Medicare’s Annual Open Enrollment Period started October 15th and will run through December 7th. During this period, all Medicare beneficiaries can make changes to their health or drug plan coverage. Changes made during this period start January 1, 2023.
Everyone with Medicare is encouraged to review their current plan’s coverage for next year to see if it will still meet their needs. PA MEDI staff and volunteers can help people across Pennsylvania review their 2023 Medicare coverage options. Medicare beneficiaries who need help reviewing their plan options for next year are encouraged to call PA MEDI’s statewide helpline at 1-800-783-7067 to connect with their local program.
Stand-Alone Prescription Drug Plans: There are 26 stand-alone prescription drug plans available across Pennsylvania for enrollment in 2023. Premiums for these plans range from $5.20 to $192.60 per month. There is no change to the “zero-premium” plans for people who qualify for full Extra Help between this year and next. There continue to be seven zero-premium plans in 2023 (click here for the 2023 list).
Medicare Advantage Plans: Residents in every county in Pennsylvania continue to have many Medicare Advantage plans to choose from. Cumberland County has the most Medicare Advantage plans (82) and Pike County has the fewest (29). These numbers do not include Medicare Special Needs Plans that limit their enrollment to certain groups of Medicare beneficiaries: dual eligibles, people in nursing homes, and people with certain chronic conditions such as diabetes or cardiovascular disease.
Most, but not all, of the Medicare Advantage plans available include drug coverage. Individuals considering a Medicare Advantage plan for 2023 should check the plan’s costs, benefits, provider network and pharmacy network, list of covered drugs, and any extra benefits offered, such as dental or vision care or Special Supplemental Benefits for the Chronically Ill (SSBCI). It’s important to note that the SSBCI benefits are not guaranteed, and people will only learn if they are eligible for SSBCI benefits after they enroll in the plan. More details about 2023 plan offerings and plan benefits can be found on www.medicare.gov.
Special Needs Plans for Dual Eligibles (D-SNPs): These plans only enroll Medicare beneficiaries who also have Medicaid – people who fall into this group are called dual eligibles. Click here for the listing of D-SNPs by county for 2023. D-SNP offerings have continued to expand in Pennsylvania.
It is important to remember that the D-SNP only provides the member with their Medicare coverage and the person still has Medicaid as separate insurance coverage that generally pays second. In 2023, all counties in Pennsylvania will have at least three D-SNPs available. Most counties have twelve or more D-SNPs available. Many of the available D-SNPs require that someone have full Medicaid to enroll, but some of the plans allow “partial duals” to enroll. Partial duals are those who receive limited help from Medicaid through the Medicare Savings Programs, including Qualified Medicare Beneficiaries (QMBs). QMBs get Medicare cost-sharing benefits as well as help with their Medicare Part B and Part A (if any) premiums. Partial duals interested in enrolling in a D-SNP should contact the plan to see if they qualify and to learn more about their costs.
Medicare Plan Finder
People can visit www.medicare.gov to get details about health and drug plans available in Pennsylvania next year. Medicare beneficiaries need to create an account on the medicare.gov website to see personalized information about their current coverage and Extra Help status as well as save their drug lists, pharmacies, and plan searches. No email address is required to create an account.
Insulin Costs and the Medicare Plan Finder
Thanks to the Inflation Reduction Act of 2022, co-pays for insulin will be limited to $35/month with no deductible next year. For those whose insulin is covered through Medicare Part D, this change will happen in January 2023. For people whose insulin is administered through durable medical equipment, such as a non-disposable pump, and thus have coverage for their insulin needs through Medicare Part B, this change will happen in July 2023. Plans are allowed to offer lower co-pays for insulin but are not allowed to charge more than $35/month. Because of the timing of when this change occurred, insulin costs are not correct on the Medicare Plan Finder. As a result, Medicare recommends a two-step comparison for people using insulin:
- First: search without insulin to find and compare the plans that best meet your needs for other medications and to compare costs for all other drugs except for insulin
- Second: add insulin to make sure the particular type of insulin you use is covered by the plan that seems to be the best fit. Add $35/month for the insulin(s) to the cost of the other drugs.
