The Inflation Reduction Act passed last year, contained six Medicare reforms. Two, vaccines without co-pays and insulin co-pays capped at $35, began this year. Two more will go into effect in 2025, a $2,000 annual cap on Part D prescriptions and the ability to spread the cost of medications annually. Here is what is new for 2024 along with items you may not be aware of:
The Part D Catastrophic Stage will be eliminated. If a person exceeds the Coverage Gap TrOOP maximum of $8,000, their drugs will be covered at no cost to them for the rest of the year. This should limit a person’s annual Part D drug costs to approximately $3,200. Note: Part B drug costs are not capped.
The standard Part D deductible for 2024 is $545, a $40 increase. The threshold for entering the Coverage Gap is an aggregate retail cost of $5,030, a $370 increase.
The average 2024 national Part D premium is projected to be $55.50/month by CMS. If accurate, the Late Enrollment Penalty (LEP) will be 55 cents per month for each month a person could have had drug coverage but did not. The LEP will be added to the plan’s monthly premium.
Insulin that is used with a disposable insulin pump is included in Part D and has a $35 co-pay.
Certain medical supplies used to inject insulin, such as syringes, gauze and alcohol swabs are covered under Part D. Part B does not cover these items.
By law, drug manufacturer patient assistance programs cannot assist people with Medicare. Other discount programs, such as Good Rx, can be used.
Advantage plan dental benefits continue to improve. Originally dental benefits covered annual exams, routine cleanings and x-rays, along with some minor comprehensive benefits such as fillings. Now some plans are including crowns, dentures, and implants, while increasing their annual maximum benefit.
Advantage plans with Health Maintenance Organizations (HMO) networks are increasing member access to providers by blending local networks into a national one. This enables an HMO member to go to HMO network providers throughout the United States.
Part B premiums decreased in 2023 to $164.90/month. In 2024, the Part B premium is projected to be in the neighborhood of $175 to $180/month.
Those subject to the Medicare Income Related Adjustment Amount (IRMA), which is anticipated to be over 16% of Medicare beneficiaries in 2024, will see an expected 6% increase of both their Part B and Part D IRMA. If accurate, that would mean those exceeding the current annual income limit of $97,000/individual and $194,000/couple, would pay $70/month more for Part B than the estimated Part B standard premium of $175/month if they are in the first of the five additional income brackets. Those in the highest bracket, $500,000/individual and $750,000/couple, would pay $419/month more. The 2024 IRMA income brackets should be available sometime in November.
Medicare will offer full benefits to those with limited resources and incomes up to 150% of the federal poverty level ($21,870/year/individual in 2023). Full benefits will cover the majority of medication costs, as well as plan premiums. Those married with a joint income under $30,000, may qualify for Extra Help and should inquire of their state Medicaid agency.
CMS has issued rules to improve the process of prior authorization. These rules require payers to implement an electronic authorization process, shorten times to respond to requests, and specifically state the reason for a denial. The rules also address increased transparency of the prior authorization process and promote health data sharing. These rules have not yet been finalized but hopefully, will be soon.
