Dear Marci,

I missed my Initial Enrollment Period so am now planning to enroll this month during the General Enrollment Period. I’ve been hearing conflicting information about it from my family and friends, though. Has the General Enrollment Period changed?

-Rob (Indianapolis, IN)


Dear Rob,

Yes, there has been a major change to the General Enrollment Period (GEP), as of January 1, 2023. This may explain why you’ve heard some conflicting information about this enrollment period recently. Hopefully I can clear up any confusion for you!

First, the GEP takes place January 1 through March 31 each year. As you mentioned, the GEP is usually for people who missed their Initial Enrollment Period (IEP) and do not qualify for a Special Enrollment Period (SEP).

When you enroll during the GEP, there’s a good chance you’ll owe a premium penalty for not enrolling sooner. Because of this, using the GEP to enroll is not ideal.

Also, before 2023, if you enrolled during the GEP, your Medicare Part B would not start until July 1. This meant that even if you signed up with Social Security on January 1, your coverage would not be effective until July 1—six months later. That’s a long time to wait for health insurance!

Thanks to the passage of key parts of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act in the Consolidated Appropriations Act of 2021, though, this months-long waiting period has been eliminated. As of January 1, 2023, enrollments made during the GEP are effective the first of the next month. This means that if you enroll in Medicare on January 20, for example, your coverage will be effective on February 1—not July 1 like in past years.

This is a big win for the Medicare program and its beneficiaries! It will also be great for you, Rob, when you use the GEP to enroll this year. Best of luck!

-Marci

Dear Marci,

I think my Part D premium is going up in 2023, which I expected. But I’ve also heard that everyone with Medicare might be saving money on drug costs because of recent legislation. How are drug costs changing in 2023?

-Jean-Claude (New York, NY)

Dear Jean-Claude,

It’s true that most people will experience some kind of change to their Part D costs each year. Part D plans can change the drugs they cover, their pharmacy networks, and their costs (such as premiums, copayments, coinsurance charges, and deductibles) from year to year. If you have Medicare prescription drug coverage, often referred to as Part D, your plan should have notified you about any changes in costs for 2023.

This year there are additional changes in Part D costs more generally due to the Inflation Reduction Act (IRA), which is likely the legislation you heard about. While some changes created by the IRA take effect in future years, the following changes take effect in 2023:

Insulin will be more affordable. The IRA limits co-payments to $35 per month for Part-D covered products and for insulin furnished under B, with no deductible for insulin products on your plan’s formulary. Currently, over 3 million Part D enrollees use insulin, and one in three people with Part D plans have diabetes. On average, in 2020, they paid $600 out-of-pocket for insulin. But some had considerably higher costs—25% spent over $800 and 10% spent over $1,300.

Because this change went into effect so quickly, the information about these lower costs was not always included in the Medicare Plan Finder tool during Fall Open Enrollment. This may have led some people to enroll in a plan that does not meet their needs. If you discover that you are not in the right plan, you may be able to change plans. Contact 1-800-MEDICARE (1-800-633-4227), your State Health Insurance Assistance Program (SHIP), or the Medicare Rights Center if you think this applies to you.

People with Medicare will be able to receive critical vaccines free of charge. The IRA eliminates cost-sharing and deductibles for Part D vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP), such as the shingles vaccine. This policy already applies to Medicare Part B and most private plans. Its expansion will save you costs and improve your access to necessary preventive care.

This will help the approximately 4 million Medicare beneficiaries who receive a Part D-covered vaccine each year—including the 3.6 million who received the shingles vaccine in 2020, at an average cost of over $100. However, it will also reach millions more. Research shows Part D immunization rates are well below those for Part B, likely due to cost-sharing. The additional expense is a well established barrier to beneficiary receipt of recommended vaccines.

You can read more about IRA changes that will take effect in future years here.

-Marci

The first day of winter is this Wednesday, December 21. Winter can be a beautiful time to enjoy with loved ones. It is also a time when cold weather, snow, and ice can create dangerous situations. FEMA gives us five tips to stay warm and safe this winter:

Keep an emergency kit in your vehicle. This kit can include jumper cables, flares, an ice scraper, a car cell phone charger, blankets, map, food, water, and warm clothes.
Prepare your car for winter, by having it checked by a mechanic and avoiding your gap from falling below half a tank.
Never use a generator inside the house. It is also a good idea to install and test carbon monoxide alarms.
Keep heat in your home by closing blinds, closing off unused rooms, and stuffing towels in cracks under doors.
Keep your body warm by layering, eating regularly, and drinking warm liquids.

Dear Marci,

I know I need to enroll in Medicare soon. What is the best way to disenroll from my Marketplace plan and enroll in Medicare?

-Faye (Sedona, AZ)

Dear Faye,

It’s great that you’re planning ahead to smoothly transition from your Marketplace plan to Medicare.

For those that don’t know, the Health Insurance Marketplaces were created by the Affordable Care Act (ACA) so that people with no insurance or not enough insurance could purchase health insurance. Qualified Health Plans (QHPs) are one type of health insurance policy that you can buy through the Marketplace.

If you have a QHP, in most cases you should enroll in Medicare and disenroll from your QHP. There are, however, two exceptions:

You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
You do not qualify for premium-free Medicare Part A.
If you qualify for premium-free Part A, you should not continue using the Marketplace to get health and drug coverage. You should enroll in Medicare when you are first eligible and disenroll from your QHP in a timely manner to avoid paying extra premiums. To disenroll from your QHP coverage, notify a state or federal Marketplace representative of your intent to disenroll form your plan at least 14 days before your Medicare coverage begins.
If you are enrolled in a plan through the federal Marketplace, contact the Marketplace Call Center at 800-318-2596 or visit www.healthcare.gov.
If you are enrolled in a plan through your state’s Marketplace, contact the state marketplace to learn how and when to disenroll from your plan.
Ask for disenrollment steps from a Marketplace representative if you are enrolled in a family plan.
Speak with your employer if you are enroll in a Small Business Health Options Program (SHOP) through the Marketplace.
Make sure to work with the Marketplace representative to ensure that your Marketplace plan ends the day that your Medicare begins, so that you do not have a gap in coverage.

Be aware that if you delay Medicare enrollment, you will likely experience gaps in coverage and have a late enrollment penalty. It is usually not cost-effective to have both Medicare and a Marketplace plan.

I hope this helps in your transition to Medicare!

-Marci