Looking Ahead: Medicare in 2023 and Beyond

Next year, the Medicare enrollment process will finally receive long overdue updates, modernization, and simplification through the implementation of the provisions of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act that were finalized in recent rulemaking.

Thanks to the BENES Act, people who enroll during the General Enrollment Period or the later months of their Initial Enrollment Period will no longer experience months-long delays waiting for their coverage to go into effect. People who make honest enrollment mistakes based on misinformation from their employer or insurance company will have more and clearer avenues to correct those errors, and people who experience other exceptional or unusual circumstances, like natural disasters or incarceration, will have long-needed enrollment flexibilities. The secretary of Health and Human Services will also, going forward, have the authority to establish additional special enrollment periods to allow people facing other exceptional situations to access the Medicare benefits they are entitled to without delay or penalty.

Also in 2023, the first provisions of the Inflation Reduction Act’s changes to the Part D prescription drug benefit will go into effect. These changes will limit the copays that people with Medicare pay for insulin to $35 a month per prescription and will eliminate out-of-pocket costs for most vaccines. This has the potential to significantly impact access to critical medication and will put more money back into the budgets of older adults and people with disabilities.

We hope that Congress will act in 2023 to continue to improve the process by which people who are approaching Medicare eligibility learn about and enroll in the program by passing the BENES 2.0 Act, which would require the government to distribute clear, unbiased, actionable information about the choices that a person faces when they reach 65 years of age or 24 months of Social Security Disability Insurance.

Past 2023, we look forward to further implementation of the Inflation Reduction Act, including a $2,000 cap on out-of-pocket spending that will go into effect in 2025 and drug price negotiation that will protect all beneficiaries from the highest-cost prescription drugs.

We will continue to work with Congress and the Biden administration to expand access to important mental health services, including substance use disorder treatments, for people with Medicare; improve service integration and care coordination for people who have both Medicare and Medicaid; improve access to and uptake of Medicare Savings Programs (MSPs) and other programs that help people with limited incomes and resources; and combat Medicare Advantage abuses.

Read Medicare in 2022: The Year in Review.