Avila Medicare Solutions

Date of publication:

Good news for all Medicare beneficiaries!

Please be advised that effective January 1, 2023, Medicare has implemented several changes to its program that will benefit millions of people. New features include expanding access to telemedicine services, adding more drugs to the list of covered medications, and eliminating the out-of-pocket limit for some treatments. These changes are designed to improve the accessibility and quality of health care for Medicare beneficiaries nationwide.

Some telehealth rules will change

Medicare has expanded access to telehealth during the pandemic. This includes allowing patients to speak with providers by telephone, rather than just face-to-face video calls as required by Medicare rules. The government has also expanded the types of providers available for telehealth visits, including physical, occupational and speech therapists.

The expansion of these additional services and ways to provide telehealth visits is possible because Medicare officials were able to temporarily suspend existing regulations due to the public health coronavirus. But many of those additional services will only be available for another 151 days after the state of emergency is lifted, Seshamani said. Congress will have to act to extend or make these extensions permanent.

One area where new flexibility in telehealth has become permanent is behavioral health. Beneficiaries will still be able to access these visits by phone only, in addition to video.

Increased emphasis on behavioral health

"There's a lot coming up to mobilize the behavioral health workforce," Seshamani says.

Seshamani said Medicare will pay for licensed clinical social workers, psychologists and other behavioral health professionals to be part of beneficiaries' primary care office visits "so they can get behavioral health services there, so that people's care is comprehensive." The program will also improve access to licensed marriage and family therapists.

In addition, Medicare will expand its addiction treatment services. "For example, we will pay for mobile vans that are used to provide opioid treatment to people," Seshamani said.

Some have access to dental care

Medicare does not cover routine dental care. It does cover the cost of some dental work related to other medical procedures, such as tooth extraction during jaw surgery. Beginning in 2023, the program will expand the types of "medically necessary" dental services that will be covered when needed, as well as other procedures, such as cleanings or other dental work, to improve the results of organ transplants or cancer treatments.

Improved access to registration

Beginning in January, as long as eligible individuals enroll in Medicare during the official enrollment period, they will not have to wait for coverage to begin. In addition, the new federal regulation provides additional special enrollment deadlines, including for those who, through no fault of their own, did not enroll when they first became eligible.

Before the new rules, people who enrolled later than expected (usually within three months of turning 65) sometimes had to wait two or three months to get coverage. For example, enrolling during the general enrollment period (January 1 through March 31) requires you to wait until coverage begins in July.

Beginning in 2023, whenever you apply for Medicare during the general enrollment period or special enrollment period, your coverage will begin at the beginning of the following month.

Individuals eligible for some of the new Special Enrollment Periods include those who were not enrolled in the initial enrollment period because they were affected by a natural disaster and those who received incorrect information from their employers, so they did not enroll when they should have. In addition, individuals who are no longer eligible for Medicaid, the federal and state health insurance program for low-income individuals, will be able to apply for Medicare during the Special Enrollment Period if they lose Medicaid coverage. This will be especially important when the COVID-19 public health emergency is eliminated, Seshamani said.

Stay tuned and feel free to share any questions or comments you may have!

In our next blog we will address other Medicare changes coming this year.

If you need help with Medicare or health plans, call us for free advice. Our local number is 512-520-5957 or you can call us on our toll free number which is 855-GO-AVILA. We are here to serve you.

Do you have any doubts? Call us now.

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