Advertising Supplement
Open Enrollment 2022
Ready to enroll? Here’s what you need to know about 2023 Medicare changes
Medicare beneficiaries will get some financial relief in 2023 as Plan B premiums and deductibles drop. Here are the primary Medicare changes for the coming year: • Part A premiums, deductibles, and coinsurance will increase. • Part B monthly premiums will decrease to $164.90. • Part B deductibles also will decrease to $226. • Part D (prescription benefit) donut hole is gone, but the maximum deductible for a standard plan will increase to $505 in 2023. The threshold for catastrophic coverage (where out-of-pocket spending decreases significantly) also increases to $7,400. Covered vaccines are free; insulin costs no more than $35 per month. • Income brackets for high-income premium adjustments for Medicare Part B and D start at $97,000 (up from $91,000 in 2022). • Medicare Advantage enrollment average premiums also are decreasing. • The maximum allowable out-ofpocket cap for Medicare Advantage plans increases to $8,300 (but most plans have lower out-of-pocket caps). • Kidney transplant recipients can keep limited Part B coverage for life to cover immunosuppressive drugs (complete Part B ends 36 months post-transplant). Medicare Part A Medicare Part A covers hospitalization costs, and although most people don’t have to pay a Part A premium, some out-of-pocket costs are associated with this coverage. Roughly 1 percent of enrollees pay a premium, while the rest receive free coverage based on work history. The Medicare Part A deductible will
increase to $1,600 in 2023 and applies to each benefit period, rather than a calendar year deductible like Part B or private insurance plans. The deductible applies to all Part A enrollees, although supplemental coverage pays all or part of the Part A deductible for many people. The Part A deductible covers the first 60 inpatient days during a benefit period. If the person needs additional inpatient coverage during that same benefit period, there’s a daily coinsurance charge. In 2023, it will be $400 per day for the 61st through 90th day of inpatient care. The coinsurance for lifetime reserve days is $800 per day. Medicare covers the first 20 days of care received in a skilled nursing facility. After that, coinsurance applies to days 21 through 100. In 2023, the coinsurance will be $200 per day. Medicare Part B In addition to the Part B monthly premium decrease to $164.90, deductibles also will decrease for the first time since 2012. The Part B deductible for 2023 is $226, down from $233. Medicare Part D The average Part D premium will be $31.50 per month in 2023, down from $32.08 in 2022. For stand-alone Part D prescription drug coverage, the maximum allowable deductible for standard Part D plans will increase to $505 in 2023. The out-of-pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023, up from $7,050 in 2022. This is a combination of drug manufacturer discounts and your costs; out-of-pocket costs for the enrollee will be around $3,100 at the catastrophic coverage level.
The copay amounts for people who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brandname drugs. Beneficiaries with highercost medications will continue to pay 5% of the cost during the catastrophic coverage phase. Recommended vaccines covered under Part D no longer require a costsharing payment. All Part D plans also must provide all covered insulin products with copays of no more than $35 per month. The Affordable Care Act eliminated the so-called Medicare Part D donut hole, means enrollees no longer have pay 100% of the costs for brand-name or generic drugs once they reach a certain threshold. Before 2010, enrollees were responsible for their deductible, then 25% of the costs until they reached the donut hole. Now enrollees only pay 25% of costs (after meeting their deductible) until they reach the catastrophic coverage threshold. High-income adjustments If you have a high income, you’ll pay more for Medicare Part B and Part D in 2023. Medicare introduced high-income brackets in 2007 for Part B and 2011 for Part D, and they originally started at an income of $85,000 ($170,000 for a married couple). The income brackets for the surcharge were adjusted for inflation starting in 2020. For 2023, the threshold increases to $97,000 for a single person and $194,000 for a married couple. This increase is due to high inflation in 2022. (The 2023 surcharge is based on 2021 tax returns, and you can appeal if your income has changed since then). The Part B premium for 2023 ranges
from $230.80 to $560.50 per month. That decreased from 2022 when premiums ranged from $238.10 to $578.30 per month. Medicare Advantage The average Medicare Advantage (Medicare Part C) premium will be about $18 per month in 2023, down from $19.52 monthly in 2022. Medicare Advantage plans protect against high out-of-pocket costs for Part A and Part B services. Unlike Original Medicare, which does not have a cap on out-of-pocket costs, Medicare Advantage plans must cap out-of-pocket expenses. For 2023, the cap is increasing to $8,300. But most Advantage plans will continue to have out-of-pocket caps below the government’s maximum. The cap does not include prescription drugs covered under Medicare Part D (even if integrated with a Medicare Advantage plan). Kidney transplants Historically, Medicare coverage for kidney transplant recipients has only lasted 36 months after the transplant. But that’s changing in 2023, and kidney transplant recipients will be able to continue to have limited Medicare Part B coverage for immunosuppressive drugs. As of 2023, the monthly cost for Part B, which covers immunosuppressive drugs, will be $97.10. The cost will be higher for those with income above $97,000 for a single individual or $194,000 for a couple. Those who turn 65 or become eligible for Medicare based on disability can transition back to full Medicare coverage.
