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Medicare Updates for 2023 AEP Part 2

Every year employees in the U.S. have to review their health coverage during October to December to make selections for the next year. Even though the new coverage does not go into affect until after January 1st, the anticipation of benefit costs increasing more than the typical annual cost of living increases cause more stress. If you think your insurance should be lower because you barely use it, think again. Many of the adjustments made are similar to car insurance actuarial data. Meaning services used across the country are weighted with a risk score trend. Your annual rates are adjusted based on the national average usage. Whether you avoid going to the doctor or not is irrelevant.

According to the Centers for Medicare & Medicaid Services (CMS) 2024 Fact Sheet released on March 31, 2023, the growth rate is largely driven by Medicare Fee-For-Service (FFS) per capita costs, as estimated by the office of the Actuary. Included in the 2024 growth rate estimate is a technical adjustment to the per capita cost calculations related to indirect and direct medical education costs associated with services furnished to Medicare Advantage enrollees.

CMS is phasing in over 3 years the technical update to the growth rates to remove indirect medical education and direct graduate medical education costs for the FFS USPCC used for MA payment. Even with these changes coming there are still more questions I would like clearer answers for, but for now we will have to settle for updates.

>What are the expected increases for Medicare Part B in 2024?

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical health services not covered under Medicare Part A. The premiums for 2024 are expected to rise by about $15 a month to a total of about $179.80 per month, according to a projection from The Senior Citizens League, a nonprofit that advocates on issues affecting seniors.

Here are a few bullet points the Inflation Reduction Act of 2022 Updates for 2024:

  • Beginning in CY 2024, cost-sharing for Part D drugs will be eliminated for beneficiaries in the catastrophic phase of coverage.

  • Beginning in CY 2024, the Low-Income Subsidy program (LIS) under Part D will be expanded so that beneficiaries who earn between 135 and 150 percent of the federal poverty level and meet statutory resource limit requirements will receive the full LIS subsidies that, prior to 2024, were available only to beneficiaries earning less than 135 percent of the federal poverty level; these subsidies provide for $0 premiums and low-cost, fixed copayments for covered prescription drugs.

  • During CY 2024, Part D plans must not apply the deductible to any Part D covered insulin product and must charge no more than $35 per month’s supply of a covered insulin product in the initial coverage phase and the coverage gap phase.

  • During CY 2024, Part D plans must not apply the deductible to an adult vaccine recommended by the Advisory Committee on Immunization Practices and must charge no cost-sharing at any point in the benefit for such vaccines.

  • Beginning in CY 2024, the annual growth in the Base Beneficiary Premium will be capped at 6 percent. The Base Beneficiary Premium for Part D is limited to the lesser of a 6 percent annual increase, or the amount that would otherwise apply under the prior methodology had the IRA not been enacted.

>Does Medicare cover Respite care for caregivers?

Although the Biden-Harris Administration announced the goal of advancing health equity for underserved communities under the GUIDE Model on July 31, 2023, the model will run for eight years beginning July 1, 2024. In the meantime, caregivers must find as many programs offered through their local communities to have access to respite care. It is wonderful that the needs of caregivers for respite care are finally being recognized on a political level because the regulations changed will be the only way they get the help. Unfortunately, caregivers need for respite care has become another political chip to play for reelections.

When in effect, the GUIDE model is intended for community-dwelling Medicare fee-for-service beneficiaries, including beneficiaries dually eligible for Medicare and Medicaid, living with dementia. According to the Guide Model published July 31, 2023, the eligible beneficiaries must meet the following criteria:

  • Beneficiary has a diagnosis of dementia, as confirmed by clinician attestation.

  • Have Medicare as their primary payer.

  • Enroll in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans and PACE).

  • Not Enrolled in Medicare hospice benefit.

  • Not residing in a long-term nursing home.

This appears to be a solution for caregivers, but it is more proof that legislators do not understand dementia, the affects of the progression on the beneficiary or caregiver, and how these options still exclude the population dealing with early dementia diagnosis ineligible for Medicare.

The plan talks about respite services paid by CMS for temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from caregiving responsibilities. It is unclear how much a caregiver will benefit beyond knowing there is an annual cap for paid respite services by Medicare.

>What is IRMAA and the Expected Brackets for 2024?

IRMAA is the Medicare acronym for Income Related Monthly Adjustment Amount. This adjustment is applied to eligible Medicare enrollees as a surcharge on top of a person's Medicare Part B and Part D premiums for having too much income in a year. You are encouraged to review your policy each year because annual income is reviewed on a two-year look back.

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