Medicare open enrollment season started Oct. 15 and ends Dec. 7, and this year there will be more plan choices, more benefit offerings, and potentially some cost savings on medications. For the 5 million Florida seniors on Medicare, there also will be more reason to scrutinize your existing plans and weigh your options.
During open enrollment, you can make changes such as join, switch, or drop a private insurer’s Medicare Advantage plan for 2024 or a Medicare Part D prescription drug plan. When you are 65, there are two routes you can go: A Medicare Advantage plan offered by a private insurer, which includes hospital care, physician care, prescription drug coverage and other benefits. Or, Original Medicare, provided by the federal government, which includes hospital care and physician care, and pair it with a Part D drug plan.
This year there are more reasons to do your homework and consider your options.
“Plans change every year,” said Bob Rees, vice president of Medicare Member Loyalty for eHealth insurance agency. “Look beyond monthly premiums at the full cost and determine if your plan is changing. You may not be required to change plans, but look to see if your out-of-pocket costs are changing, and that may be a good reason to make a switch.”
What’s new with Medicare Advantage?
Centers for Medicare & Medicaid Services expects more people to enroll in Medicare Advantage plans in 2024, estimating enrollment at approximately 50% of Medicare eligible seniors, compared to approximately 48% for 2023.
While premiums, deductibles, co-pays and out-of-pocket maximums for Medicare Advantage plans differ greatly, every person with Medicare Advantage coverage must pay the Medicare Part B premium (part of Original Medicare) in addition to their private plan’s premium. If enrollees choose to stay in their plan, most will experience little or no premium increase for next year. In Florida, the average premium will increase slightly by 79 cents.
But there are more than premiums to consider.
In choosing among Medicare Advantage plans, an important determinant in 2024 is whether your doctor and preferred hospital will continue to accept your Medicare Advantage plan. Becker’s Healthcare reports a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether. The reason: Excessive prior authorization denial rates and slow payments from insurers. You also will want to see if your primary care doctors and specialists are in the network, and look at whether a plan includes dental and vision coverage.
“If you keep it simple and ask ‘Are my doctors in network? Are my hospitals in network?’ — by doing that you will eliminate half the plans,” said Evan Tunis with Florida Health Insurance in Coral Springs. “Once you are done with that, ask, ‘Am I okay with an HMO or do I want bigger access to doctors and hospitals, and in that case maybe I need to go with a PPO.’”
Also in 2024: Your plan must notify you if your provider is leaving the network so you have time to choose a new plan. You’ll get this notice if it’s a primary care or behavioral health provider and you have gone to that provider in the past three years.
For the last few years, Medicare Advantage plans have added more supplemental benefits that change yearly, such as dental, vision, meal delivery or gym memberships. Jenny Chumbley Hogue, an analyst for medicareresources.org , said that trend will continue in 2024. “There are going to be even richer benefits,” she said. “If those things are important to you, then it’s important to look at the options.”
However, experts say don’t pick a plan just because of a benefit like dental or vision. It’s more useful to find a plan that covers your cover your health care providers and your medications.
Saving on drug costs
Where you likely will see big differences in 2024 is in the drug plans, also known as Medicare Part D. Your Annual Notice of Change for a Part D plan will arrive in the mail and say how much the insurer will pay for prescriptions as well as rules regarding which pharmacies are included. The notice also will break out the costs of buying prescriptions via mail order versus at a retail pharmacy.
Florida will offer 21 stand-alone Medicare prescription drug plans, according to Centers for Medicare & Medicaid Services, Of those, 81% of people with a stand-alone Medicare Part D option will have access to a plan with a lower premium than what they paid in 2023.
The average Part D plan’s premium will decrease slightly, from $56.49 in 2023 to an expected $55.50 in 2024. Many plans will have improved benefits for drug coverage costs, including a $35 cost-sharing limit on a month’s supply of insulin and free adult vaccines recommended by the Advisory Committee on Immunization Practices, including the shingles and COVID-19 boosters.
Not every drug plan’s premium will decline.
“It will depend on the prescription drug plan, but we anticipate that while some carriers will decrease their premiums, others will nearly double their rates,” said Chumbley Hogue with medicareresources.org.
Chumbley Hogue said beyond just looking at the premium, check your prescriptions to see what tier of coverage they are and how much your out-of-pocket costs will be at various pharmacies. If a medication falls into a different tier within a plan in 2024, that could make it significantly more costly for you.
Three major changes in Part D drug plans will go into effect in 2024:
- People with Medicare prescription drug coverage who fall into the catastrophic phase of the prescription drug benefit won’t have to pay anything out of pocket during that phase for covered prescription drugs.
- Everyone qualifying for Medicare’s Extra Help subsidies won’t pay anything for Part D premiums and deductibles and will pay a reduced amount for generic and brand-name drugs. You’ll be eligible for Extra Help if your 2023 income was 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). If you meet the thresholds, you’ll want to sign up for Extra Help when enrolling in a Part D plan. Enrollees can save nearly $300 per year, on average, according to estimates.
- In the deductible phase, Part D enrollees pay 100% of their drug costs up to $545 in 2024 compared to $505 in 2023. Not all Part D plans charge a deductible, but some do.
Traditional Medicare
Florida’s seniors enrolled in Original Medicare will receive better mental health care coverage in 2024. You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment. New this year, 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.
During the pandemic, seniors were able to have their telehealth appointments covered by Medicare. This will continue for now. You can still get telehealth services at any location in the U.S., including your home until the end of 2024.
For 2024, Medicare is prohibited from covering weight loss drugs, worth noting with the popularity of Ozempic and Wegovy. There are efforts underway to change that, but it won’t happen in 2024. However, Medicare is covering acupuncture, up to 12 visits in 90 days for chronic lower back pain and an additional eight visits if you are showing improvement.
If you have Original Medicare and want a supplemental plan, also known as Medigap, Tunis said there are some well-priced plans available in South Florida this year. He suggests shopping around.
“Look for a carrier who has been in South Florida a decent amount of time,” Tunis said. “You don’t want a carrier who has only offered supplemental insurance one or two years. If they know the market, they are not going to be shocked if one year claims outnumber premiums. You want that rate stability with a company that has has been here.”
Cindy Krischer Goodman reports on health for the South Florida Sun Sentinel. She can be reached at cgoodman@sunsentinel.com.
