Medicare beneficiaries can change their plans during the yearly open enrollment period, which lasts from mid-October to December 7. People can move between Original Medicare and Medicare Advantage, change their Medicare Advantage plan, change their prescription drug plan, or even drop their drug coverage for good during this time. Because of these options, recipients can change their health care coverage to better fit their needs right now.
The “doughnut hole” in Part D has been taken out, which is one of the most important changes. Before, this coverage gap meant that after spending a certain amount on prescription drugs (about $5,030), beneficiaries would have to pay for all of their drug costs out of their own pocket until they hit a higher limit of $8,000. At that point, “catastrophic coverage” began to apply.
People whose prescription drugs cost a lot were hit hard by the gap, which meant they had to pay a lot of money out of their own pockets. But starting in 2024, Medicare Advantage plans, which are extra coverage on top of main coverage, will put a $2,000 limit on how much you have to pay out of pocket for prescription drugs. The monthly fees are not included in this cap, but deductibles, copayments, and coinsurance are.
People who get benefits should know that even though the $2,000 cap is good, their premiums may go up because of it. Some Medicare Advantage providers may raise their premiums to cover the cost of putting the cap in place, so beneficiaries should think about whether the savings from the new cap are greater than any possible premium rises.
In an interview with AARP, Dr. Meena Seshamani, head of the Federal Center for Medicare, talked about how important these changes are. She said, “It’s the first time in the history of the Medicare program that people have a cap on how much they could have to pay out of pocket.” The new limit on how much people can pay out of pocket for prescription drugs is a big change in how Medicare helps its members.
As open enrollment for Medicare starts, it’s important for seniors to know about these changes. “Such a big change means that shopping is very important during open enrollment,” Seshamani said. “Because times have changed so much, there may be a plan that works better for your health and money.”
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Other changes to Medicare Plans
Also, the list of prescription drugs that Medicare Advantage plans may cover could grow again in 2024. This change is because the FDA decided in March 2023 to approve the drug Wegovy for people with heart disease. Because of this, Medicare Advantage companies might start to pay for this drug, which is mostly used to control weight.
Part D plans already cover drugs like Ozempic and Mounjaro, which are used to treat Type 2 diabetes. However, Wegovy’s approval means that people with certain health conditions will be able to get more treatment choices.
Zepbound is another drug that could be covered if the FDA agrees that it can be used to treat conditions like sleep apnea. This would mean that there are even more ways to treat these conditions.
It can be hard to keep up with all of these changes, and users may find it hard to stay up to date on their benefits throughout the year. To fix this, Medicare Advantage plans will now send members midyear statements that explain their benefits and how they are being used.
These statements will list the benefits that recipients have not yet used, like dental, vision, or fitness benefits. This program is meant to help seniors get the most out of their plans by getting them to use important health services they may have missed.
Finally, Medicare.gov, the program’s website, is a great place to find information about all the plans available. It lets people look at different plans’ coverage choices, costs, and quality ratings.
During open enrollment, people can make any changes they need to their coverage. It’s more important than ever to look at and compare plans now that prescription drug coverage and other parts of the plans have changed.
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