2023 Medicare Parts A and B Cost Sharing Amounts

The Centers for Medicare and Medicaid Services (CMS) released the 2023 premiums, deductibles and coinsurance amounts for Medicare Part A and Part B.  While cost sharing for Medicare Part A services will increase in 2023, cost sharing for Medicare Part B services will decrease. 

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation and some home health care services.  The inpatient hospital deductible covers the first 60 days of Medicare-covered inpatient hospital care and will increase from $1,556 in 2022 to $1,600 in 2023.  For the 61st through 90th day of a hospitalization, the coinsurance amount will increase from $389 per day in 2022 to $400 per day in 2023.  After the 90th day, lifetime reserve days may be used after paying a coinsurance amount of $800 per day, which is an increase from the 2022 amount of $778 per day.  The daily coinsurance for days 21 through 100 of extended care services in a skilled nursing facility will increase from $194.50 per day in 2022 to $200 per day in 2023.

Medicare Part B covers physician services, outpatient hospital services, some home health services, durable medical equipment and other medical services not covered by Medicare Part A.  The standard monthly premium for Medicare Part B coverage will decrease from the 2022 amount of $170.10 to $164.90 in 2023.  The annual deductible for Part B beneficiaries will decrease from $233 in 2022 to $226 in 2023.

Plans that reimburse Medicare-eligible retirees through a Medicare Supplemental benefit will need to make the necessary decisions and adjustments to the plan of benefits to incorporate these changes to Part A and Part B cost sharing amounts.

CMS Website: https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly

2021 Consolidated Appropriations Act Requirements

The Consolidated Appropriations Act became law on December 27, 2020 and introduces a host of new compliance requirements for Health and Welfare Funds. The attached newsletter discusses these requirements including:

  • Mental Health Parity and Addiction Equity Act (MHPAEA) Comparative Analysis
  • Prohibition of Gag Clauses
  • Broker and Consultant Compensation Disclosure
  • Medical and Drug Cost Reporting

Download the TMC Newsletter here: https://www.mckeogh.com/wp-content/uploads/Health-News-July-6-2021-CAA-Requirements.pdf

COBRA Subsidies Available for COVID Relief

The American Rescue Plan Act of 2021 (ARPA) was passed into law on March 11, 2021 by President Biden. This law provides 100% tax-free subsidies for COBRA continuation coverage to eligible individuals for six months. The subsidy will begin on April 1, 2021 and end on September 30, 2021.

For more information on eligibility, notice requirements, tax credits and actionable steps, download the TMC Newsletter here: https://www.mckeogh.com/wp-content/uploads/TMC-Health-News-March-15-2021-COBRA-Subsidies.pdf

What Your Health Fund Should Consider during the COVID-19 Crisis

Here are some key points your Health and Welfare Fund should consider during the COVID-19 pandemic.

As part of the Families First Coronavirus Response Act, plans are now required (effective March 18th) to cover all testing for COVID-19 with no cost sharing. Your medical carrier should have reached out to you by this point with a communication regarding this. This is now a federal requirement and cannot be altered. Plans will need to be amended and SMMs sent to the membership.

Trustees should give consideration to waiving cost sharing requirements for the treatment of COVID-19. This is NOT a requirement but there is a possibility this too will be mandated by the government. Again, you should have heard from your medical carrier regarding this OPTIONAL plan change.

Telemedicine is proving to be a useful tool in today’s environment. Trustees should give consideration to implementing a telemedicine benefit if one is not currently in place. If these benefits are already available, consideration should be given to waiving any cost sharing associated with this service at least on a temporary basis.

Trustees should give consideration to early refills for prescription drugs. Most PBMs have communicated their policy regarding early refills during this crisis. However, you can alter your plans to allow for more generous time frames if desired.

Funds should remind members of their EAP and mental health benefits. Many individuals and families are struggling with mental health and should be encouraged to seek help when needed.

One of the biggest concerns moving forward will be eligibility. With the majority of work shut down for the time being, consideration should be given to any potential eligibility changes or COBRA premium subsidies that may help members stay on coverage.

Communications should be sent to the membership letting them know of any changes that are made and providing reminders of the coverage that is provided by the Fund.

New Jersey Health Coverage Reporting for 2019

After the repeal of the federal individual mandate which required that all individuals have minimum essential coverage, New Jersey enacted a mandate of their own.  The New Jersey Health Insurance Market Preservation Act imposes a penalty on New Jersey taxpayers who do not have minimum essential coverage during each month.  To administer the penalty, New Jersey is looking to providers of minimum essential coverage to New Jersey residents to send returns to the state for the 2019 tax year.  If reporting is required, the same Forms 1095-B and 1095-C that are transmitted to the IRS may be sent to New Jersey.  However, only forms for New Jersey residents should be submitted to the state in order to avoid privacy and HIPAA issues.  Returns must be filed with New Jersey no later than March 31, 2020.

Funds with New Jersey residents should seek advice from their accountant concerning these reporting obligations. 

Annual Reporting Deadlines Extended

The Internal Revenue Service (IRS) published Notice 2018-06 which provides an extension of the deadlines for 2017 ACA annual reporting requirements. The deadline for providing individuals with Forms 1095-B and 1095-C has been extended from January 31, 2018 to March 2, 2018. The deadline to file Forms 1094-B, 1094-C, 1095-B and 1095-C with the IRS remains unchanged and is February 28, 2018 for paper filings and April 2, 2018 for electronic filings.

These extensions are automatic and replace any extension requests that have been submitted. There will be no further extensions available. The IRS has continued the interim good faith compliance standard. Therefore, no penalties will be assessed for incomplete or inaccurate information on the forms filed provided the filer can show it completed the forms in good faith. This relief is only available if the forms were filed on time.

Mental Health Parity Rules Include Eating Disorders as Mental Health Conditions

On June 16, 2017, the Department of Labor (DOL) issued FAQ 38 implementing the Affordable Care Act (ACA) as it relates to the Mental Health Parity Act and Addiction Equity Act (MHPAEA) and the 21st Century Cures Act (Cures Act). The DOL is requesting comments on a draft model form for participants to use when requesting information about nonquantitative treatment limitations as well as confirming that benefits for eating disorders must comply with the MHPAEA.

The MHPAEA requires that financial requirements such as coinsurance and copayments and treatment limitations such as visit or day limits for mental health and substance use disorder benefits are no more restrictive than those placed on medical and surgical benefits. The regulations also state that a non-quantitative treatment limitation must be comparable.

The Cures Act requires that benefits for eating disorders are consistent with the requirements of MHPAEA. The DOL in this FAQ clarifies that the MHPAEA applies to any benefits a plan may offer for treatment of an eating disorder. Plans should review their plan information to ensure compliance with these regulations and guidance.

All comments regarding disclosures and eating disorders must be submitted by September 13, 2017.