Will There be Changes in 2024 for My Dual-eligible Benefits?
Medicare and Medicaid are both vital healthcare programs for seniors and retirees in the United States as well as individuals and families with low incomes. Typically, Medicare is only available to American citizens 65 or older, but some people can qualify for Medicare under the age of 65 with a qualifying disability.
Medicaid is a state-run program administered by the Centers for Medicare & Medicaid Services (CMS). This is an income-based health insurance program that provides coverage for a huge range of healthcare items, including doctor visits, surgery and hospital admission.
What is a dual-eligible?
If you qualify for both programs, you may be classified as dual-eligible. A dual-eligible must meet the criteria for Medicare by being 65 or older or having a qualifying disability while at the same time meeting the income requirements to qualify for Medicaid. Because Medicaid is administered on the state level, qualifications for Medicaid can vary from state to state.
Will there be changes in 2024 for my dual-eligible benefits?
Each year, CMS evaluates both the Medicare and Medicaid programs. Changes are generally announced in the fall of each year, and as 2024 begins, new changes are on the way. You’re encouraged to check with your plan provider for exact details about how your Medicare or Medicaid benefits will be affected by changes in 2024 as each person’s plan and situation are different.
Changes to prescription drug coverage and costs in 2024
In 2024, dual-eligibles may have access to more prescription medication options, including some that have no copay. New drugs have been added to formularies for 2024 for dual-eligible special needs plans (D-SNPs). A formulary is a list of covered medications under a prescription drug plan. Under Original Medicare coverage, formularies are associated with Medicare Part D, the prescription drug benefit.
Changes to hearing, vision and dental
Some D-SNPs will also have dental, vision and hearing benefits added to them. Traditionally, Medicare benefits do not cover services for these healthcare items. Medicaid programs in various states sometimes provide coverage for these items to a certain extent, but this once again depends on the state.
In 2024, D-SNPs from providers like Humana will include benefits for some hearing, vision and dental services. These are not benefits that are being added to Original Medicare, however, and only select plans and providers will offer these benefits.
Medicare Part D coinsurance removed
Dual-eligibles will also no longer face a 5% coinsurance on prescriptions upon reaching the catastrophic coverage phase in Medicare Part D. Previously, this coinsurance cost was required for prescription costs over the catastrophic maximum for each benefit period. In 2024, this requirement is going away.
Medicare Part D plans require a deductible. In 2023, the deductible couldn’t exceed $505, but in 2024, the maximum deductible increases to $545. This is the amount of prescription drug costs a Medicare Part D recipient will need to incur in a benefit period before Medicare benefits begin paying for medications. In 2024, Medicare recipients will still only be eligible for prescription drug coverage for medications purchased from retail pharmacies. Medications purchased over the counter remain out-of-pocket expenses.