Medicare Open Enrollment Begins October 15
By Anna Sochocky
The Inflation Reduction Act passed in 2022, ushered in historic changes to Medicare, mandating a $35 monthly cap on insulin costs in 2023, a limit projected to decrease further by 2026.
Additional changes benefiting Medicare recipients are on track to continue in 2024, including slight decreases in Part D premiums and the elimination of co-insurance expenses for catastrophic prescription drug coverage. The Extra Help program for low-income enrollees will also receive a financial upgrade.
Premium Monthly Part D Costs Stabilize
The 2022 Federal Inflation Reduction Act has been credited with stabilizing monthly Medicare drug premiums. Beginning on January 1, 2024, average monthly premiums for Medicare Part D prescription drug coverage are projected to decrease by an average of two percent, according to the Centers for Medicare and Medicaid— the average Medicare Part D monthly premium in 2023 of $56.49 is dropping to $55.60 next year.
New Threshold for Catastrophic Coverage Limits
Transformative changes to catastrophic coverage designed to lessen financial burdens will eclipse modest premium reductions next year. The Medicare Prescription Drug Part D plan shares coverage costs between enrollees, Part D plans, drug manufacturers, and government agencies. Medicare pays 80% of total drug costs, Part D plans pay 15%, and Part D enrollees pay 5%. Out-of-pocket expenses for the consumer can approach $7,400.
In 2024, two significant changes in the catastrophic phase of Medicare Part D are anticipated. First, the 5% costs paid by enrollees disappear, making medically necessary medications more affordable. Second, Medicare Part D’s responsibility for total drug costs will increase from 15 to 20 percent, meaning out-of-pocket consumer spending decreases.
While the out-of-pocket cap for prescription drug coverage will be $8,000 in 2024, $600 higher than in 2023, by 2025, the threshold plummets to $2,000 as another phase of the Inflation Reduction Act is implemented.
The annual open enrollment period starts October 15, 2023, and continues through December 7, making it time for original Medicare beneficiaries, those with supplemental drug coverage, and Medicare Advantage plans to mark their calendars. Beneficiaries should have received an Annual Notice of Change letter from their insurance provider in September, outlining anticipated changes taking effect on January 1, 2024.
Marlene Baca, Sales Vice President at Blue Cross and Blue Shield of New Mexico (BCBSNM), notes that BCBSNM expanded its service area this year, bringing the total to 30 New Mexico counties served. “BCBSNM strives to meet the needs of all Medicare beneficiaries in our community,” said Baca. Baca encourages people to consider whether their current Medicare plan meets their needs. Do they need to attend a BCBSNM informational seminar? Does a conversation with family or friends make sense? What do they think their out-of-pocket costs will be next year?
In 2024, BCBSNM will offer six $0 premium plans. Medicare plan specialists will be available for questions for existing members and potential members beginning October 16, 2023, and continue through December 7 at BCBSNM headquarters at 5701 Balloon Fiesta Parkway NE in Albuquerque. Hours will be 9 a.m. until 3 p.m., Monday through Friday. To locate seminars, call 1-866-286-6159 or visit
www.bcbsnm.com/medicare/blue-cross-medicare-options and select Attend a Seminar. Information about BCBSNM Medicare Advantage is also available at getbluenm.com.
Presbyterian Health Services, Vice President of Sales and Marketing, Brian Brown, encourages Medicare enrollees to consider their health goals and future needs when reviewing traditional Medicare Advantage Plans. “What does the year ahead look like for you? Do you want to travel? What health concerns do you have? If you’re on traditional Medicare, people should ask whether they should be on a Medicare Advantage plan. The cost savings and the out-of-pocket expenses will be significantly lower than if they were to stay on traditional Medicare alone.”
Presbyterian Health Plan offers two Medicare Advantage options – UltraFlex, which provides more flexibility to frequent travelers using providers out-of-state, and Senior Care, which provides free primary care to in-network providers. Both plans have $0 premiums and $0 deductibles.
Brown emphasizes that removing guesswork and complications is central to Presbyterian Health Plans’ mission. To learn more during open enrollment, Presbyterian Health Plan is offering seminars from October 2 through December 4 at locations across New Mexico. A list of seminar dates and locations can be found on their website: www.phs.org/medicare or by calling 1-800-347-4766 (TTY 711) 8 a.m. to 8 p.m.
Offering a Helping Hand
According to Baca, approximately 65,000 people are eligible for both Medicaid and Medicare in New Mexico and require more support. Next year, BCBSNM will introduce a monthly farm box delivered to individuals enrolled in a Dual Special Needs Medicare Advantage plan with BCBSNM. “Eligible members will receive a monthly farm box, including produce, recipes, and some wellness activities. We continue to focus on wellness for diabetes management, making sure their hypertension and blood pressure are all in line. We’ll be using local farms here in New Mexico for distribution, whenever possible,” said Baca.
Low-income persons enrolled in Medicare’s Extra Help program will see more cost savings in their coverage next year. The Extra Help program assists people with drug overage costs, premiums, deductibles, and co-insurance expenses. Previously, enrollees paid a partial amount of all charges. Anyone qualifying for Extra Help in 2024 won’t pay a penny for their Medicare drug plan premium or the plan’s deductible.
“Those on the Extra Help program will now be fully covered, allowing them to pay $0 for the Part D premiums and deductibles. And then, of course, pay lower amounts for generic brand name drugs,” Brown notes.
Plan for Your Health, Plan for Your Budget
The open enrollment period is just around the corner. Planning ahead and reviewing health and financial options leads to peace of mind. Mark your calendar. Ask questions. Consider dental and eye care needs, too.
For more information, the official U.S. government Medicare handbook is another resource for current and prospective enrollees. The guide may be downloaded from the Centers for Medicare and Medicaid Services website at https://www.medicare.gov/publications/10050-Medicare-and-You.pdf. Here’s to good health in 2024.