Medicare Part D 2024
In this post, we will discuss some important information about Medicare Part D 2024.
Medicare Part D plans cover the cost of prescription drugs for Medicare enrollees. Private insurance companies offer these plans to beneficiaries. In order to remain complaint, all plan providers must follow CMS’ rules.
Prescription plan costs
There are a few costs associated with Medicare prescription plan coverage. One of those costs include the monthly plan premium, this amount can range greatly depending on the plan and carrier. Beneficiaries can opt to have the premium deducted from their monthly Social Security payment. If the beneficiary has a greater than average income, they may be subject to an IRMAA, an adjusted premium amount based on income. The premium may also be adjusted for those who have a lower-than-average income and qualify for Extra Help.
Other costs associated with Part D prescription are co-pays and coinsurance amounts paid at the pharmacy. Many plans also include an annual deductible. In 2024, the maximum annual deductible has increased from $505 in 2023 to $545 for 2024.
For those who neglect to sign up for a Medicare Part D plan on time, a late enrollment penalty is added to the monthly cost. The penalty applies to anyone who goes without creditable Part D coverage for a period of 63 or more days. CMS applies the penalty for as long as the beneficiary has Part D coverage.
Changes for Medicare Part D for 2024
Because of the Inflation Reduction Act that was signed into law in 2022, there will be changes to the Medicare Part D program. One important change has to do with the cost Medicare beneficiaries pay for prescription drugs.
Here are some of the changes in place for 2024:
In 2024, Medicare PDP members who reach the catastrophic phase ($8,000 in 2024) will not pay any additional out-of-pocket costs for the remainder of the year. This means they are no longer subject to a 5% copay.
PDP plans are no longer able to raise their premiums over 6% per year starting in 2024.
Beneficiaries who use insulin will pay no more than $35 for a 1-month supply for covered insulin brands. It is important to check your plan’s formulary to confirm which brands they include. This pricing is in effect until the end of 2025.
Medicare covers many adult vaccines at no cost to Medicare beneficiaries. this includes the Shingles vaccine as well as TDAP (tetanus vaccine), Covid, flu vaccine, Hepatitis A and many others.
More Medicare beneficiaries will qualify for Extra Help to pay for their health care needs in 2024. This is because beneficiaries with an income of up to 150% of the federal poverty level (up from 135% in 2023) may be qualified for the Part D Extra Help. This program pays the Part D annual deductible, monthly premium and ensures beneficiaries pay a lower cost for generic and brand name drugs.
A few changes to prescription drug plans in 2025 and 2026
In 2025, one of the changes to the Part D program is a $2,000 out-of-pocket maximum in place for PDP beneficiaries. CMS is also starting a prescription payment plan program. The program is referred to as “smoothing” and begins Jan 1, 2025. This program gives beneficiaries an opportunity the spread out the cost of prescription medications out over the year by using a payment plan.
In 2026 price negotiations will begin for expensive drugs that have no generic alternatives.
To view a comprehensive guide to all the ins and outs of Medicare for 2024, click this link and download a copy of CMS Medicare and You handbook for 2024. Information on Medicare Part D starts around page 79.
Take a look at some of the other compliance updates CMS has in place or has proposed for agents :
Watch a quick YouTube video on the CMS proposed rule CMS 4205-P an how this could effect our business
Make sure you are up-to-date with the SOA rules – click here and learn more
Please note: agents who offer Medicare Part D plans need to complete annual carrier certifications as well as AHIP before they can offer the plans. AHIP is an annual certification that CMS requires. It includes marketing and compliance guidelines as well as FWA laws.
If you don’t follow the Medicare marketing rules, you risk losing commissions, termination of your contracts, losing your license and receiving fines.