enrollment access, deductibles, and drug-maker negotiations. It’s important to keep track of these updates, and comply with them using technology like Inferscience’s HCC coding tool, to maximize the program.

In this post, we’ll take a look at the new rules for Medicare for 2023.


Improved Enrollment Access

In the past, people who enrolled for Medicare outside of their applicable enrollment period would have to wait two to three months for coverage to kick in. But at the beginning of January 2023, those who sign up during the month of their sixty-fifth birthday or within three months after that will be able to enjoy coverage just a month later. 

This quick effect also applies to those who sign up during the general period from January 1st to March 31st each year or during a special enrollment window. The latter seeks to accommodate people who, through no fault of their own, weren’t able to enroll during their designated eligibility period.


Tighter Drugmaker Rules and Negotiations

A new provision requires pharmaceutical manufacturers to pay a rebate to Medicare if they raise the prices of their drugs above the rate of general inflation. This affects companies that market prescription drugs and doctor-administered medicine. The penalty would total the amount the company raised a drug’s price above inflation rates multiplied by how much Medicare paid for sales.

By September 1st, Medicare also started a process that involved negotiating prices with drugmakers that produce the fifty most widely purchased medicines, with prices to take effect in 2026.


Changes in Deductible Costs

Medicare Part B is a medical insurance that covers doctor visits and medical equipment. Everyone pays it in their monthly premium, and in 2023, the deductible decreased to $226, down from $233 in 2022.

On the other hand, Medicare Part A, which covers inpatient stays in hospitals or nursing facilities, went up. While most people don’t pay for premiums for Part A, those who do will now have to shell out $506 per month from $499 in 2022. Additionally, the deductible for a hospital stay clocks in at $1,600 per benefit period versus $1,556 in 2022. 


Accessible Drugs

Starting in 2023, copays for a thirty-day supply of Medicare-covered insulin were capped at $35. This means that enrolled patients won’t have to pay more than that, even if they haven’t met their annual Part D deductible yet.

Additionally, more vaccines were made available to Medicare recipients with prescription drug coverage for free. Some vaccines covered under Part B are already available without charge, including shots for the flu, pneumonia, COVID-19 (including boosters), and hepatitis B. 

Under the new changes, vaccines recommended for adults by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) are also offered, the most notable being the two-dose Shingrix, which guards against shingles.


Access to Dental Care

Medicare doesn’t cover routine dental care, but it does pay for dental work needed with other medical procedures. In 2023, this was expanded to include other ‘medically necessary’ services, including cleaning (given that it improves the outcome of another major covered procedure).


Emphasis on Behavioral Health

Medicare expanded behavioral health services by including licensed clinical social workers, psychologists, and other behavioral health specialists in a beneficiary’s primary care office visit. It has also improved access to licensed marriage and family therapists, as well as services for substance abuse.


Catch Up with New Medicare Rules with Inferscience

To ensure that you’re maximizing Medicare, you must keep up with new rules and comply with them through best practices. One way to do this is by employing Inferscience’s HCC coding assistant, which can help you address HCC coding gaps and risk adjustment factor issues, as well as improve documentation and maximize reimbursements. Request a demo today!










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