5 Medicare Changes to Expect in 2023, Like $35 Insulin & Free Shingles Shots

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A new year means new changes to your Medicare coverage.

New rules include eliminating costs for shingle vaccines and capping a month’s supply of insulin to $35.

Here’s a recap of five Medicare changes to expect in the new year.

  • Medicare Part B premiums are decreasing slightly.
  • There’s expanded access to behavioral health services.
  • Some Medicare start dates are changing.
  • A month’s supply of insulin will be $35.
  • The shingles vaccine is now free.

1. Medicare Part B Premiums Are Getting Cheaper

Medicare Part B premiums are going down starting Jan. 1. It’s the first decrease in a decade.

The standard Medicare Part B premium will be $164.90 a month in 2023, down from $170.10 in 2022.

The Part B deductible — the cost you pay out-of-pocket each year before Medicare starts paying its share — is also decreasing next year, from $233 in 2022 to $226 in 2023.

Medicare Part B covers a wide range of services, including doctor visits, outpatient surgeries, medical equipment and more. The monthly premium is usually deducted from Social Security checks.

2. Expanded Access to Behavioral Health Services

Expanded access to behavioral health and addiction treatment services are also rolling out next year.

A final rule issued by the Centers for Medicare & Medicaid Services on Nov. 1 loosens requirements to see a therapist or a counselor.

Marriage and family therapists, licensed professional counselors, addiction counselors and certified peer recovery specialists will be able to provide services without a doctor or nurse practitioner physically on site. This is meant to expand access to more people.

Enrollees will be able to access opioid addiction treatment via telehealth (including telephone-only appointments) and mobile units, like vans, to help reach patients in rural and underserved communities.

Medicare is also boosting payments to opioid treatment programs.

Finally, Medicare will pay for the initiation of buprenorphine (used to treat opioid addiction) when it’s prescribed via telehealth, instead of just in person.

3. Some Medicare Start Dates Are Changing

If you sign up for Medicare in 2023, your coverage will begin sooner than it did before.

Previously, if you enrolled in Medicare one to three months after turning 65, it could take another two to three months before your coverage kicked in.

Starting in 2023, if you enroll in Medicare one to three months after your 65th birthday, your coverage begins the following month.

4. $35 Insulin

Starting Jan. 1, Medicare beneficiaries will pay no more than $35 for a month’s supply of certain insulin products. You’ll be able to get this copay amount even if you haven’t met your yearly deductible yet.

The new insulin cap was signed into law as part of the Inflation Reduction Act in August.

But the Medicare Plan Finder — the primary website used to help beneficiaries find drug and medical plans during open enrollment — isn’t updated to reflect the $35 insulin price changes.

That can make it tricky to estimate your actual out-of-pocket costs when comparing plans for 2023.

When insulin users access the plan finder, the projected cost could show up as thousands of dollars a year instead of the maximum $420 stipulated by law, according to Kaiser Health News.

“This new $35 cap may not be reflected when you compare plans,” a pop-up window notes when a plan finder user indicates they take insulin.

CMS is already anticipating some confusion.

The federal agency is creating a special enrollment period for people who use a covered insulin product to add, drop or change their Part D coverage any time from Dec. 8, 2022, to Dec. 31, 2023.

Counselors with the State Health Insurance Assistance Program, or SHIP, can help you navigate the enrollment process at no cost.

Use this online search tool to find the SHIP contact information in your state.

5. The Shingles Vaccine Is Free

Shingles vaccines can be pricey, costing up to $300 per dose without insurance.

Even though all Medicare drug plans cover the shingle vaccine, copays and deductibles still apply. The average Part D copayment for vaccines was $47 in 2020, according to a study by Avalere Health, a health care consulting firm.

That changes in 2023 when the shingles vaccine will be free with no deductible and no cost-sharing to people with Medicare prescription drug coverage.

Shingles is a viral infection that causes a painful rash. The CDC recommends all adults 50 and older get the shingles vaccine.

Cost sharing will also be eliminated for the Tdap (tetanus, diphtheria, whooping cough) vaccine on all Medicare drug plans in 2023.

Rachel Christian is a Certified Educator in Personal Finance and a senior writer for The Penny Hoarder.