By Deborah Jeanne Sergeant
If you receive Medicare, look for these changes coming in 2024:
• No more coverage gap–doughnut hole
“The stage four catastrophic stage has been eliminated,” said Vicki James, chief executive officer of Clear Benefits Advisors, formerly MEDICARE EASY! in Rochester. “Once they’ve paid the maximum out-of-pocket of $8,000 a year, the insurance plan and Medicare pays the rest. That’s part of the Inflation Reduction Act.”
• Higher rates for drug plans
“The insurance companies are preparing for the additional costs they’ll have to pay,” James said. “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 preventive 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 Rochester and Buffalo.
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.”
James advises clients to talk with a local agent rather than responding to an advertisement on TV or the radio, since sometimes they may be calling a national call center operated by people who are not related to their local area.