Since January 1, 2024, Medicare drug coverage (Part D) has significantly improved, substantially benefiting many enrollees. One of the key changes is the introduction of the catastrophic coverage phase. Once your out-of-pocket drug costs reach $8,000, this phase kicks in, relieving you from co-payments and coinsurance for the rest of the calendar year. This provision effectively caps out-of-pocket costs at approximately $3,250 in 2024, according to KFF, providing a significant safety net for your healthcare budget.

Furthermore, the Part D Extra Help program, which is designed to assist with Part D plan costs, has been expanded. It will now be accessible to individuals with incomes up to 150% of the federal poverty level (FPL), up from the previous limit of 135% of the FPL. To check if you qualify, you can use the online tool on the Medicare website or contact your local Social Security office. This means that more people will now qualify for the program, potentially leading to significant cost savings. Those who qualify will have zero premium and deductible costs if they are enrolled in a benchmark plan. In 2024, California will have two benchmark plans accepting new enrollees. Additionally, prescription drug copays will be capped at $4.50 for generic drugs and $11.20 for brand-name drugs under these plans.

Furthermore, the new Medicare Prescription Drug Rebate Program will adjust coinsurance amounts for some Part B-covered drugs. This adjustment is made if the price of a prescription drug has increased higher than the rate of inflation. This measure is aimed at ensuring that you are not burdened with excessive costs due to inflation in drug prices.

As a reminder of the 2023 changes, the cost-sharing for insulin is capped at $35 for a one-month supply of each insulin product covered by Part D, and there is no deductible for it. This also applies to insulin used with traditional insulin pumps under Medicare Part B’s durable medical equipment benefit. Adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), such as the flu vaccine and the shingles vaccine, will also be available at no cost.

To apply for the Part D Extra Help program, you can use the online tool on the Medicare website or contact your local Social Security office. The online tool on the Medicare website provides a convenient way to check if you qualify for the program. If you prefer direct assistance, contacting your local Social Security office can also help you determine your eligibility and guide you through the application process.