4 Medicare Advantage Changes in 2024 That You Should Know About
Enrollment in Medicare Advantage (MA), also known as Medicare Part C, has steadily grown over the past 20 years, with the majority of consumers now choosing to substitute MA plans for Original Medicare. That’s largely because private insurers often charge a low monthly premium — or no premium at all — while providing a variety of benefits, such as coverage for prescription drugs and dental, vision, hearing, and telehealth services.
However, the combination of coverage, restrictions, and networks included in each MA plan is different and subject to change on a yearly basis. That’s why, if you’re new to Medicare, it’s important to consider all your options carefully and seek advice from a licensed insurance agent. And if you’ve signed up for Medicare in the past, the Annual Enrollment Period (from October 15 to December 7) is a great time to check if there are options that better meet your needs next year by reaching out for a PlanFit CheckUp.
In addition to any adjustments that come from insurers, the federal government’s Centers for Medicare and Medicaid Services (CMS) imposes updates that affect all MA plans. CMS issued a final rule for 2024 in April 2023. Here are some of the biggest developments you should be aware of heading into the new year:
1. Speeding Up Access to Care
Prior authorization (sometimes also called preauthorization or precertification) is a decision made by your insurer that a proposed treatment, prescription, or device is medically necessary and therefore likely to be covered. Requiring prior authorization helps insurers to manage costs but can also mean it takes longer to access care.
That’s why CMS has clarified its requirements to help MA beneficiaries receive services more efficiently. The rules now specifically state that MA plans must generally cover any care that would be authorized under Original Medicare. MA plans won’t be able to create their own policies to restrict services that are included in Medicare Part A or B.
CMS also set out to ensure that people who switch to a new MA plan won’t have their care interrupted because of prior authorization policies. Patients who are currently undergoing a course of treatment will have, at minimum, a 90-day transition period after starting a new plan when they can’t be required to obtain authorization for that treatment.
2. Help to Pay for Prescriptions
The Extra Help, or Low-Income Subsidy (LIS), program assists people under certain levels of income to afford prescription drugs through Medicare Part D coverage. In the past, some beneficiaries only qualified for partial benefits, but the CMS has instituted changes that the agency predicts will broaden access to subsidized prescription drug coverage for 300,000 people with low incomes.
Full benefits are now available to everyone who has limited resources (which are assessed based on the contents of their savings, checking, and retirement accounts, as well as any stocks or bonds) and an income under 150% of the federal poverty line. As of 2023, the income limits were $21,870 for an individual or $29,580 for a married couple.
3. Trustworthy Guidance for Medicare Decisions
To help consumers to make better informed decisions about their coverage, regulators instituted new rules governing promotions for Medicare plans. For example, a ban on potentially confusing ads means private insurers will not be allowed to design their communications to look like they come from the U.S. government.
Looking ahead, CMS is also taking steps to improve its Star Rating system. The stars are a simple way to compare plans, with ratings based on evaluations that consider factors like customer service and the resources that members receive for preventive care and managing chronic conditions. Beginning in 2027, the system will also account for how well plans address concerns about equity in the healthcare system.
4. Making Behavioral Health Services More Accessible
CMS is striving to make it easier for Medicare beneficiaries to access behavioral healthcare. In the past, Medicare covered outpatient therapy as well as psychiatric hospitalization and partial hospitalization. However, other forms of behavioral healthcare, classified as intensive outpatient services, fell into a coverage gap.
Under the new rule, more of these services, such as family therapy for people living with substance abuse disorders, will now be covered. Meanwhile, CMS is working to expand behavioral healthcare in underserved and rural communities by loosening requirements for physician supervision over outpatient clinics classified as Federally Qualified Health Centers (FQHCs) and facilities certified as Rural Health Clinics (RHCs).
CMS policies and individual plans continue to evolve each year, so you should check regularly to make certain you still have the benefits that best fit your needs and budget. As a trusted marketplace for Medicare Advantage plans, GoHealth is committed to providing customers with accurate information and connecting them with benefits they can rely on.
About GoHealth
GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.
