The Biggest Changes Coming to Medicare in 2023 (2024)

Beginning on July 1, Medicare enrollees who take their insulin through a pump as part of the Part B durable medical equipment benefit will not have to pay a deductible and they will also benefit from the $35 copay cap.

Another provision of the new law calls for some high-priced drugs to be subject to price negotiation with drugmakers. So although the monthly maximum copay for insulins covered by Medicare will be $35 in 2023, 2024 and 2025, beginning in 2026 — the first year negotiated prices will take effect — covered insulin copays for any drugs that have been part of the new negotiations will be $35 or 25 percent of the negotiated price, whichever is less.

Free vaccines

Also under the new law, vaccines recommended for adults by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) will be available to Medicare recipients with prescription drug coveragefree of charge.

Some vaccines are covered under Part B and are already free to Medicare enrollees. Others are covered by Part D prescription drug plans and require beneficiaries to pay some of the cost.

For example, shots for the flu, pneumonia, COVID-19 (initial shots and boosters) and hepatitis B for some enrollees are free under Part B and that coverage will continue in 2023. Part B also covers vaccines needed to treat certain injuries or if you have direct exposure to a disease. Those include hepatitis A, rabies and tetanus.

Other vaccines, most notably the two-dose Shingrix, which guards against shingles, are covered under Part D prescription drug plans and may require cost sharing depending on the plan. Shingrix, for example, can run as much as $200 a dose. Starting in 2023, even if a beneficiary hasn’t satisfied their Part D deductible, that vaccine and others recommended by ACIP will be free to beneficiaries.

Drugmakers face penalties for high price hikes

Another provision of the new law that will be fully effective in 2023 requires pharmaceutical manufacturers to pay a rebate to Medicare if they raise the prices of their drugs more than the rate of general inflation.

Beginning in 2023, companies that market both Part D prescription drugs — those bought at pharmacies — and Part B drugs, typically administered in doctor’s offices, will face penalties if they increase prices more than the rate of inflation. The rebates the companies owe will be the amount they raised a drug’s price above an increase to equal inflation, multiplied by what Medicare paid for all sales of that drug.

This new requirement is intended to discourage drug companies from raising their prices above inflation. According to research from the nonpartisan Kaiser Family Foundation, from 2019 to 2020 the prices of half of all drugs covered by Medicare increased more than the rate of inflation.

Beginnings of price negotiations

By Sept. 1, Medicare will announce the first 10 Part D drugs that under the new law will begin a first-ever process in which Medicare will negotiate prices with drugmakers, Seshamani said, and that “will have a huge impact for providing more affordability for drugs for people with Medicare.”

Negotiated prices for that first group of drugs, which will be selected from the 50 medicines for which Medicare prescription drug plans spend the most, will take effect in 2026.

Some telehealth rules will change

During the pandemic, Medicare expanded the availability of telehealth. This included allowing patients to talk to providers by phone, not just on face-to-face video calls, which is what Medicare rules had required. The government also expanded the types of providers who would be available for telehealth visits, including physical, occupational and speech therapists.