Recent changes announced by the U.S. Centers for Medicare & Medicaid Services (CMS) will improve how new beneficiaries, those who missed initial enrollment windows and those seeking specific dental coverage become eligible for care. These improvements aim to save Medicare beneficiaries from unnecessary penalties, allow quicker access to coverage and lower the costs of newly covered dental services.
3 New Medicare Rules for 2023
The newly finalized 2023 rules for Medicare improvements take effect on Jan. 1, 2023.
New 2023 Coverage Rules
Beneficiaries who sign up for Medicare after they turn 65 will have access to coverage more quickly in 2023. In 2022, they could have to wait several months for coverage to begin. The rules below relate to coverage for Premium-Part A and Part B.
| If you sign up: | In 2022, your coverage started: | In 2023, your coverage starts: |
|---|---|---|
| Before the month you turn 65 | The month you turn 65 | The month you turn 65 |
| The month you turn 65 | The next month | The next month |
| 1 month after you turn 65 | 2 months after you sign up | The next month |
| 2 or 3 months after you turn 65 | 3 months after you sign up | The next month |
Special Enrollment Periods in 2023
Starting in January 2023, there are five new instances that qualify beneficiaries for a Special Enrollment Period (SEP). If you miss the General Enrollment Period (GEP), you can sign up for Part B and Premium-Part A during a SEP. If you miss the GEP for any of the exceptional scenarios listed below, you qualify for a SEP.
Newly Established SEPs for 2023
- Individuals impacted by an emergency or disaster
- Individuals whose employer or health plan made an error with their Medicare enrollment information
- Formerly incarcerated individuals being released from correctional facilities
- Individuals who missed the Medicare enrollment period after termination of Medicaid eligibility
- Other exceptional conditions on a case-by-case basis
Source: U.S. Centers for Medicare & Medicaid Services
These additional SEP opportunities can potentially save beneficiaries from paying the Part B penalty — an extra 10% for each year they could have signed up for Part B plus higher premiums, depending on income level.
New Dental Coverage in 2023
The most significant dental coverage change announced for 2023 is a wider range of covered dental services. The 2023 Medicare Physician Fee Schedule Final Rule states that CMS will extend coverage for “other dental services that were inextricably linked to, and substantially related and integral to, the clinical success of an otherwise covered medical service.”
To qualify for coverage in 2022, dental procedures must have been linked to specific Medicare-covered procedures, like an oral exam before a kidney transplant. The 2023 rules allow more flexibility for dental coverage.
Dental and Oral Health Services Coverage Comparison
| 2022 Coverage Examples | 2023 Coverage Examples |
|---|---|
| Reconstruction of a beneficiary’s jaw after an injury or surgery | Everything included in 2022 |
| Tooth extractions in preparation for radiation treatment for cancer involving a beneficiary’s jaw | Dental services when they are necessary for the specific treatment of a beneficiary’s primary medical condition |
| Oral exams before a kidney transplant | Necessary dental treatments prior to organ transplants, heart valve replacements and valvuloplasty procedures |