Medicare prescription drug plans drop for 2023
The Medicare Part D program helps people with Medicare pay for brandname and generic prescription drugs. According to the Centers for Medicare & Medicaid Services, Part D remains one of Medicare’s most popular programs, with more than 49 million Medicare beneficiaries enrolled for prescription drug coverage. The average Part D premium will be $31.50 per month in 2023, a decrease from $32.08 in 2022. For stand-alone Part D prescription
drug coverage, the maximum allowable deductible for standard Part D plans will increase to $505 in 2023. When researching Medicare Part D plans, it’s important to compare prices and coverage options to find the best fit for your needs. Several programs can help reduce or cover the costs of healthcare for seniors. The PACE program provides all-inclusive care for elderly patients. Medicare’s Extra Help program can also assist with expenses.
The out-of-pocket threshold (where catastrophic coverage begins) will increase to $7,400 in 2023, up from $7,050 in 2022. This is a combination of drug manufacturer discounts and your costs; out-of-pocket costs for the enrollee will be around $3,100 at the catastrophic coverage level. Catastrophic coverage phase copayments for those who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brand-name
drugs. Beneficiaries with higher-cost medications will continue to pay 5% of the cost during the catastrophic coverage phase. CMS carefully analyzes changes to the Part D program and engages with stakeholders to identify improvement opportunities, particularly for reducing costs. The American Society of HealthSystem Pharmacists expects total drug spending in the U.S.to increase by 4% to 6% in 2022.
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Medicare Annual Enrollment
Learn the Lingo to Make the Choice that Works for You By Dr. Matthew Lewis, Senior Medical Director of Primary Care with New West Physicians, part of Optum
• You or your spouse had Medicarecovered government employment.
NOT SURE WHAT PLAN FITS YOUR NEEDS? CALL 303-802-1784 TO TALK TO A MEDICARE EXPERT.* New West Physicians is now accepting Humana, UnitedHealthcare, and Aetna plans in 2023.
It’s that time of year again, when millions of Americans across the country will have the opportunity to select or switch their health insurance benefits for the coming year. The Medicare Annual Enrollment Period is now through December 7th. For many older adults and caregivers, the process of choosing a Medicare plan can be challenging. Learning the lingo can help guide you in the right direction. Eligibility You may be eligible for Medicare benefits if: • You are a US citizen 65 years of age or older. • You are a younger person with disabilities. • You are a kidney dialysis or kidney transplant patient. • You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.
Types of Coverage You can choose Original Medicare provided by the government or add on additional benefits referred to as Medicare Advantage, or Medicare Supplement plans offered through private insurance. Original Medicare includes: • Part A is hospital coverage that helps pay for hospital inpatient care, skilled nursing facilities, hospice care and home health care. • Part B is medical coverage that helps pay for outpatient services from doctors and other providers, preventive services and medical equipment like wheelchairs and walkers. You can enroll in a Medicare Advantage plan called Part C or a Medicare Supplement, also referred to as Medigap. Both plans are offered by private insurance companies approved by Medicare. • Medicare Advantage plans combine Part A and Part B coverage into one comprehensive plan. These plans often include prescription drug coverage (Part D) and offer benefits not provided by Original Medicare. These plans are suited for those who are generally in good health and don’t expect a great
deal of medical expenses. • Medicare Supplement plans cover some of what Medicare Parts A and B do not cover, such as portions of coinsurance, out of pocket costs, copayments, and deductibles. These plans may be good for people with Medicare who have significant health issues and out of pocket costs. Enrollment Period There are several enrollment periods depending on your unique situation. • Initial Enrollment Period: This period starts three months before the month you turn 65 and ends three months after the month you turn 65. • Annual Enrollment Period: This period runs from October 15 through December 7 each year and allows you to sign up for a plan, switch plans or leave a plan. • Special Enrollment Period: This period applies only to special circumstances; it allows you to make changes to your Medicare Advantage plan and prescription drug coverage when certain events happen in your life like moving or losing your coverage. • General Enrollment Period: This period from January to March allows you to enroll in Part A or Part B, but your coverage will not go in effect until July 1 of that same year. This period applies to individuals who forgot to enroll when first eligible or delayed enrollment for one reason or another. Health care coverage is an important decision, so educate yourself before you choose. The best advice is to avoid waiting until the last minute. Start now and give yourself enough time to make the decisions that will be right for you. A good resource is an independent licensed insurance agent or health plan sales agent that helps Medicare beneficiaries learn about benefit options, which options will fit their needs and how they can continue to see their preferred doctors. They can also share options for coverage of unique needs, such as chronic conditions or
alternative medicine. Remember, the Medicare Annual Enrollment Period ends December 7. Now’s the time to take charge of your health. A New West Physicians doctor and Medicare Advantage plan can help you enjoy lower costs, better health and more coverage. New West Physicians, part of Optum, is a proud provider of the Optum Care Network – Colorado giving you access to more than 140 providers across 26 clinics and all major hospitals throughout the Denver metro area as well as virtual visits. We’re here for you, helping you feel your healthiest for nearly 30 years.
