The Top 7 Medicare Questions You Need Answered for 2023

The Centers for Medicare & Medicaid Services (CMS) has released the Medicare Physician Fee Schedule (PFS) proposed rule for 2023. The PFS proposed rule would update payment policies, payment rates, and quality provisions for services furnished under the Medicare PFS on or after January 1, 2023.

CMS is proposing several changes, including:

Revising the evaluation and management (E/M) visit codes and guidelines
Implementing a new payment rate for office/outpatient E/M visits
Increasing the Medicare telehealth services list
Expanding the use of virtual check-ins and virtual visits

In this blog post, we will answer the top 7 questions that you need answered about the Medicare changes for 2023.

What’s new with Medicare in Missouri for 2023?

Missouri Medicare beneficiaries can expect the following changes for 2023:

The Medicare Part B premium will increase by 6% in 2023.
The Medicare Part A deductible will be decreased by $153 to $1,408.
There will be an expansion of telehealth options, enabling Medicare beneficiaries to receive more services without traveling to a doctor’s office.
The outpatient E/M visit codes and guidelines will be revised, and payment rates for office/outpatient E/M visits will be implemented.
Barrier reduction for substance use disorder treatment will be included, allowing Medicare beneficiaries to use telehealth services to receive substance use disorder services and ensuring that all providers can assess, diagnose, and treat individuals with addiction.
The quality improvement program known as the Merit-based Incentive Payment System (MIPS) will be simplified.
Medicare will provide coverage for Haemophilus influenza type B (Hib) and hepatitis B vaccines for adults with chronic liver disease.

How do I sign up for Medicare in Missouri?

The simplest way to enroll in Medicare in Missouri is to visit the official Medicare website. You can also apply directly to the Social Security Administration (SSA). To qualify for Medicare, you must be 65 or older, a US citizen, or a permanent resident who has lived in the US for at least five consecutive years.

If you already receive Social Security benefits, you will be automatically enrolled in Medicare Parts A and B when you turn 65. However, suppose you still need Social Security benefits when you turn 65. In that case, you will need to sign up for Medicare during the Initial Enrollment Period, which is the seven months that starts three months before you turn 65, the month you turn 65, and the three months following the month you turn 65.

You can also apply for Medicare Part D, a prescription drug coverage plan. To apply for Part D coverage, visit the Medicare website or contact the SSA directly. You can also get a local insurance carrier to learn more about enrolling in a Medicare Part D plan.

What are my Medicare coverage options in Missouri?

In Missouri, you can choose from Original Medicare (which consists of Part A and Part B), Medicare Advantage plans (known as Part C), Medicare Prescription Drug Plans (Part D), and Medicare Supplement Insurance (also known as Medigap).

Original Medicare is the federal government’s health insurance plan for those 65 and older. It has two parts:

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Part B covers outpatient services, which you receive outside the hospital. It also covers mental health treatment, durable medical equipment, and preventive care services.

Managed by private insurance companies, Medicare Advantage plans are an alternative to Original Medicare. These plans cover all of the services that Original Medicare covers and additional services such as vision, hearing, and dental.

Medicare Prescription Drug Plans (Part D) are plans offered by private insurance companies to help cover the costs of prescription drugs.

Finally, Medicare Supplement Insurance (Medigap) is additional coverage offered by private insurance companies to help cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.

How much does Medicare cost?

This depends on the type of Medicare plan you choose. Original Medicare Part A is usually accessible for most people, provided you have the required 40 credit hours of work. For those without the required 40 credits, Medicare Part A will cost $471 each month you are enrolled.

Medicare Part B has a monthly premium that’s based on your income. Most people will pay a dividend of $148.50. People with higher incomes will pay more.

Medicare Advantage plans, and Medicare Prescription Drug Plans typically have monthly premiums and may require copayments for healthcare services and prescription drugs. In addition, Medicare Supplement Insurance (Medigap) premiums vary depending on the plan and the insurer you choose.

When can I make changes to my Medicare coverage?

It is essential to know that you can make changes to your Medicare coverage during the following periods:

Open Enrollment: The Open Enrollment period is the annual period in October through December in which you can change your Medicare coverage. You can join, switch, or drop Part D and Medicare Advantage plans without incurring any penalties.
Special Enrollment Period (SEP): You can change your Medicare coverage during a SEP if you have a qualifying life event, such as a change in living situation (move) or loss of other insurance coverage.
Initial Coverage Election Period (ICEP): If you are signing up for Medicare as a new beneficiary, you have seven months to sign up for Medicare Part A and Part B starting three months before your birth month, the month of your 65th birthday, or when your coverage from your employer or union ends (whichever is first).
Medicare Advantage Open Enrollment Period (MA OEP): During the MA OEP, you have a one-time window to switch from a Medicare Advantage plan to Original Medicare. You can do this once per year from January 1 through March 31.

What should I do about Medicare between now and my retirement?

If you retire or lose employer coverage before turning 65, you will need alternative health coverage until you become eligible for Medicare. In such cases, you may qualify for a Special Enrollment Period (SEP), which allows you up to eight months to enroll in Part B without incurring late enrollment penalties.

It’s important to note that you only have two months to enroll in a Medicare Advantage (Part C) or Part D prescription drug plan during this period. Please register during this timeframe to avoid late enrollment penalties. Prior to making any Medicare decisions, it is advisable to consult with your employer plan benefits administrator and obtain a written notice of “creditable coverage” to qualify for a SEP and avoid late penalties.

I still have questions. Who can I contact for help?

If you have additional questions about Medicare, you can reach out to our team at STL Medicare Benefits or call directly, either online or by phone. In addition, you can speak to a customer service representative who can answer your questions and provide you with the information and resources you need.

When you contact Medicare, ensure you have all the details about your situation available when you call. This will help the representative better assist you and provide more detailed information.

You can also consider talking to a Medicare insurance advisor. A Medicare insurance advisor is available to help you make the best decision for your unique situation and will answer any questions.