by Russell Noga | Updated September 19th, 2023
What Are the Changes in Medicare for 2024
As Medicare evolves, it’s essential for beneficiaries to stay informed about the latest changes in policy and coverage. “What are the changes in Medicare for 2024?” you might ask.
The year 2024 brings several updates to Medicare Advantage and Part D plans aimed at improving healthcare access, equity, and affordability.
This blog post will delve into these changes, providing you with a comprehensive understanding of what to expect and how to navigate the new landscape. Buckle up as we journey through the world of Medicare reforms!
Short Summary
- CMS has finalized policy updates for Medicare Advantage and Part D plans in 2024 to reduce costs, improve healthcare experience, and incorporate provisions from two Acts as well as the President’s budget proposals.
- Quality Improvement Programs are being implemented to enhance health equity while measures such as annual prescription drug cost limits aim at reducing financial burden of medications for beneficiaries.
- Non-Medicare beneficiaries will benefit from enhanced premium subsidies until 2025. Staying informed about reforms is essential for understanding their implications.
Medicare Advantage and Part D Policy Updates for 2024
The Centers for Medicare & Medicaid Services (CMS) has finalized policy updates for Medicare Advantage and Part D plans in 2024, incorporating provisions from the Inflation Reduction Act of 2022 and the Consolidated Appropriations Act of 2021.
These policy changes aim to streamline processes, reduce costs, and improve the overall healthcare experience for beneficiaries, including those enrolled in traditional Medicare.
Key reforms include granting prior authorizations that cover an entire course of treatment and incorporating electronic medical record interoperability capabilities in the processing of prior authorizations.
Additionally, President Biden’s 2024 budget proposals for Medicare include:
- increasing taxes on high-income individuals,
- decreasing drug prices,
- prolonging the solvency of Medicare’s Hospital Insurance trust fund,
- and enhancing benefits.
Implementation of Inflation Reduction Act Provisions
The Inflation Reduction Act provisions will significantly impact Medicare Advantage and Part D plans. Notably, the Limited Income Newly Eligible Transition (LI NET) Program will become a permanent component of Medicare Part D.
The LI NET program is available for individuals who meet the low-income requirements and who do not have prescription drug coverage yet. It offers Part D coverage that can help eligible beneficiaries cover their medications.
Moreover, modifications to the Part D Low-Income Subsidy (LIS) program will be implemented in 2024. Individuals with Medicare and limited resources and incomes up to 150 percent of the federal poverty level will be eligible for full benefits, which may help lower prescription drug costs for them.
Extra Help, which provides assistance with Medicare Part D costs, is available for individuals with an income below $22,000 and married couples with an income below $30,000.
Resources like State Health Insurance Assistance Programs (SHIPs) and the Social Security Administration (SSA) can provide one-on-one assistance and access to the Extra Help program.
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Consolidated Appropriations Act, 2021 Effects
The Consolidated Appropriations Act of 2021 further influences Medicare Advantage and Part D plans, with a focus on enhancing patient protections and health equity.
The Act includes provisions related to raising the minimum actuarial value of Medicare Advantage plans, increasing the minimum coverage of Part D plans, and augmenting the number of preventive services covered by Medicare Advantage plans.
The Consolidated Appropriations Act 2021 emphasizes enhancing patient protections and health equity. Key provisions include expanding access to:
- behavioral health services,
- broadening dental,
- vision, and hearing benefits,
- and streamlining the prior authorization process.
These changes aim to ensure that all beneficiaries receive the care they need, regardless of their background or financial status.
Enhancing Health Equity in Medicare Advantage Programs
Recognizing the importance of health equity, CMS has introduced measures to promote health equity by enhancing equal access to high-quality healthcare services and achieving equitable health outcomes for all individuals, regardless of their socioeconomic status or demographic characteristics.
These measures include expanding the list of populations requiring specific consideration and implementing best practices for provider directories.
In addition to addressing low digital health literacy, CMS has implemented several quality improvement programs to support health equity in Medicare Advantage programs.
These programs, such as the Quality Improvement Program, the Medicare Advantage Quality Improvement Program, and the Medicare Advantage Quality Improvement Program Plus, aim to identify and address disparities in healthcare access and outcomes among various populations.
Addressing Low Digital Health Literacy
To address low digital health literacy, CMS recommends including the cultural and linguistic capabilities of each provider in their directories, making it easier for beneficiaries to find providers who can cater to their unique needs.
Moreover, CMS has expanded the list of populations requiring specific consideration, such as people with disabilities, limited English proficiency or reading skills, and those residing in rural areas or areas with high levels of deprivation.
CMS is also proactively working to provide educational materials, webinars, and other resources to help members better understand their benefits and make informed decisions about their healthcare.