*A licensed insurance agent. New West Physicians patient advocates connect Medicare beneficiaries with resources including licensed insurance agents that sell Medicare Advantage and Medicare prescription drug plans. New West Physicians does not discriminate on the basis of race, color, national origin, sex, age, or disability in its health programs and activities. ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Please call 303.763.4900 Ext. 61500. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 303.763.4900 Ext. 61500. 請注意：如果您說中文(Chinese), 我們免費為您提供 語言協助服務。請致電 :303.763.4900 Ext. 61500.
Talk to a Medicare expert* at 303-802-1784 or visit optum.com/2023AEP to learn more.
Medicare Part B premiums, deductibles decrease for 2023 Looking for some good news? The standard monthly premium for Medicare Part B will decrease by $5.20 in 2023, down from the 2022 rate of $164.90. The Part B deductible for 2023 also decreases to $226, down from $233. Medicare Part B covers medical and health services, including physician, outpatient, home health, durable medical equipment, and more. The Social Security Act sets Medicare Part B premiums, deductibles, and coinsurance rates each year. Part B monthly standard premiums apply for individuals who make $97,000 or less yearly and couples earning $194,000. They are higher for people with higher incomes. For example, individuals who make $97,000 up to $123,000 and couples who make more than $194,000 and up to $246,000 will pay an additional monthly premium of $65.90 for Part B and $12.20 for Part D. Individuals who make $500,000 a
year or more will be charged an extra $560.50 a month for Part B and $76.40 for Part D next year. The income limits mark an increase over 2022 when standard premiums applied for individuals who made up to $91,000 a year and joint filers who made $182,000 annually. The 2022 premium included a contingency margin to cover projected Part B spending for a new drug, Aduhelm. Thanks to lower-than-projected spending on Aduhelm and other Part B items and services, there are much larger reserves in the Part B account of the Supplementary Medical Insurance (SMI) Trust Fund. If you’re enrolled in Medicare and use an insulin pump as part of the Part B durable medical equipment benefit, you won’t have to pay a deductible. Under the new Inflation Reduction Act of 2022, cost sharing for insulin will be capped at $35 a month next year.
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Helping you feel your healthiest for nearly 30 years. We’re here for you. Just as we’ve been since 1994. New West Physicians, part of Optum, gives you access to more than 140 providers across 26 clinics and all major hospitals throughout the Denver metro area. Virtual visits are available as well. Choose a Medicare Advantage plan that gives you all that New West Physicians has to offer. Call 303-802-1784 to talk to a Medicare expert* or visit NWPhysicians.com/2023AEP.
Medicare Annual Enrollment Period ends December 7 Now accepting Humana, UnitedHealthcare, and Aetna plans
New West Physicians is a proud provider of the Optum Care Network – Colorado. *A licensed insurance agent. New West Physicians patient advocates connect Medicare beneficiaries with resources including licensed insurance agents that sell Medicare Advantage and Medicare prescription drug plans. New West Physicians does not discriminate on the basis of race, color, national origin, sex, age, or disability in its health programs and activities. ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Please call 303.763.4900 Ext. 61500. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 303.763.4900 Ext. 61500. 請注意：如果您說中文 (Chinese), 我們免費為您提供語言協助服務。請致電 :303.763.4900 Ext. 61500.
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Am quiae arum Smile bigger Smile biggerrecto with eaquia volupis with $4,000 in officim volo bearum dental coverage dental coverage um illaut autem
This Medicare Advantage plan may have the dental benefits you want Smile more, spend less. Your oral health is a critical part of your overall health. HumanaChoice SNP-DE H5216-267 (PPO D-SNP) includes: • $4,000 in dental coverage on select services
• Two free cleanings • Exams • Fillings
• Crowns • Dentures … and more
Everything you’d get with Original Medicare, and more As a Medicare Advantage plan, it has everything you’d get with Original Medicare, and may include additional benefits. Humana strives to go the extra mile to help you get the healthcare you need. That’s called human care.
Call a licensed Humana sales agent Humana MarketPoint® Office 303-267-9000 (TTY: 711) Monday – Friday, 9 a.m. – 5 p.m.
A more human way to healthcare™ Humana is a Coordinated Care PPO SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in this Humana plan depends on contract renewal.Applicable to HumanaChoice SNP-DE H5216-267 (PPO D-SNP). At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, ethnicity, marital status, religion or language. English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-877-320-1235 (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-320-1235 (TTY: 711). 繁體中文 (Chinese): 注意：如果您使 用繁體中文 ，您可以免費獲得語言援助服務 。請致電 1‑877‑320‑1235 （聽障專線：711）。 Y0040_GHHLRMVTE_23_AD_M