Ophthalmology and Optometry Coding Alert

Let this Q&A shed light on how these updates will impact patients and reimbursement.

Every year Medicare makes changes, and you need to be aware of what’s being revised year to year so you can modify how your eye care practice operates accordingly. To help you start the year off right, we’ve compiled a list of the most frequently asked questions on key changes for 2023, with answers from the experts.

Q: Did the Medicare Part B standard premium and deductible increase for 2023?

No. Part B costs are on the decline. Because Medicare Part B spending was lower than expected in 2022, there was a surplus left over that is being used to decrease premiums for 2023. The standard Part B premium dropped from $170.10 in 2022 to $164.90. This is the first year-over-year drop since 2012. Similarly, the Part B deductible has decreased for the first time in over a decade from $233 to $226 in 2023.

Q: Did Part A premiums, deductible, and coinsurance increase for 2023?

Yes. Part A premiums, which have trended upward over time, are increasing again. In fact, Part A premiums, deductible, and coinsurance all increase in 2023. For 2023, the Part A premium for people with 30-plus (but less than 40) quarters of work history is $278/month, up from $274/month in 2022. And for people with fewer than 30 quarters of work history, the premium for Part A is $506/month in 2023, up from $499/ month in 2022.

Remember: Medicare Part A covers hospitalization costs, but most enrollees — roughly 1 percent of Medicare Part A enrollees — pay premiums. The rest get it for free based on their work history or a spouse’s work history that includes at least 40 quarters. Part A has a deductible that applies to each benefit period, which covers the enrollee’s first 60 inpatient days during a benefit period. If the individual needs additional inpatient coverage during that same benefit period, there’s a daily coinsurance charge.

The Part A deductible will be $1,600 in 2023, up from $1,556 in 2022, although many enrollees have supplemental coverage that pays all or part of the Part A deductible. For 2023, the coinsurance charge will be $400 per day for the 61st through 90th day of inpatient care (up from $389 per day in 2022). The coinsurance for lifetime reserve days is $800 per day in 2022, up from $778 per day in 2022.

Q: How are Medicare Advantage premiums changing for 2023?

Medicare Advantage (MA) premiums have been declining for the last several years, and this year is no different. According to the Centers for Medicare & Medicaid Services (CMS), the average MA (Medicare Part C) premium is about $18/month in 2023 (in addition to the cost of Part B), which is down from $19.52/month in 2022 and $23/month in 2020. This has helped to fuel enrollment in these plans, which has been steadily growing for more than 15 years, with enrollment projected to reach 31.8 million people in 2023.

Q: How is Medicare Part D prescription drug coverage changing for 2023?

The average Part D premium is projected to be $31.50/month in 2023, down from $32.08 in 2022. Once the calendar flips to Jan. 1, 2023, the Part D donut hole will disappear, but:

• A standard plan’s maximum deductible will increase to $505 next year
• The threshold for entering the catastrophic coverage phase — where out-of-pocket spending decreases significantly — will increase to $7,400
• The Inflation Reduction Act ensures that Part D enrollees no longer have to pay for vaccines
• Part D enrollees are covered for insulin at a cost of no more than $35/month

“The Affordable Care Act ‘closed’ the donut hole in Medicare Part D, so there is no longer a ‘hole’ for brand-name or generic drugs: Enrollees in standard Part D plans pay 25 percent of the cost (after meeting their deductible) until they reach the catastrophic coverage threshold,” notes health insurance broker Louise Norris. “Prior to 2010, enrollees paid their deductible, then 25 percent of the costs until they reached the donut hole, then they were responsible for 100 percent of the costs until they reached the catastrophic coverage threshold.”

Q: Will there be inflation adjustments for Medicare beneficiaries in high-income brackets in 2023?

Yes. The threshold for high-income surcharges (and each of the income brackets) is increasing for 2023. Although the premiums that people pay for Part B are decreasing, that includes those who pay the high-income surcharge.

Medicare began adjusting the income brackets for inflation in 2020. For 2023, the threshold where the surcharge starts to be added is increasing again, to $97,000 for a single person and $194,000 for a married couple, up from $91,000 and $184,000, respectively, in 2022.

5 Tips to Help Boost Your Practice’s Performance

Consider these five actions that will likely benefit your practice and patients:

1. Patients often do not give you all of their insurance information, so make sure you collect all of each patient’s insurance information — not just their vision insurance.

2. Review reimbursement and third-party policies to make sure you are maximizing what you are entitled to.

3. Schedule your Medicare patients later in the year after their deductibles have been met.

4. Remind your providers that there are time limits on submitting insurance claims, and “make sure they aren’t waiting too long to file,” says Mary Pat Johnson, CPC, CPMA, COMT, COE, senior consultant with Corcoran Consulting Group. “Work on putting systems in place to be able to submit third-party claims the day care is provided or no later than the next day.”

5. Review your third-party systems every November and plan for changes that will happen the next year.