These efforts aim to bridge the digital divide and ensure that all beneficiaries have equal access to the resources and support they need to navigate their Medicare Advantage plans.
Utilizing Quality Improvement Programs
Quality Improvement Programs play a crucial role in promoting health equity in Medicare Advantage programs. These systematic and formal approaches analyze and improve performance in various areas, such as healthcare delivery, with the goal of enhancing the quality of care and outcomes for patients.
By identifying and addressing disparities in healthcare access and outcomes among various populations, Quality Improvement Programs help ensure that all Medicare Advantage beneficiaries have access to the same quality of care, regardless of their race, ethnicity, gender, or other factors. This, in turn, contributes to a more equitable and inclusive healthcare system for all.
Improving Access to Behavioral Health Services
CMS has finalized provisions to improve access to behavioral health services for enrollees, including the integration of these services with physical health services and the expansion of network adequacy requirements to include additional types of behavioral health specialties.
Behavioral health services encompass the promotion, prevention, and treatment of mental health and substance use disorders, as well as addressing life stressors and crises.
These changes aim to facilitate access to essential behavioral health services for enrollees, delivered by providers who are suitably trained and experienced.
By expanding network adequacy requirements to encompass additional behavioral health specialties, including psychiatrists, psychologists, and social workers, CMS ensures that beneficiaries have timely access to the care they need.
Integration with Physical Health Services
The integration of behavioral health services with physical health services involves coordinating and collaborating between providers and systems to address the mental health and physical health needs of individuals.
By combining the delivery of behavioral health and primary care services, integrated care models seek to enhance access, quality, and outcomes for patients.
Integrated care models offer several advantages in managing chronic conditions and reducing the stigma associated with seeking mental health treatment.
By developing comprehensive care plans and leveraging electronic medical records to integrate treatment plans, these models ensure that individuals receive the holistic care they need, ultimately contributing to better health outcomes and overall well-being.
Expansion of Network Adequacy Requirements
Network adequacy requirements are standards and regulations that health plans must adhere to in order to guarantee reasonable access to healthcare services for their members.
These requirements differ across states and types of coverage, with the aim of ensuring that health plans have an adequate network of providers and facilities to deliver the promised benefits to their members.
To further enhance access to behavioral health services, CMS has expanded network adequacy requirements to include additional types of behavioral health specialties, such as mental health counselors, marriage and family therapists, and substance abuse counselors.
This extension of network adequacy regulations guarantees that health plans have an adequate network of providers and facilities, ensuring that members have access to the care they require, when they require it.
Changes to Prescription Drug Coverage and Costs
Beginning in 2025, Medicare’s Part D will implement a $2,000 annual limit on prescription drug costs. This significant change aims to provide financial relief to beneficiaries who face high out-of-pocket costs for their medications.
In addition to the annual limit, cost-sharing adjustments will be made, including the termination of the five percent coinsurance for Part D catastrophic coverage and the introduction of a monthly installment payment option for out-of-pocket prescription costs.
These changes to Medicare prescription drug coverage and costs are expected to benefit both current and future beneficiaries, making it easier for them to manage their medication expenses and receive the treatments they need without breaking the bank, thanks to improvements in prescription drug plans and access to prescription drugs.
Lowering Prescription Drug Costs
The new $2,000 annual limit for prescription drug costs in Medicare’s Part D will be implemented starting in 2025. This cap aims to provide financial relief for beneficiaries by lowering their out-of-pocket expenses for medications.
The cap amount will be adjusted in accordance with inflation in subsequent years, ensuring that the limit remains relevant and effective over time.
With the implementation of this annual limit, beneficiaries can better manage their prescription drug expenses and be more confident in their ability to access the medications they need.
This change is a significant step towards making prescription drug coverage more affordable and equitable for all Medicare beneficiaries.
Cost-Sharing Adjustments
In addition to lowering prescription drug costs, cost-sharing adjustments are being made to further alleviate the financial burden for beneficiaries. One such adjustment is the elimination of the five percent coinsurance for Part D catastrophic coverage.
This change will be particularly beneficial for beneficiaries who require high-cost medications, as it removes an additional financial hurdle they may face.
Another significant adjustment is the introduction of a monthly installment payment option, or “smoothing,” for out-of-pocket prescription costs.
This option allows beneficiaries to spread their out-of-pocket expenses over the course of the year, making it easier for them to manage their medication costs and maintain adherence to their prescribed treatments.
Dental, Vision, and Hearing Benefits Expansion
While Original Medicare (Parts A & B) does not provide coverage for dental, vision, and hearing benefits, advocacy for the expansion of these benefits in Medicare continues.
One recent development in this area is the establishment of a new category of over-the-counter hearing aids by the U.S. The Food and Drug Administration (FDA) is a federal agency that ensures the safety of food and drugs in the United States. It is responsible for protecting public health by regulating these products.
