3 Insurance Changes That May Impact Your Coverage This Year

Many health laws passed in 2022 are taking effect in 2023, including a continuation of some telehealth benefits and a cap on insulin costs for Medicare beneficiaries. 

Some of the provisions of the massive Omnibus appropriations bill, for example, can save you time, money—or both. Telehealth, which exploded during the pandemic, is still at least partially covered by many insurers, and new legislation in the Omnibus bill allows Medicare to keep many telehealth options in place.

"This legislation will deliver critical support and resources so we can better care for our patients and create healthier communities," Rick Pollack, president and CEO of the American Hospital Association, told Verywell.

Telehealth Lives Another Day

Medicare has extended many telehealth benefits that were granted during the pandemic through the end of 2024. 

“It’s hard to overstate how restrictive the telehealth rules were prior to the pandemic,” Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center in New York City, told Verywell. For instance, before the pandemic, telehealth visits from a patient’s home were not covered by Medicare.

Now, telehealth visits can happen anywhere, and in some circumstances, can even take the place of emergency room followup visits. The Hospital-at-Home program has been renewed until 2024. This allows some patients seen at a hospital ER to continue care at home under certain circumstances, such as agreeing to remote care and nurse visits. 

Covered telehealth providers include physicians, occupational therapists, physical therapists, speech-language pathologists, and audiologists. Both audio-only and video visits are covered.

Insulin Gets a Price Cap

Legislation in the Inflation Reduction Act, passed in August, caps the cost of insulin at $35 per month for Medicare beneficiaries. This provision does not apply to those who only have private insurance or no insurance.

Schwarz says that because many people signed up for Medicare in the fall before the price cap was finalized among drugs plans, they may not be reaping the benefit of this change yet. The Centers for Medicare & Medicaid Services (CMS) says the $35 price cap will be finalized in March. Anyone who pays more than $35 per month for insulin in January or February will be reimbursed the difference. 

Because of the confusion, Medicare is allowing people whose prescription costs are covered through Medicare Part D to sign up again, through the end of the year, and make changes to any drugs. 

Starting July 1, Medicare beneficiaries who get their insulin through an insulin pump paid for through Medicare Part B will also have a $35 monthly insulin price cap.

No deductible has to be met for the insulin price caps to go into effect. 

Medicaid May Require Re-enrollment

During the public health emergency declared at the start of the pandemic—which is set to end in May—Medicaid plans could not push people out, even if their incomes went above Medicaid eligibility. This COVID-era protection, referred to as “continuous eligibility,” ends on March 31.

According to the Kaiser Family Foundation (KFF), millions of people could lose Medicaid coverage beginning in April when they will have to show their income eligibility.

If you or someone you know is on Medicaid, know that it’s essential to reply to requests for information from your county, including current contact information and income. Not replying could result in you losing your Medicaid coverage even if you are eligible.

If your income is too high to stay on Medicaid, your county Medicaid office can help you find other plans that may cost you little or nothing through the Affordable Care Act. LA Care Health Plan, for example, which covers over 2 million people in Los Angeles, has been sending notices to members about the need to respond to coverage queries and options for coverage if they no longer qualify for Medicaid.