Medicare open enrollment season is approaching—Oct. 15 to Dec. 7—when you can join, switch, or drop a Medicare Part D prescription drug plan or a private insurer’s Medicare Advantage plan for 2024. Experts say it’s vitally important to explore your options carefully.
“Every survey I’ve seen finds that year-to-year [Medicare Part D and Medicare Advantage] plan changes may offer improved coverage, lower costs, or both, to people who take the time to research next year’s plan offerings,” Phil Moeller noted in his Get What’s Yours newsletter on Medicare, Social Security, and health care.
If you wait to compare plans in January, says Diane Omdahl, president of 65 Incorporated, a Medicare advisory firm, “it’s too late.”
Lowering out-of-pocket health costs can be a huge help for people on Medicare. More than one in five Medicare beneficiaries struggle to afford their health premiums, according to a recent Commonwealth Fund study.
3 big Medicare changes for 2024
This is an especially important year to review Part D and Medicare Advantage (also known as Part C) plans because of three changes taking effect Jan. 1, 2024, described in detail in the government’s new Medicare & You 2024 handbook:
- The end to some out-of-pocket costs for catastrophic prescription costs. Once your Part D out-of-pocket spending for prescriptions tops $8,000, you won’t owe a copayment or co-insurance. In 2023, you pay co-insurance of 5% once out-of-pocket spending reaches $7,400 (the dollar amount will drop to $2,000 in 2025).
Bottom line: If you have steep prescription drug costs in 2023, that may be less true in 2024, so there may be more reason to compare Part D plans for your medications.
- Bigger savings for up to 3 million low- and moderate-income people. In 2024, everyone qualifying for Medicare’s Extra Help subsides will pay $0 for Part D premiums and deductibles and a reduced amount for generic and brand-name drugs. You’ll be eligible if your 2023 income is under $21,870 ($29,580 for a couple) and have less than $16,660 in resources other than a primary residence, vehicles and personal possessions (below $33,240 for married couples).
Bottom line: If you’ll meet the thresholds, you’ll want to sign up for Extra Help when enrolling in a Part D plan.
- Better mental health care coverage. Medicare will cover mental health services provided by marriage and family therapists and mental health counselors as well as intensive outpatient program mental health services. But the therapists will need to accept Medicare for you to get this coverage and some won’t, says Omdahl.
Bottom line: This could be a reason to look for Medicare Advantage plans whose networks will have the pros you’ll want.
One more change that you’re likely to see during this year’s open enrollment: fewer misleading TV commercials and mailers for Medicare Advantage plans.
Last fall, there were an average of more than 9,500 Medicare ad airings daily, according to KFF, along with a rise in complaints about them. The Biden administration is cracking down on these types of ads, though, starting in October.
The plans’ Annual Notice of Change
Medicare Part D and Medicare Advantage plans will soon announce their rules for 2024 premiums, co-insurance, copayments, and other out-of-pocket costs.
If you already belong to one of those plans, you’ll get its Annual Notice of Change and Evidence of Benefits in late September if you haven’t already. Be sure to read those to learn how the plan will differ next year.
“I’d say that one step above doing nothing during open enrollment is making sure you look at the Annual Notice of Change,” says Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center.
The Annual Notice of Change for a Part D plan will say whether and how much the insurer will pay for prescriptions as well as its rules regarding which pharmacies it works with and costs buying prescriptions mail order versus in person.
Omdahl noted that her Annual Notice of Change says some of her medications were going from a flat $47 charge to 25% coinsurance. “With co-insurance, when the drug price goes up, you pay more,” she says.
The notice for a Medicare Advantage plan will say if the insurer will drop or add doctors and hospitals in its networks, affecting how much you’ll pay for care. It will also tell you if the plan’s prior authorization rules are changing, which could restrict or increase your ability to get treated.
Lately, a growing number of hospitals and health systems around the country are dropping out of Medicare Advantage plans due to prior authorization denials and slow reimbursements from insurers, according to the Becker’s Hospital Review site.
And some, such as St. Charles Health System in Bend, Ore., are encouraging older patients not to enroll in Medicare Advantage plans during Open Enrollment season for 2024.
Although some Medicare Advantage plans have been tooting their horns about reducing prior authorizations, their changes may be less significant than you might think. “I don’t think that’s going to have a significant impact, but it’s got a lot of PR punch,” says Omdahl.
How to compare Part D and Medicare Advantage Plans
If you’ll enroll in a Part D or Medicare Advantage plan for the first time in 2024 or might switch plans, you’ll want to do some comparison shopping.
You could do it online, either by calling Medicare (800-MEDICARE) or through Medicare’s Plan Finder tool. It lets you compare costs and coverage of various Part D and Medicare Advantage plans available where you live.
Alternatively, you could speak with someone at your state’s SHIP plan. The State Health Insurance Assistance Programs have free, unbiased advisors who can answer open enrollment questions, though they’re not allowed to recommend particular Part D or Medicare Advantage plans.
Or you might want to hire a Medicare agent or broker who can suggest possible Part D and Part C plans and get paid by insurers. But be careful. The Centers for Medicare and Medicaid has reported a big rise in complaints about the marketing of Medicare Advantage and Part D plans, often due to their brokers.
“It’s a good idea to understand from that agent or broker whether they work with, or represent, all of the plans available in your area or only a subset,” says Schwarz. “In some situations, you won’t be presented with all the options that are available if you go through a broker.”
When sizing up Medicare Advantage plans to see which health care providers are in their networks, Schwarz advised doing it in this order: First, see if your primary care doctors and the specialists see regularly are in them. Then, see if your hospital of choice is in network. Finally, look into skilled nursing facilities or long-term care rehab facilities.
That last group, Schwarz noted, “is often something people don’t think about until they’re really facing needing one, which can add a layer of complication to a pretty stressful situation.”
If you’ll be comparing the cost of Medicare Advantage plans, don’t look only at their premiums. Check too at how they differ regarding copayments, co-insurance, and annual out-of-pocket maximum. As Omdahl likes to say: A zero-premium Medicare Advantage plan is free only if you never need any medical care.
One last thing: People in Medicare Advantage plans will also get what Schwarz called “a pressure relief”—an extra open enrollment period, from Jan. 1 to March 31, 2024, to change plans or switch to Original Medicare.
