By Deborah Jeanne Sergeant
If you receive Medicare, look for these changes coming in 2024:
No more stage four-catastrophic stage for prescription drug plans and Advantage plans
“One fairly big change includes those plans that include Part D prescription coverage,” said Sally Stier, licensed representative and president of Clarity Group in Buffalo, Depew, Blasdell, Amherst and Batavia. “The level of coverage before you hit catastrophic is going up to $8,000. If you hit that, you currently pay 5% coinsurance or a small copay but starting in 2024, you pay $0 if you hit that stage. That can help people who have a lot of very expensive medications. They’ll be capped at $8,000 for true out-of-pocket expenses.”
Higher rates for drug plans
“The insurance companies are preparing for the additional costs they’ll have to pay,” said Vicki James, AHIP-certified CEO of Clear Benefits Advisors, formerly MEDICARE EASY! in Rochester. “Prescription coverage plans and stand-alone prescription plans premiums are increasing. They can’t go up more than 6%. The maximum out of pocket for the doughnut hole will be $2,000 by 2025, which is going to be a huge savings for people with expensive prescription drugs.”
Supplement plan (aka MediGap plans) premium hike
“These premiums are anticipated to go up,” James said. “That will probably be announced toward the end of the year.”
Better dental coverage
Medicare recipients trying to maintain their oral health have struggled to get coverage for care. But that will become less costly in 2024.
“Dental has finally become one of the more robust benefits,” James said. “It’s always been a pain point for clients as Advantage Plans haven’t offered much coverage. Now they’re offering for 2024 at least preventative care and many offer additional comprehensive coverage at no additional rider cost. We’re really excited about that.”
More over-the-counter
“That allows you to buy things medically related like Band-Aids, aspirin or cough and flu medication,” said Lee Kern, licensed insurance agent and owner of NY Medicare Specialists in Buffalo and Rochester.
This can lower costs for everyday items that help support good health.
More lifestyle inclusions
“Some plans have allowed that for healthy foods, pet food and utilities,” Kern said. “It’s a lifestyle benefit. Some of the lower income supporting plans have transportation for beneficiaries.”
Transportation benefits can help recipients stay current with visits to healthcare providers and seek preventative health.
He added that some new plans provide gift cards for recipients who schedule a check-up in their homes. Another offers rewards to enrollees who track their steps with an app and record sufficient steps. Lifestyle inclusions are all about promoting healthy living.
More plan counseling
“They require us to go over plan benefits with clients and make sure their doctors are within their plans and to go over the formulary and explain benefits,” Kern said.
Although that’s how he’s always operated his office, the review service is now a requirement for agents.
“I don’t see how you could provide good service without doing this,” he added, “because it changes each calendar year. People have to look at their annual notice of change.
“It’s about finding a plan that will provide the right coverage if you’re planning on traveling. Understand the cost of a surgical procedure. If you’re using a network facility, usually, that is covered. I have a license in Florida and it seems they have a lot of fragmentation within the system.”
It can be tough to know the new Medicare benefits in your plan or another plan that may better suit your needs.
Mike Merrill, physician and internist and chief medical officer of Brook Health, encourages patients to talk with a broker about what’s new.
“People at your insurance company can help you navigate,” he said. “It can be helpful to find out what your benefits are. The office on the aging is great at helping you shop around, too.”
To avoid possible fraud, he encourages patients seeking Medicare advice to talk with a local agent rather than responding to a cold caller. Advertisements on TV or the radio can also lead a beneficiary to the wrong plan, since sometimes they may be calling from a national call center operated by people who are not related to their local area.
“The people calling may be brokers only offering a health plan from a certain insurance, not everything on the market,” he added.