Medicare Advantage and prescription drug programs to remain stable next year

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Average premiums, benefits, and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024, the Centers for Medicare and Medicaid Services has said.

Improvements adopted in the 2024 Rate Announcement, as well as the 2024 Medicare Advantage and Part D Final Rule – such as increased beneficiary protections around marketing and prior authorization and increased access to behavioral health – support this stability, CMS said.

People with Medicare Part D prescription drug coverage will continue to have improved and more affordable benefits, the agency said, including a $35 cost-sharing limit on a month's supply of each covered insulin product, recommended adult vaccines at no cost and additional savings on their Medicare Part D drug coverage costs. CMS attributed this primarily to the Inflation Reduction Act.

These savings include the expansion of the Low-Income Subsidy (LIS) program, also called Extra Help, which helps eligible enrollees afford their premiums and cost-sharing, as well as a cap on out-of-pocket costs for millions of people with very high drug costs in the catastrophic phase of the Part D benefit.

CMS is releasing this information, including 2024 premiums and deductibles for Medicare Advantage and Medicare Part D prescription drug plans, ahead of the upcoming Medicare Open Enrollment, beginning Oct. 15, to help people with Medicare determine their best coverage options.

WHAT'S THE IMPACT

The average monthly plan premium for all Medicare Advantage plans, which includes Medicare Advantage-Prescription Drug plans, is projected to change from $17.86 in 2023 to $18.50 in 2024 (an increase of $0.64). If enrollees choose to stay in their plan, most will experience little or no premium increase for next year, with an estimated 73% of beneficiaries not seeing a premium increase.

Plan choice is also increasing, and people with Medicare continue to have the ability to switch Medicare options. Medicare Advantage supplemental benefit offerings will increase slightly in 2024.

Enrollment in Medicare Advantage is projected to increase from 31.6 million in 2023 to 33.8 million in 2024. The projected Medicare Advantage enrollment in 2024 will represent approximately 50% of all people enrolled in Medicare, compared with about 48% for 2023.

In addition, more than 1,500 Medicare Advantage plans will participate in the CMS Innovation Center's Medicare Advantage Value-Based Insurance Design (VBID) Model in 2024, which CMS said will test the effect of offering person-centered innovative benefits that are critical to meeting healthcare needs and improving health equity to a projected 8.7 million people. 

The VBID Model expands access to additional supplemental benefits that can address a wide range of needs, such as food and nutrition benefits. The model offers the flexibility to target these benefits to people with chronic conditions or low incomes, CMS said.

The VBID Model's Hospice Benefit Component, now in its fourth year, will also be offered by 78 Medicare Advantage plans in portions of 19 states and U.S. territories, providing enrollees with increased access to palliative and integrated hospice care.

THE LARGER TREND

Medicare Open Enrollment begins on Oct. 15 and ends on Dec. 7. During this time, people eligible for Medicare can compare 2024 coverage options on Medicare.gov.

Medicare Plan Finder will be updated with the 2024 Medicare health and prescription drug plan information by Oct. 1. During Open Enrollment, people with Medicare are encouraged to call 1-800-MEDICARE or contact their State Health Insurance Assistance Programs for help comparing plans and costs this year.

To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance and copayments if people meet the conditions of eligibility.

In addition, the Low-Income Subsidy Program, also called Extra Help, is a Medicare program that helps qualifying individuals pay Part D premiums, deductibles, coinsurance and other costs. In 2024, the program is expanding, allowing all eligible enrollees to benefit from no deductible, no premium and fixed lower copayments for certain medications. 

Enrollees can save nearly $300 per year, on average, according to CMS' estimates; up to 3 million seniors and people with disabilities could benefit from the Extra Help program now but aren't currently enrolled. Individuals who enroll in MSPs automatically qualify for help affording their prescription drugs through the Extra Help program.

ON THE RECORD

"A top priority for CMS is to protect and strengthen the Medicare program for people with Medicare, their children, and their grandchildren," said CMS Administrator Chiquita Brooks-LaSure. "It is important for people with Medicare to review their healthcare coverage and explore their Medicare options during Open Enrollment. The Biden-Harris Administration has taken many steps to improve Medicare Advantage and the Medicare Part D prescription drug program, and premiums and benefits in 2024 for Medicare Advantage will remain stable."

"Today's release shows that, as expected, people with Medicare will continue to have robust options and stable benefit offerings in the MA market," said CMS Deputy Administrator and Director of the Center for Medicare Dr. Meena Seshamani. "We encourage individuals eligible for Medicare to review these options as well as Traditional Medicare and enroll in the option that best meets their health needs."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com