2024 will bring some positive changes and expanded Medicare benefits. Below is a summary of some of these changes with references for more information. You can also view your 2024 Medicare & You handbook for more information.
Prescription Drug Savings
Starting January 1, 2024, if you have Medicare drug coverage (Part D) and your out-of-pocket drug costs reaches $8,000 – the catastrophic coverage phase, you don’t have to pay co-payments and co-insurance for the rest of the calendar year. (Note that according to KFF, this provision will effectively cap out-of-pocket costs at approximately $3,250 in 2024.)
In addition, the Part D Extra Help program, which helps cover your Part D plan costs, will expand to people with incomes up to 150% of the federal poverty level (FPL). This is up from 135% of the FPL. People who qualify will have $0 premium and deductible costs if enrolled in a benchmark plan. In 2024, California has two benchmark plans accepting new enrollees. Prescription drug copays are capped at $4.50 (generic) and $11.20 (brand).
Also, coinsurance amounts for some Part B-covered drugs may be less if a prescription drug’s price increased higher than the rate of inflation. This is thanks to the new Medicare Prescription Drug Rebate Program.
A reminder of 2023 changes, your insulin cost sharing is capped at $35 for a one-month supply of each insulin product Part D covers, and you don’t have to pay a deductible for it. This also applies to insulin used with traditional insulin pumps under Medicare Part B’s durable medical equipment benefit. Adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are also available to you at no cost.
Chronic Pain Management & Treatment Services
If you have lived with chronic pain for 3 months or more, starting January 1, 2024, Medicare covers monthly services, including assessment, medication management and care coordination and planning. Medicare’s Part B deductible and 20% coinsurance apply.
Lymphedema Compression Treatment Items
Starting January 1, 2024, if you’ve been diagnosed with lymphedema, Medicare will cover your prescribed gradient compression garments (standard and custom fitted). You pay 20% of the Medicare-approved amount. The Part B deductible applies.
Mental Health Care (Outpatient)
Starting January 1, 2024, Medicare will cover mental health care services provided by marriage & family therapists and mental health counselors.
Medicare will also start covering intensive outpatient program services provided by hospitals, community mental health centers, federally qualified health centers, and Rural Health Clinics. See Medicare.gov/coverage/mental-health-care-partialhospitalization for more information. For more information on Medicare’s mental health coverage in general, see: Medicare.gov/coverage/mental-health-care-outpatient.
Changes to Telehealth Coverage
You can continue to use telehealth services at any location, including your home, through December 31, 2024. After that, however, you must be in an office or medical facility located in a rural area to get most telehealth services. There are some exceptions, like for mental health services. For more information, see: Medicare.gov/coverage/telehealth.
Medicare Advantage Provider Change Notification
Your network of providers may change during the year, yet your plan must notify you of provider changes, including if a provider is leaving your plan. And your plan must provide you with access to qualified doctors and specialists. See page 62 of your 2024 Medicare & You handbook for more information.
New Time to Join a Medicare Advantage or Part D plan
In addition to the current times you can join, switch, and/or drop an MA or Part D plan, starting January 1, 2024, if you have to pay for Part A, and you sign up for Part B during the General Enrollment Period (January 1 – March 31), you can also join a Medicare drug plan when you sign up for Part B. You’ll have 2 months after signing up for Part B to join a drug plan. Your drug coverage will start the month after the plan gets your request to join.
New Special Enrollment Period
Special Enrollment Periods (SEPs) allow you to enroll in or disenroll from a Medicare Advantage (MA) plan or Part D plan depending on your situation. Starting January 1, 2024, if you sign up for Part A or Part B during a Special Enrollment Period because of an exceptional condition, you’ll have 2 months to join a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan (Part D). Your coverage will start the first day of the month after the Medicare Advantage Plan gets your request to join.
Also, remember if you recently lost Medicaid (Medi-Cal in California) due to the COVID-19 Public Health Emergency (PHE) “unwinding”, you may have a SEP to enroll into Medicare. If you delayed enrollment into Medicare during the (PHE) due to Medicaid’s continuous enrollment, you have a SEP to join Original Medicare if you lost your Medicaid on or after 1/1/23. Your SEP starts the day you received notification that your Medicaid (Medi-Cal in California) coverage is ending and ends six months after Medi-Cal ends. Your Medicare coverage beings the month after you sign up, or the date your Medi-Cal coverage ends. You can decide.
For more information on all these changes, see your 2024 Medicare & You handbook or visit Medicare.gov. For questions and assistance, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.