Understanding Your Rights Under Medicare Advantage in 2023

As more and more Baby Boomers reach retirement age, understanding the ins and outs of Medicare Advantage is becoming increasingly important. With the passing of several new laws, 2023 will bring a number of changes to the program. In this article, we’ll take a look at what you need to know about Medicare Advantage 2023. 

What Is Medicare Advantage? 

Before we dive into the specifics of what’s changing in 2023, let’s first take a quick look at what Medicare Advantage is. Simply put, it is an alternative way for seniors to receive their Medicare benefits. Rather than receiving coverage through traditional fee-for-service plans or supplemental insurance plans, seniors can choose to enroll in a managed care plan that offers additional benefits as long as they continue to pay their monthly premium. 

What’s Changing in 2023? 

In 2020, Congress passed two pieces of legislation that will have significant implications for people enrolled in a Medicare Advantage plan by 2023. The first is the Affordable Care Act (ACA), which expands access to quality healthcare for seniors on fixed incomes. Under the ACA provisions, all Medigap policies issued after 2021 must cover certain preventive services and provide coverage for those with pre-existing conditions—both of which were previously excluded from most policies. Additionally, insurers are now required to cap out-of-pocket costs at $6,550 per year starting in 2022 and eliminate lifetime caps on spending by 2023. 

The second piece of legislation is the Bipartisan Budget Act of 2018 (BBA). This law expands coverage under Part D—the prescription drug portion of Medicare—by eliminating deductibles beginning in 2020 and capping out-of-pocket expenses at $3,100 per year by 2025; however, there are no changes planned for 2021 or 2022. Additionally, it eliminates cost sharing on brand name drugs and requires insurers to cover generic drugs at lower levels beginning in 2020. Finally, it reduces cost sharing for certain specialty drugs used to treat rare or serious conditions starting in 2021. 

Changes Coming in 2023 

The Centers for Medicare & Medicaid Services (CMS) recently announced new rules for MA plans that will go into effect in 2023. Under these new rules, MA plans must now offer a minimum of three different levels of coverage—basic, enhanced, and premium—with each level offering different levels of benefits and cost-sharing arrangements. In addition, these plans must also offer enrollees an out-of-network benefit option as well as access to telehealth services and more affordable prescription drugs. They must also offer additional preventive care benefits such as diabetes screenings, mammograms, and vaccinations at no additional cost to the enrollee. 

Conclusion: 

2023 promises to be an exciting year for those enrolled in Medicare Advantage plans thanks to two major pieces of legislation passed by Congress over the last few years: The Affordable Care Act and The Bipartisan Budget Act of 2018. These laws expand access to quality healthcare services through preventive care coverage and reduced out-of-pocket costs while also providing additional prescription drug coverage options for those who need them most. For anyone considering enrolling in a Medicare Advantage plan by 2023 or beyond, these changes are certainly worth exploring further!