Fall is always a busy time for reviewing and changing health coverage. But this year’s open enrollment periods for Medicare and the Affordable Care Act (ACA) have some surprises in store.
Medicare’s Annual Election Period (AEP) runs from October 15 to December 7. Though many beneficiaries don’t compare options, we encourage all people with Medicare to consider their health care needs and assess whether they are in the best coverage for their circumstances. Those who are in Original Medicare alone may choose to do nothing. Those who are in a standalone Part D drug plan should make sure their plan covers their needed medications. Coverage and costs can change every year, and there are often better fits elsewhere.
Similarly, those who are in or are thinking about a Medicare Advantage (MA) plan should look at their likely health needs, including hospitals, doctors, and durable medical equipment, as well as their prescription costs. Just like with standalone Part D plans, MA plans can change coverage and costs every year, and people’s health needs can also change.
As a result of the Inflation Reduction Act (IRA), starting January 1, 2023, Part D enrollees will pay no more than $35 per month for each insulin prescription covered by their drug plan. This makes it vital for insulin users to determine whether their insulin is on their drug plan’s formulary before they sign up or renew. Those who take insulin via a pump are covered by Part B, not Part D. Part B insulin will have the same cap starting July 1.
Importantly, Medicare Plan Finder will not reflect the IRA’s insulin cap. We urge people using the tool to compare plans without insulin first, then run a search adding in any insulin prescriptions to make sure they are covered.
Also starting January 1, recommended Part D vaccines, like the vaccine for shingles, will be available for people at no cost.
The ACA’s Open Enrollment starts November 1 and runs through January 15. Some state marketplaces have longer enrollment periods.
Also, due to the IRA, ACA plans will continue to offer reduced premiums. In addition, the Biden administration just corrected the “family glitch,” a flawed interpretation of the ACA that left many families unable to afford coverage.
Whatever your coverage, fall is the time of year to consider your options. Need help with your Medicare coverage? Contact your local State Health Insurance Assistance Program (SHIP) for unbiased one-on-one counseling; contact Medicare online at https://www.medicare.gov/ or by calling 1-800-MEDICARE; or call the Medicare Rights Center’s national helpline at 800-333-4114.
For ACA plans, try https://www.healthcare.gov/, your local state marketplace, or find local help.
Read more about Medicare insulin coverage in 2023.
Read more about the family glitch.
Sign up to receive Medicare news, policy developments, and other useful updates from the Medicare Rights.