People taking insulin are encouraged to get help comparing plans this year and may want to call their chosen insurance company directly to double check the plan formulary and confirm insulin costs. As a reminder, people who get Extra Help already have limited co-pays for any Part D covered insulin they use.
Medicare beneficiaries should beware of high pressure sales tactics or aggressive marketing during the open enrollment period, as well as TV ads that overpromise. Agents and brokers selling Medicare Advantage and Part D prescription drug plans may not market to beneficiaries door to door, including leaving materials at a beneficiary’s doorstep. They also may not make unsolicited calls or send unsolicited text messages to Medicare beneficiaries, or approach beneficiaries unsolicited. Please be aware that insurance companies can contact members of one product to market another product. For example, if someone is covered by Best Drug Plan, then someone from Best Insurance Company can call to market their Best Health Plan. Even though insurance companies can make unsolicited calls in this limited situation, they still cannot pressure someone to join a plan or provide misleading, wrong, or incomplete information to get someone to agree to switch their plan. Anyone with concerns about Medicare marketing, fraud, abuse, or scams can call Pennsylvania’s Senior Medicare Patrol program at 1-800-356-3606.
If someone was enrolled in a Medicare health or drug plan because of high pressure sales tactics or marketing abuses, they can contact Medicare at 1-800-633-4227 and ask for a Special Enrollment to change their plan. If possible, people should provide Medicare with as much detail as possible about any marketing abuses or enrollment fraud in order to get a Special Enrollment Period approved and to help with any follow-up investigation that Medicare might do.
Watch Out for Extra Help Mailings to Medicare Beneficiaries
The Center for Medicare & Medicaid Services (CMS) sends several mailings each Fall related to Extra Help. Notices are sent when someone’s automatic Extra Help will end this year, when their copay amounts are changing next year, and when someone needs to complete a redetermination form to determine if they will qualify for Extra Help again next year.
- Loss of deemed status letter (grey): Mailed in September to those who no longer automatically qualify for Extra Help in 2023. This happens when someone lost Medicaid coverage or help with the Medicare Part B premium between July 2021 and June 2022 and has not requalified for that assistance. Because of protections in place since March 2020 due to the COVID-19 federal public health emergency declaration, most people should not have lost Medicaid this year. Unless someone voluntarily ended their Medicaid coverage or help with the Medicare Part B premium, people should generally not be receiving these grey letters this year.
- Extra Help redetermination form from SSA: Every year, Social Security chooses a certain number of people to review for continued Extra Help eligibility. Redetermination paperwork is sent in September and must be completed and returned. If the renewal is not completed, Extra Help will end in 2022.
- Extra Help Copay Changes: In October, Medicare notifies people who automatically get the Extra Help but whose copay levels are changing next year. This notice is sent on orange paper.
Readers can find more information about mailings to Medicare beneficiaries here.
Dual Eligibles and People with Extra Help Who Want to Change Plans for 2023 Must Act By December 7th!
Current dual eligibles can pick a new plan to start January 1, 2023; however, they must choose the new plan before the end of the Annual Open Enrollment Period on December 7, 2022. Dual eligibles are people that have Medicare and Medicaid (called Medical Assistance in PA). As a reminder, dual eligibles and others with Extra Help are limited to changing their Medicare health or drug plan once per quarter during the first three quarters of the year. Now that we are in the final quarter of the calendar year, people generally cannot make any changes to their Medicare coverage for this year. Any plan change made during the Open Enrollment Period takes effect on January 1, 2023.
Current dual eligibles interested in switching plans for November or December 2022 should review the list of available Special Enrollment Periods to see if any of them apply to their situation. People can contact PA MEDI at 1-800-783-7067 or Medicare at 1-800-633-4227 for help with plan comparisons or information about Medicare Special Enrollment Periods.