Medicare's annual enrollment has ended - what's next?

Medicare has ended its annual enrollment period, the time when those on Medicare do their dance comparing their current Rx plan or Advantage plan to other plan offerings.

Beneficiaries on Advantage plans essentially get a "do-over" from Jan. 1 to March 31 to pick a different plan, while those on just a Part D Rx plan do not.

There have been several changes for 2023 that could directly impact Medicare beneficiaries. The first change is a requirement for drug companies to pay a rebate should the prices of their drugs rise faster than inflation. Lawmakers considered this a problem having seen drug prices steadily rise faster than inflation. The rule will use 2021 as the base year for determining price changes relative to inflation.

The next provision for 2023 is the new rules regarding insulin. The cost of insulin will be capped at $35 for a month's supply through 2025. After 2025 it will be $35 or the lesser of 25% of the negotiated price.

According to the Kaiser Family Foundation, under the new Inflation Reduction Act requirement, all Part D plans do not have to cover all insulin products at the $35 monthly co-payment amount. Part D plans will only cover insulin products that are listed on their plan's formulary.

So what could this mean for a person on an Advantage plan? It would mean that if the brand of insulin being used is not covered by that plan, the plan beneficiary could change to a different plan that covers it. For those on just a Part D plan and without any special circumstances, the plan beneficiary would be locked-in to that plan for the remainder of the year.

Also, for next year Medicare is improving vaccine coverage for adult vaccines. All Medicare Part D plans will be required to cover all ACIP (Advisory Committee on Immunization Practices) recommended adult vaccines with no cost sharing, regardless of the phase of the benefit. Advantage and Part D enrolled beneficiaries will now have access to ACIP-recommended Part D vaccines without cost sharing.

Further down the road in 2024, Medicare will eliminate the 5% coinsurance in the catastrophic coverage phase and will be expanding subsidies for beneficiaries making less than 150% of the federal poverty level. The biggest news doesn't happen until the beginning of 2025 when Medicare will add a $2,000 out of pocket cap on Part D expenses.

As Medicare and its many facets continue to evolve, it is becoming critical for Medicare beneficiaries to evaluate their health plans from year to year and to seek the assistance of a trusted health coverage professional.

• Dave Castillo, president of Davesurance Inc. in Lisle, has been helping individuals and small businesses with their health insurance needs for over 25 years. He is considered a local area expert regarding Medicare coverage. He is a licensed agent in the state of Illinois and six Midwest states.