Medicare 2023: A Briefing for LTC Pharmacy

Well, September has come and gone, and right around the corner is the annual open enrollment for the 2023 Medicare Part D plan year. 

Right on schedule, CMS has just announced the Part B premium and deductible and released the landscape files (list of plans) for Medicare PDPs,  Medicare Advantage Plans, Special Needs Plans. and Medicare-Medicaid plans under the Medicare Prescription Drug Benefit.

Dual-Eligible Plan Assignments

Medicare beneficiaries have the freedom to choose any Medicare drug plan they wish during open enrollment (October 15-December 7), they also have freedom not to enroll at all.

For dual-eligible residents, if they do not choose a plan CMS will make an assignment for them. The plans to which dual-eligibles can be assigned are those with zero dollar premium and a full low-income subsidy. They are denoted in column E in the PDP Landscape file with an “x”.

The small adventure comes during annual open enrollment. Not all plans that currently qualify for dual-eligible assignment are eligible the following year. If that’s the case the dual-eligible must be reassigned to another qualified plan. CMS has tried to assign beneficiaries that find themselves in this situation to another eligible plan that is operated by the same insurer that is being discontinued. For example, if the beneficiary is assigned to a dual-eligible plan operated by Humana, CMS is likely to assign the beneficiary to another plan operated by Humana, if there is one available.

If the plan is no longer available and there is not a plan available operated by the sponsor of the current plan, CMS will randomly assign the beneficiary to an eligible plan.

Tracking the Changes

To prepare for 2023 it’s helpful to be able to anticipate how many residents will be reassigned to new plans. While we can’t have all the answers on this, I have put together an Excel workbook that shows which plans are available for auto-assignment in 2022 and which are available for 2023.

The screenshot above is a look at Region 1 of the workbook that compares 2022 dual-eligible plans vs. 2023 plans. Note that Elixir RxSecure is available for auto-assignments in 2022 but will not be available in 2023. The Clear Spring Health Value Rx plan will be available in 2023 and all the others listed in the 2023 column are available in 2023 and are currently available in 2022. So, you may want to take a look at the dual-eligible residents in Maine and New Hampshire currently enrolled in the Elixir plan. They will likely be enrolled in a different plan unless they have already chosen the elixir plan in previous years. Remember, auto-assignments don’t automatically take place if the beneficiary has chosen a plan.

Fewer Plan Changes in 2023

A quick review of the PDP Landscape for 2023 reveals that there are relatively few beneficiaries that will be affected by this policy. A total of 19 regions out of the 34 PDP regions have no plan changes for dual-eligibles. I think this may be a new record for low churn.

Keep in touch over the next few weeks as we explore the 2023 Medicare Part D year. It looks to be shaping up to be an interesting year.