During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D prescription drug coverage, either a stand-alone prescription drug plan (PDP) for people in traditional Medicare, or a Medicare Advantage plan that covers all Medicare benefits, including prescription drugs (MA-PD).

Highlights for 2023:

  • The average Medicare beneficiary has a choice of nearly 60 Medicare plans with Part D drug coverage in 2022, including 24 Medicare stand-alone drug plans and 35 Medicare Advantage drug plans.
  • A total of 801 PDPs will be offered in 2023 nationwide, a modest increase from 2022. Of this total, 191 PDPs will be premium-free for enrollees receiving the Low-Income Subsidy (LIS) (benchmark plans).
  • The estimated average monthly premium for Medicare Part D stand-alone drug plans is projected to be $43 in 2023, based on current enrollment, a 10% increase from $39 in 2022 – a rate of increase that outpaces both the current annual inflation rate and the Social Security cost-of-living adjustment for 2023.
  • Average monthly premiums for the 16 national PDPs are projected to range from $6 to $111 in 2023. Among the national PDPs, average monthly premiums are increasing for 12 PDPs, including 4 PDPs with increases exceeding $10.
  • Most PDP enrollees will face much higher cost sharing for brands than for generic drugs, including coinsurance for non-preferred drugs between 40% and 50% (the maximum coinsurance rate allowed for the non-preferred drug tier) in 12 of the 16 national PDPs, similar to recent years. Close to half of all PDP enrollees will also face coinsurance, rather than copays, for preferred brands, ranging from 15% to 25%; coinsurance can mean less predictable out-of-pocket costs than copayments. Most Part D PDP enrollees who remain in their current plan for 2023 will be in a plan with the standard (maximum $505 deductible).
  • Beginning in 2023, under a provision in the Inflation Reduction Act, Part D enrollees will pay no more than $35 per month for covered insulin products in all Part D plans, and will pay no cost sharing for adult vaccines covered under Part D. Also beginning in 2023, drug manufacturers will be required to pay rebates for drug prices that rise faster than the rate of inflation, which could impact costs for Part D enrollees. The law also adds a hard cap on out-of-pocket drug spending under Part D by eliminated the 5% coinsurance requirement for catastrophic coverage in 2024 and capping out-of-pocket drug spending at $2,000 in 2025 and authorizes the federal government to negotiate drug prices under Medicare, with negotiated prices for 10 Part D drugs first available in 2026.

For more information regarding Part D Plan Availability and Part D Premiums, click here.

Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.