Medicare Part D plans help enrollees cover expenses for prescription drugs. They are sold by private insurance companies that work with Medicare. Anyone who is already enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) can enroll in a stand-alone Part D prescription drug plan that’s available in your service area.
Because Part D plans are sold by private companies, the drugs they cover and plan costs can change from year to year. If you’re already enrolled in Part D, or may be considering switching plans during Open Enrollment, you should have an idea of the changes that will affect Medicare prescription drug coverage in 2024.
How changes in 2024 Part D benefits may affect my coverage
You should have access to your Part D plan’s benefits. Every fall, you’ll receive notification of any upcoming changes in copayments, coinsurance percentages, and coverage gaps that will take effect on January 1.
Part D monthly premiums
Each Part D plan provider sets its own monthly premium, but it looks like the average premium will be around $55.50 per month in 2024. This is a slight drop from the average cost of $56.49 in 2023, and it’s because of the premium stabilization provision in the American Rescue Plan Act passed in 2021.
Drug plan formularies
Part D plan providers update their formularies (lists of drugs the plan covers) often, but most commonly at the start of a new year. Some of these changes can include:
- Dropping a covered drug
- Adding a new drug
- Moving a drug to a different cost-sharing tier, which changes the copayment amount
- Adding or changing a prior authorization, step therapy restriction, or quantity limit to the drug
You should review your plan’s formulary changes carefully to ensure that all your medications are still covered. If your prescription coverage has changed, you can make a plan change during an allowed enrollment period.
Part D premiums and deductibles
All Medicare prescription drug plans set their own premiums and deductibles, and they can make changes in the new year that might impact your out-of-pocket expenses for your prescriptions.
Your Part D plan provider must inform you of any upcoming changes, so you have time to compare other available prescription drug plans and switch during the annual Open Enrollment Period (OEP), if you choose to. Medicare’s OEP begins October 15 and ends December 7.
In 2024, when you pay $8000 out-of-pocket for your prescription drugs, you won’t have to pay any more drug copayments or coinsurance costs for the rest of the year.
Coverage gap (donut hole)
In 2024, the coverage gap will begin when you and your Part D plan have spent $5,030 on prescription medications covered by the plan’s formulary. This is higher than the 2023 amount of $4,660. When you reach $5,030, you pay out-of-pocket until you meet the 2024 threshold of $8000, then coverage begins again.
Eligibility for the low-income subsidy (LIS)
In 2024, eligibility for LIS will include people with income levels that are up to 150 percent of the federal poverty level. This will allow more people to apply for financial help to cover Medicare Part D plan premiums and out-of-pocket expenses.
Insulin costs and vaccine coverage
In 2024, your out-of-pocket expenses for insulin products will be capped at $35 per month, no matter what Medicare Part D plan you’re enrolled in.
Also in 2024, adult vaccines such as those for shingles, flu, pneumonia, Hepatitis B, etc. will be provided for free to all eligible beneficiaries.
If you’re already enrolled in a Medicare Part D plan, your insurance provider should have informed you about changes taking effect in 2024 regarding the plan’s formulary and costs. You can change plans during OEP if you find one that better suits your current needs.