A Closer Look at 2024: What’s Changing with Medicare

As 2024 unfolds, Medicare is set to undergo substantial changes in 2024, focusing on enhancing care and affordability for its over 65 million beneficiaries. A notable shift in the Medicare landscape is the increasing popularity of Medicare Advantage (MA), with more than 50% of enrollees opting for this private insurance alternative. In response, new requirements for MA insurers include:

  • Expanded behavioral health coverage.
  • Standardized commissions for brokers.
  • A mandate for plans to inform consumers midyear about additional entitlements.

The Centers for Medicare and Medicaid Services is dedicated to improving care coordination for original Medicare enrollees. Meena Seshamani, director of the federal Center for Medicare, highlights the goal of enrolling all beneficiaries in organizations that coordinate the quality and cost of their care by 2030, emphasizing the role of accountable care organizations (ACOs).

Recognizing healthcare challenges, Medicare will reimburse providers for assisting patients, particularly those facing complex illnesses. This change aims to streamline care coordination, promote health, and save Medicare costs. Additionally, Medicare will support providers in training family caregivers to better assist their loved ones.

In terms of affordability, changes in the drug law will expand eligibility for the Extra Help program, aiding beneficiaries with low incomes in affording prescription drugs. Limits on out-of-pocket costs for enrollees with high medication expenses are also introduced, addressing concerns about the financial burden of healthcare.

Fundamental Medicare Changes in 2024:

Fundamental Medicare Changes in 2024:

Below is everything about these changes, encompassing shifts in premiums, deductibles, drug coverage, and the ever-growing prominence of Medicare Advantage (MA) plans.

Premiums and Deductibles

Understanding the financial aspects is paramount, and 2024 brings forth noteworthy adjustments to premiums and deductibles. 

Part A

Part B

While most Medicare enrollees enjoy premium-free Part A coverage, those who need to pay will see a marginal change with a $1 decrease to $505 per month. The Part A deductible 2024 rises by $32 to $1,632 per stay, impacting those in Original Medicare and prompting Medicare Advantage beneficiaries to check their plan specifics. The standard monthly Part B premium climbs by almost $10, reaching $174.70. Individuals with higher incomes will experience an additional increase, with those earning between $103,000 and $129,000 paying $244.60 per month. Additionally, the Part B deductible for Original Medicare rises from $226 in 2023 to $240 in 2024.

Prescription Drugs for Shaping the Future of Medication Coverage

Prescription Drugs for Shaping the Future of Medication Coverage

From the introduction of a catastrophic cap in Medicare Part D to the expansion of the Extra Help program, these alterations are designed to alleviate the financial burden and enhance accessibility to essential medications:

Catastrophic Cap:

A notable change in the drug law introduces a catastrophic cap, ensuring that Medicare Part D plan members with high prescription costs won’t incur additional out-of-pocket expenses after spending $8,000 on medications in a year.

Extra Help Program:

Expanding eligibility for the Extra Help program in 2024 assists those with limited incomes, with the income threshold now at 150% of the federal poverty level. This change aims to benefit approximately 3 million eligible individuals who may not be enrolled.

Ongoing Provisions:

Since 2023, several provisions remain in place, including a $35 cap on a 30-day supply of covered insulin, coverage for recommended adult vaccines, and drugmakers facing rebates for price increases exceeding the inflation rate.

Medicare Advantage Evolution

As Medicare strides into 2024, the healthcare landscape undergoes a notable transformation with the evolution of Medicare Advantage (MA) plans. From proposed regulations standardizing commissions to prioritizing behavioral health through expanded provider eligibility, these shifts aim to redefine the Medicare Advantage experience. 

Commissions:

Proposed regulations for 2024 aim to standardize broker and insurance agent commissions for Medicare Advantage plans at a flat $642. This move ensures unbiased advice for beneficiaries and prevents steering toward plans with higher commissions.

Behavioral Health:

To prioritize mental health, licensed marriage and family therapists and mental health counselors are now eligible Medicare providers. A proposed CMS regulation introduces a new coverage category for outpatient behavioral health in MA plans.

Extra Benefits Communication:

To maximize the utilization of extra benefits offered by Medicare Advantage plans, a proposed regulation requires insurers to inform enrollees midyear about entitled services they have yet to utilize.

Expanded Healthcare Services

Expanded Healthcare Services

As the healthcare industry continues to evolve, the emphasis on holistic well-being takes center stage in 2024 with the expansion of healthcare services. From mental health counseling to addressing chronic pain, these expanded services signify a profound shift towards a healthcare system that not only treats ailments but also prioritizes the overall well-being of individuals.

Outpatient Mental Health Services:

The expansion of behavioral health services includes the enrollment of marriage and family therapists and mental health counselors as Medicare providers. Additionally, coverage for intensive outpatient programs for mental health is extended, with beneficiaries responsible for a percentage of the Medicare-approved amount and their Part B deductible.