This change makes hearing aids more accessible to Medicare beneficiaries, allowing them to more easily access the devices they need to maintain their quality of life.
As Medicare evolves, it is important for beneficiaries to stay informed about potential changes to dental, vision, and hearing benefits. By staying up-to-date on the latest developments, beneficiaries can ensure they are making the most of their Medicare coverage and advocating for the best possible care.
Prior Authorization Process Improvements
CMS has issued rules to improve the prior authorization process, a cost-saving measure in which benefits are only paid if medical care has been pre-approved by Medicare. These improvements include requiring electronic implementation of prior authorizations and shortening decision times for prior authorization requests.
By streamlining the prior authorization process, CMS aims to decrease administrative burden, enhance patient access to care, and ensure that decisions are based on medical necessity.
The electronic implementation of prior authorizations will reduce paperwork and enable quicker decision times, ultimately improving the overall healthcare experience for beneficiaries.
Impact on Non-Medicare Beneficiaries
Changes in Medicare will also impact non-Medicare beneficiaries. Notably, the Inflation Reduction Act provision extends enhanced premium subsidies for healthcare costs available to Marketplace consumers until 2025. While out-of-pocket costs may be reduced for certain patients in 2024 and 2025, financial barriers will still persist for many individuals.
It’s essential for both Medicare and non-Medicare beneficiaries to stay informed about changes in healthcare policy and how they may affect their coverage and costs.
By staying updated on the latest developments, individuals can make informed decisions about their healthcare and ensure they receive the care they need at a price they can afford.
Staying Informed about Medicare Reforms
Staying informed about Medicare reforms is crucial for beneficiaries to understand the changes and their implications. Resources such as the PAN Foundation and CMS provide updates on changes and their effects, helping beneficiaries navigate the evolving landscape of Medicare coverage.
Some ways to stay informed about Medicare reforms include bookmarking websites that provide information on Medicare reforms, signing up for alerts and newsletters from organizations that focus on Medicare, monitoring Medicare-related news and policy changes, and participating in webinars and educational events on Medicare reforms.
By consulting official sources and trusted organizations for accurate and current information, beneficiaries can ensure they are prepared for the changes ahead.
Summary
In conclusion, the year 2024 brings numerous changes to Medicare Advantage and Part D plans, aiming to improve healthcare access, equity, and affordability. From policy updates and health equity measures to the expansion of dental, vision, and hearing benefits, these reforms will have a significant impact on Medicare beneficiaries.
By staying informed about Medicare reforms, beneficiaries can better navigate the evolving healthcare landscape and make informed decisions about their coverage and care. Together, these changes represent a step forward towards a more equitable and accessible healthcare system for all.
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Frequently Asked Questions
What will Medicare premiums be in 2024?
The average Medicare Part D premium for prescription drug coverage is estimated to be $55.50 in 2024, a decrease of 1.8% from the current rate of $56.49.
Medicare Part B premiums could also increase to about $179.80 per month.
What is the final rule of CMS 2024?
On August 1, the Centers for Medicare & Medicaid Services (CMS) released their final rule that will increase Medicare inpatient prospective payment system rates by a net 3.1% in fiscal year 2024 compared to FY 2023. This rule also includes adoption of three new measures, removal of three existing measures, and modification of three current measures.
Additionally, there are two changes to policies related to data submission, reporting, and validation.
What is the CMS proposed rule for 2024 Medicare Advantage?
The CMS proposed rule for 2024 Medicare Advantage aims to reduce inappropriate care denials, simplify administrative processes for physicians, and ensure more consistency between Medicare Advantage and traditional Medicare by curtailing overly restrictive coverage policies.
This rule seeks to improve the quality of care for Medicare Advantage beneficiaries by reducing administrative burden and increasing transparency. It also seeks to reduce the number of denials for medically necessary services and ensure that coverage policies are consistent with those of traditional Medicare.
What are the key changes to Medicare Advantage and Part D plans in 2024?
In 2024, key changes to Medicare Advantage and Part D plans include provisions from the Inflation Reduction Act of 2022 and Consolidated Appropriations Act of 2021, aimed at reducing costs, streamlining processes, and improving overall healthcare experiences for beneficiaries.
These changes are designed to make healthcare more affordable and accessible for beneficiaries, while also providing better quality care. They include provisions such as increased coverage for preventive services, reduced cost-sharing for certain services, and improved access to telehealth services. Additionally, the new laws provide for more flexibility in plan design, allowing beneficiaries to create their own plan.
What measures are being taken to enhance health equity in Medicare Advantage programs?
CMS has implemented measures to promote health equity in Medicare Advantage programs, such as addressing digital health literacy gaps and utilizing quality improvement programs.
This will ensure that all individuals have equal access to high-quality healthcare services and achieve equitable health outcomes.
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Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.