Big Medicare Changes Coming in 2024

If you are enrolled in Medicare Advantage, you most likely will have to pay the full Part B premium, unless you sign up for a private plan that offers a “giveback” benefit in which the insurer will cover part or all of the Part B charge. Whether you will have an added monthly premium for your MA plan will depend on which plan you choose and where you live.

Part B premiums for Medicare beneficiaries with high incomes are also going up. Individuals with annual incomes greater than $103,000 will pay more than the standard premium — how much more will depend on their earnings. For example, someone filing an individual tax return whose income is between $103,000 and $129,000 will pay $244.60 a month for Part B instead of the standard $174.70. Medicare officials say about 8 percent of Medicare enrollees pay more than the standard monthly premium.

The annual Part B deductible for original Medicare is also increasing, from $226 in 2023 to $240 in 2024. The deductibles for MA plans vary depending on what plan you pick and where you live.

Prescription drugs

Catastrophic cap: Under the new drug law, Medicare Part D plan members whose prescription costs are so high that they enter what’s called the catastrophic phase of coverage will not have any more out-of-pocket costs for the rest of the year once they’ve spent $8,000 on their medications. In 2025, an annual $2,000 out-of-pocket cap on Part D spending will take effect.

Extra Help: In 2024 the new drug law is expanding the eligibility for the Extra Help program, which assists people with limited incomes in affording their prescription drug costs, such as premiums and copays. The income threshold for Medicare enrollees to qualify for that program will be 150 percent of the federal poverty level ($21,870 for an individual in 2024), up from 135 percent of poverty.

“It’s really important for people to see if they could qualify for that program,” Seshamani says, “because we estimate there are about 3 million people out there who are eligible and not enrolled.” Medicare beneficiaries can apply for the Extra Help program through the Social Security Administration.

New law provisions still on track: The provisions of the new prescription drug law that took effect in 2023 will still be in place in 2024. These include:

• A $35 cap on a 30-day supply of any insulin that Medicare covers, whether you have prescription drug coverage through a stand-alone Part D plan or your medications are covered under your Medicare Advantage plan.

• Vaccines recommended for adults by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) continue to be covered with no out-of-pocket costs. Included are the vaccines for shingles and RSV. Medicare also covers vaccines for flu, COVID-19, pneumonia, hepatitis A, rabies and tetanus.

• Drugmakers that raise their prices more than the rate of general inflation will continue to have to pay a rebate to Medicare. In 2023, 64 drugs were subject to that rebate.

• For the first time in history, Medicare is in the process of negotiating with drugmakers over the price of their products. Under the new drug law, the first 10 drugs that are being negotiated were identified in September, and by September 2024 CMS will publish the list of what the maximum fair prices will be for those medications.

More Medicare Advantage changes

Commissions: Under a proposed regulation, expected to take effect in 2024, broker and insurance agent commissions for the sale of a Medicare Advantage plan would be set at a flat $642. Currently there is a $611 cap on such payments, but those commissions are not fixed. CMS officials say the variation in these payments can lead to consumers not getting the best prices because some brokers may be inclined to push consumers toward MA plans paying higher commissions.

Seshamani says CMS wants to make sure that those who sell MA policies to people in Medicare are giving them the information they need to make the best decision, “not steering people towards a plan that is giving a super-high commission.”

Behavioral health

Beginning Jan. 1, licensed marriage and family therapists as well as mental health counselors, including addiction counselors, will be able to enroll in the Medicare program so they can be paid for treating Medicare enrollees.

Seshamani says about 400,000 clinicians will qualify to see Medicare patients. In addition, a proposed CMS regulation would add a new coverage category for MA plans called outpatient behavioral health, and those providers would be included in that category. 

Extra benefits 

Most Medicare Advantage plans offer extra benefits beyond what the law requires. Most often these include some dental, vision and hearing coverage; sometimes gym memberships, transportation to doctors’ offices, accessibility improvements to homes or even meals delivered to homes are included as well.

CMS officials say that often Medicare enrollees don’t take full advantage of some of these extras and may not even realize they are entitled to them.

Under a proposed regulation, expected to be finalized in 2024, halfway through the year, insurers will have to send a letter to enrollees letting them know what services they are entitled to but have yet to begin using.