Medicare Advantage plans, also known as Medicare Part C, are a type of Medicare plan that is offered by private insurance companies. These plans provide all of the benefits of Original Medicare, which includes Part A and Part B, but may also offer additional benefits such as dental, vision, and hearing coverage. Medicare Part D plans to provide prescription drug coverage to beneficiaries.
Changes in Medicare Advantage for 2023
Increase in benefits and access to additional services
In 2023, Medicare Advantage plans will see an increase in benefits and access to additional services. One of the changes that will be implemented is the addition of dental coverage for beneficiaries with certain chronic conditions. In addition, plans will be required to offer additional benefits such as transportation services, in-home support, and meal delivery.
Improved flexibility in plan design and coverage options
Medicare Advantage plans will have improved flexibility in plan design and coverage options for 2023. Plans will have the ability to offer a wider range of benefits and services to meet the unique needs of their members. For example, plans may offer expanded mental health services, acupuncture, or physical therapy.
Changes in the quality rating system
The quality rating system for Medicare Advantage plans will also see changes in 2023. Plans will be rated based on a new set of measures that will better reflect the quality of care provided to beneficiaries. These measures will include patient experience, clinical outcomes, and access to care.
Changes in Part D for 2023
Lowering drug costs for beneficiaries
Part D plans will see changes in 2023 that will help lower drug costs for beneficiaries. Plans will have the ability to negotiate prices with pharmaceutical companies and pass on those savings to beneficiaries. In addition, the coverage gap, also known as the “donut hole,” will continue to shrink until it is fully closed by 2025.
Coverage gap changes
As mentioned above, the coverage gap will continue to shrink until it is fully closed by 2025. In 2023, the coverage gap will begin after a beneficiary has spent $4,150 on covered drugs, up from $4,130 in 2022. Once a beneficiary reaches the coverage gap, they will pay no more than 25% of the cost of their prescription drugs until they reach catastrophic coverage.
Improved access to generic drugs
Part D plans will also see improved access to generic drugs in 2023. Beneficiaries will have access to a wider range of generic drugs, which are often more affordable than brand-name drugs.
Explanation of how drug pricing works under Medicare
Under Medicare, drug pricing is complex and can be difficult for beneficiaries to understand. The cost of drugs is determined by a number of factors, including the drug’s average sales price, the manufacturer’s discount, and the beneficiary’s copayment or coinsurance
Changes in drug pricing for 2023
In 2023, there will be changes to the way drug pricing is calculated under Medicare. One of the changes is the implementation of a new payment model for certain drugs that will be based on clinical outcomes. This is intended to encourage the use of drugs that have been shown to be effective and will help to reduce costs.
Beneficiary Access
Changes in telehealth and remote monitoring services
Beneficiaries will have improved access to telehealth and remote monitoring services under Medicare Advantage in 2023. This will allow beneficiaries to receive care in the comfort of their own homes and reduce the need for in-person visits to the doctor’s office.
Improved access to preventive care
Medicare Advantage plans will also offer improved access to preventive care services for beneficiaries. This includes services such as annual wellness visits, cancer screenings, and immunizations.
