Medicare and You

Randal C. Hill

PEOPLE OFTEN GRUMBLE ABOUT OUR GOVERNMENT, but few folks complain once they experience the benefits of Medicare, the program designed decades ago with us seniors in mind. Still, understanding how it works and how to get started can be daunting. The following answers to some basic rules of Medicare can help you navigate the system with less stress and greater success.

What exactly is it?

Medicare is a national health insurance program begun in 1965 under the Social Security Administration (SSA). It primarily provides limited health insurance for Americans 65 and older, as well as some younger people with disabilities.

How many people are enrolled?

Around 65 million citizens — more than 57 million ages 65 and older, plus about 8 million younger people — have about half of their healthcare expenses covered by the program.

Enrollees almost always cover most of the remaining costs with additional private insurance and/or by joining a public Medicare Part C and/or Medicare Part D health plan. (More on those later.)

What are positive changes for 2023?

While some costs may go up by a few dollars, more than 65 million people will benefit from lower premiums and deductibles this year.

With the Inflation Reduction Act of 2022, some Medicare enrollees with diabetes will find the cost of a 30-day supply of insulin will now be capped at $35, even if the annual Part D (prescription drug coverage) deductible has yet to be met. If your Part D plan covers disposable insulin patch pumps, the pump is considered an insulin supply. Because it isn’t an insulin product, the pump isn’t subject to the $35 cap and might cost more.

Vaccines recommended for adults by the Centers for Disease Control or CDC will be made available free of charge to Medicare enrollees who have prescription drug coverage (Part D). Also free are vaccines for shingles and tetanus-diphtheria-whooping cough.

Medicare will also be expanding its services for substance abuse programs, including coverage for licensed clinical social workers, psychologists and other behavioral health specialists.

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What about out-of-pocket costs?

Enrollees’ overall coverage choices impact how much they pay in premiums, deductibles and co-pays or co-insurance. How often an enrollee uses the healthcare system can also contribute to costs. Beneficiaries with limited income may qualify for Medicaid or other programs that help defray certain costs.

When do I enroll?

The next open enrollment period is Oct 15 to Dec 7, 2023. Changes made during this period will take effect January 2024. You become eligible for Medicare three months before your 65th birthday. The period during which changes can be made to Medicare Advantage Plans runs January 1 to March 31.

What if I have questions?

Go online to medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-