Chronic Pain Treatment:

2024 sees coverage expansion for individuals with chronic pain, encompassing services like pain assessment, medication management, and care planning. Beneficiaries are responsible for their Part B deductible and coinsurance for these monthly services.

Telehealth Services:

While Medicare-covered telehealth services are available until 2024, changes are anticipated in 2025. Most telehealth appointments will be covered only in medical facilities or offices in rural locations, with exceptions for specific services.

Is Medicare Part B Going to Increase in 2024?

Is Medicare Part B Going to Increase in 2024?

Yes, the cost of Medicare Part B is indeed on the rise for 2024. The standard premium for Medicare Part B is slated to be $174.70 monthly, an almost 6% increase from the 2023 premium of $164.90. Additionally, the annual Medicare Part B deductible is set to climb to $240 in 2024, up from $226 in the preceding year. These adjustments are primarily attributed to the escalating costs in healthcare spending, underscoring the dynamic nature of the healthcare landscape.

Explore more: Recommended Reads for You – Medicare Giveback Plans: Exploring Medicare Part B Giveback Benefits.

What Are Medicare Advantage Plan Changes in 2024?

What Are Medicare Advantage Plan Changes in 2024?

In 2024, Medicare Advantage plans undergo significant changes to enhance the overall healthcare experience. New limits on prior authorization requirements are introduced, ensuring a smoother process for obtaining necessary medical services. Moreover, a concerted effort exists to enhance cultural competence within MA organizations, fostering health equity and expanding access to behavioral health services. These alterations signify a commitment to addressing diverse healthcare needs and creating a more inclusive healthcare environment.

What Is the Projected Medicare Premium for 2024?

What Is the Projected Medicare Premium for 2024?

The projected Medicare premium for 2024 varies depending on the specific Medicare part. For Part A, most Medicare recipients continue to enjoy premium-free coverage. However, for Part B, the premium increases to $174.70. Depending on the chosen plan, Medicare Advantage premiums can vary, with some plans offering $0 premiums.

On average, the premium for Medicare Advantage plans is $18.50. Part D plan premiums also exhibit variability, with an average monthly cost of $55.50. Understanding these projections is crucial for beneficiaries to make the right decisions about their healthcare coverage based on their needs and preferences.

Will Medicare be around in the future?

The future of Medicare depends on various factors, including potential policy changes, healthcare reforms, and the overall economic landscape. As of current projections, it is suggested that without significant interventions or overhauls, particular challenges may arise in the sustainability of specific aspects of Medicare:

  • Hospital Insurance Trust Fund: The trust fund supporting Medicare’s Hospital Insurance (Part A) is projected to face financial strain, with an inability to pay full benefits anticipated after 2031. This aspect primarily covers hospital-related benefits for Medicare beneficiaries.
  • Social Security Trust Fund: The Social Security trust fund, which covers retirees and their survivors, is projected to encounter challenges as well, with an expected inability to pay full benefits after 2033.

What is the New Special Enrollment Period?

What is the New Special Enrollment Period?

In a proactive move to address evolving healthcare needs, a new set of Special Enrollment Periods (SEPs) has been introduced, providing Medicare beneficiaries with increased flexibility to enroll in or disenroll from Medicare Advantage (MA) plans or Part D plans based on specific circumstances. Effective January 1, 2024, this initiative aims to cater to individuals facing exceptional conditions, ensuring they have timely access to essential healthcare coverage.

  • Exceptional Condition Enrollment: If you enroll in Part A or Part B during a Special Enrollment Period due to an exceptional condition, you now have a window of 2 months to join a Medicare Advantage Plan or a Medicare drug plan (Part D). The coverage becomes effective on the first day of the month following the submission of your request to join the Medicare Advantage Plan.
  • COVID-19 Public Health Emergency (PHE) Impact: For those who recently lost Medicaid (known as Medi-Cal in California) due to the unwinding of the COVID-19 Public Health Emergency (PHE), a Special Enrollment Period is available to enroll in Medicare. If you postponed Medicare enrollment during the PHE due to continuous Medicaid coverage, you now have a SEP to join Original Medicare if you lost Medicaid on or after January 1, 2023.
  • SEP Duration: The Special Enrollment Period starts on the day you receive notification that your Medicaid (Medi-Cal in California) coverage is ending and concludes six months after the end of Medi-Cal coverage.

Conclusion

The transformative shifts in Medicare for 2024 present challenges and opportunities for beneficiaries. Once you understand the details of premium adjustments, drug coverage enhancements, and the evolving landscape of Medicare Advantage, individuals can make informed decisions that align with their healthcare priorities. As Medicare continues to evolve, staying informed is the key to ensuring optimal healthcare access and affordability for all beneficiaries.