The annual Medicare open enrollment period is finally here, so now's the time to think about your health insurance needs for 2024. The federal government has made a number of changes to Original Medicare (Parts A and B), as well as Part D plans for the coming year, that could affect how much you pay out of pocket for your care. Here are seven of the most important changes to be aware of.
1. Expanded access to Extra Help
The Medicare Extra Help program helps low-income seniors pay for their prescription drug costs. In 2023, single adults with annual incomes less than $21,870 and resources worth less than $16,600 and married couples with annual incomes less than $29,580 and resources worth less than $33,249 qualify for this program.
Resources include money in bank and retirement accounts. But they don't include your home, one car, burial plots, up to $1,500 for burial expenses, furniture, or other household or personal items.
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Currently, there are two tiers of Extra Help: partial and full. Beginning in 2024, all those eligible for partial Extra Help will automatically become eligible for full Extra Help. The Social Security Administration website has more information about the Extra Help program and how to apply.
2. Rising maximum costs for prescription drugs under Extra Help
In 2023, those enrolled in the Extra Help program only pay up to $4.15 for each generic drug or up to $10.35 for each name-brand drug. But this will rise to $4.50 and $11.20, respectively, for 2024.
3. No co-pays on Part D-covered drugs once you reach catastrophic coverage
Once your out-of-pocket spending reaches $8,000 for the year, you won't have a co-pay for any Part D-covered prescription drugs for the rest of the year. Payments made on your behalf by other entities, like Medicare's Extra Help program, count toward the $8,000.
This is a change from 2023, where you face a reduced co-pay of no more than 5% for Part D-covered prescription drugs if your out-of-pocket spending exceeds $7,400 for the year.
4. Coverage for chronic pain treatment
Medicare will start covering monthly treatments for those who have suffered from persistent or recurring chronic pain for at least three months. These services include pain assessment, medication management, and care coordination and planning. You will still have to pay your Part B deductible and co-pay, though.
5. Expanded coverage for mental health services
In 2023, Medicare covers mental health services provided by psychiatrists, clinical psychologists, clinical nurse specialists, clinical social workers, nurse practitioners, and physician assistants. In 2024, this will expand to also include services provided by marriage and family therapists and mental health counselors.
In addition, Medicare will also cover intensive outpatient programs provided by hospitals, community mental health centers, federally qualified health centers, and rural health clinics, as well as partial hospitalization services.
6. Coverage for lymphedema compression treatment items
Those suffering from lymphedema -- swelling due to a buildup of lymph fluid in the body -- will have their gradient compression treatment items covered beginning in 2024. This includes standard and custom-fitted items, as long as they're prescribed. You will still have to pay a 20% co-pay and your Medicare Part B deductible.
7. Option to join Medicare Advantage plan or Part D plan during special enrollment periods and the general enrollment period
Medicare offers special enrollment periods to those experiencing exceptional circumstances, like a natural disaster, incarceration, an employer or health plan error, losing Medicaid coverage, or other emergencies. This gives these individuals the opportunity to enroll in Original Medicare, which is composed of Part A (hospital insurance) and Part B (medical insurance).
Starting in 2024, individuals enrolling in Medicare during a special enrollment period will have two months to sign up for a Medicare Advantage plan or a Part D plan if they choose. This coverage will begin the first day of the month after the Medicare Advantage plan or Part D plan gets your request to join.
Individuals enrolling during the general enrollment period for those who didn't sign up for Original Medicare when they became eligible can also sign up for a Part D plan during their first two months after signing up for Part B.
These changes may not all affect you, but it doesn't hurt to keep them in the back of your mind. If you have any questions about your Medicare coverage, don't hesitate to reach out for clarification. But remember, if your questions are about a Medicare Advantage or Part D plan, you'll have to speak to the health insurance company that provides it.
