How Is Medicare Changing in 2024?

Medicare makes changes every year and 2024 is no exception.

From the Medicare Part B premium and deductible increases to the several changes we will see with Part D Medicare drug coverage, here are several Medicare changes to expect for 2024.

1. Medicare Part B Premium and Deductible Increases

In 2024, the Medicare Part B premium will be $174.70, which is an increase of $9.80. If you have a higher income, your premium might be higher.

The Part B deductible is also going up by $14 to $240 in 2024. This means you'll need to pay this deductible before Original Medicare starts covering your healthcare costs.

2. New Part B IRMAA Chart

The standard Part B premium for 2024 is $174.70, but if your income is high, you'll have to pay more. This additional amount is known as the Income-Related Monthly Adjustment Amount (IRMAA).

Here is the updated Part B IRMAA chart for 2024:

3. Out-of-Pocket Maximum for Catastrophic Coverage for Part D Increases

If you have Part D Medicare (drug coverage), once your total drug costs reach $8,000, (total meaning what your plan and entities like Medicare's Extra Help program contribute, along with your own payments) you will reach the catastrophic coverage phase.

At that point, you won't have to pay any copayments or coinsurance for covered Part D drugs for the rest of the year.

The threshold has increased by $600 from last year, but once you reach it the copayments and coinsurance are $0 rather than the reduced 5% copay you had to pay in past years.

4. Lower Costs for Insulin and Vaccines

The $35 per month price cap for insulin that was in effect during 2023 is extending through 2024.

Starting in 2024, all recommended adult vaccines that are covered by Medicare will now be available with no cost-sharing.

5. Extra Help Coverage Extended to Help More People

Extra Help is a Medicare program that helps those with limited income cover the cost of Medicare Part D premiums, deductibles, and coinsurance.

In 2024, there will no longer be partial Extra Help. Everyone eligible for Extra Help will automatically get full Extra Help.

That means you will pay:

• $0 for your Part D premium
• $0 for your Part D deductible
• Reduced prescription costs: Up to $4.50 for each generic drug, and up to $11.20 for each brand-name drug

In 2024, the income limit to qualify for Extra Help is also going up.

Now, you'll be eligible if your income is up to 150% of the federal poverty level, compared to the 135% limit in 2023.

6. Changes to Telehealth Coverage

Telehealth services are still accessible nationwide, until the end of 2024. But then, most telehealth services will be limited to offices or medical facilities situated in rural areas.

Some exceptions apply and you will still be able to receive telehealth services for:

• Monthly home dialysis visits for End-Stage Renal Disease (ESRD).
• Services for an acute stroke including diagnosis, evaluation, or treatment of symptoms.
• Services for a mental health disorder including diagnosis, evaluation, or treatment.
• Services to treat a substance use disorder or a co-occurring mental health disorder.
• Behavioral health services.

Some Medicare Advantage plans still offer telehealth benefits to everyone regardless of where they live, so if you want to be sure to continue receiving telehealth benefits, check with your Medicare agent for details on individual plans.

7. Coverage for Chronic Pain

In 2024, Medicare will now cover monthly services to treat those living with chronic pain which is defined as recurring pain lasting longer than 3 months.

Services may include:

• Pain assessment
• Medication management
• Care coordination/planning

8. Extended Mental Health Care Coverage

Medicare helps cover services for mental health conditions like depression and anxiety.

Previously, coverage has included outpatient settings like a doctor's office or hospital, with various professionals like psychiatrists, psychologists, clinical nurse specialists, social workers, nurse practitioners, or physician assistants.

Starting in 2024, healthcare services provided by marriage and family therapists and mental health counselors will also be covered.

It will also cover intensive outpatient program services provided by hospitals, community mental health centers, federally qualified health centers, and Rural Health Clinics.

9. Lymphedema Compression Treatment Coverage

If you've been diagnosed with lymphedema, in 2024, Medicare will cover the cost of the gradient compression garments your doctor prescribes, whether they are standard or custom fitted.

10. Expensive Drug Negotiations Continue in 2024

The Medicare Drug Price Negotiation Program is happening as part of The Inflation Reduction Act and is aiming to lower drug prices starting in 2026.

In 2023, CMS set guidelines for the negotiation program so that the public is well informed along the way about what to expect, and they also chose the drugs covered under Medicare Part D that would be part of the first round of negotiations.

Then, drug companies with drugs selected for negotiation met with CMS to share data and information about their drugs and CMS held public patient-focused listening sessions to delve into and discuss the shared data.

In 2024, we can expect CMS to make an initial offer for the maximum fair price, along with a detailed explanation, by February 1. Companies then have 30 days to respond, choosing to accept the offer or propose a counteroffer.

If CMS and the drug company can't agree, they will do up to three more negotiation meetings in Spring and Summer 2024. All negotiations will wrap up by August 1, 2024.

11. More Times to Sign Up for Part D and Medicare Advantage Plans

In general, you have 3 times to sign up for Medicare or switch your Part D or Medicare Advantage plan;

• Initial Enrollment Period: 3 months before your 65th birthday, the month of your birthday, and 3 months after.
• Open Enrollment Period: October 15th - December 7th each year
• Medicare Advantage Open Enrollment Period: Only applies if you already have a Medicare Advantage Plan – you can switch to a different one, or drop it and go with original Medicare (and join a Part D drug plan) from January 1st – March 31st each year.

In 2024, if you qualify for a Special Enrollment Period and use it to sign up for Part A or Part B, you'll also have 2 months from then to sign up for a Medicare Advantage plan or Part D plan.

Additionally, if you have to pay for Part A and you sign up for Part B during the General Enrollment Period, you will also have 2 months to join a drug plan.

12. Additional Rules for Medicare Advantage Plans

Medicare Advantage Plans have to stick to the rules set by Medicare, but each plan can set its own costs and rules for how you access services.

And healthcare providers can join or leave your plan's network at any time during the year. The plan itself can also switch up its network of providers during the year.

So starting in 2024, your plan must notify you if any primary care or behavioral health provider that you have seen in the last three years is leaving your plan so you have time to choose a new one.

Your plan must also:

• Give you access to qualified doctors and specialists.
• Help you choose a new provider.
• Help you continue needed care that’s already in progress.
• Let you know what enrollment periods you qualify for so that you can switch plans if you aren't satisfied.

13. Agent Compliance Rules and Regulations

At this point, you're probably familiar with your phone calls to your Medicare agent being recorded and the disclaimers we have to read, but the rules and regulations that CMS sets for agents like us to follow tighten each year and there will certainly be new regulations for 2024.

We will do our best to communicate what they are as soon as we know.

While some of the changes can be frustrating (we understand not everyone enjoys having their phone calls recorded), CMS is genuinely trying to protect seniors from scams and make sure they have the best chance of finding the right plan for them.

And that's why we are committed to complying with whatever regulations they establish.

Conclusion

Medicare is always making changes, so it's good to stay up-to-date on what's happening and make sure you understand how these changes will affect you.

If you have any questions about any of these changes or wonder how they will affect you in 2024, give us a call at 217-423-8000 to schedule an appointment with a licensed insurance agent.