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November 12, 2023
Medicare Part B premiums expected to rise for 2024
Although final prices aren’t finalized, consumers can expect to spend about $15 more monthly, which will raise their Medicare Part B premium to $180 for 2024. Blame part of the price increase on Leqembi, a new treatment for those in the early stages of Alzheimer’s disease, which adds $5 monthly to premiums. Medicare will cover the drug for some patients, but they may still need to pay over $5,000 annually.
Without insurance, the drug would cost $26,000. The annual deductible for Medicare Part B in 2024 is expected to remain unchanged at close to $225, the 2023 deductible. Once recipients hit the deductible, Medicare and Plan G pay 100% of Medicare-approved expenses. Medicare Part B covers medical and health services, including physician, outpatient, home health, and durable medical equipment.
Medicare Part D premiums expected to hold steady for 2024 Part D premiums are expected to fall about $1 per month to $55.50 in 2024 due to the Affordable Care Act’s focus on controlling prescription costs. Other changes to expect in 2024 to Part D coverage: • Eliminates the 5% coinsurance requirement and sets the catastrophic threshold at $8,000. That means enrollees without low-income subsidies won’t have to pay additional medication costs after they reach this threshold, which will provide significant savings for those using high-cost medications covered by Part D. • Out-of-pocket insulin costs in all Part D plans are limited to $35 per month. • Part D covers adult vaccines like the shingles vaccine provided without cost sharing.
• Medicare recipients with incomes up to 150% of poverty and resources at or below the limits for partial lowincome subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy Program. This change eliminates the partial benefit for individuals with incomes between 135% and 150% of poverty. •Starting in 2025, Part D enrollees can spread out their out-of-pocket costs over the year rather than face high outof-pocket costs in any given month. According to the Centers for Medicare & Medicaid Services, Part D remains one of Medicare’s most popular programs, with more than 50 million Medicare beneficiaries enrolled for prescription drug coverage.
The Social Security Act sets Medicare Part B premiums, deductibles, and coinsurance rates each year. Income guidelines for 2024 also have yet to be announced but likely will hew closely to the 2023 guidelines. In 2023, Part B monthly standard premiums applied for individuals who earned $97,000 or less annually or couples earning $194,000.
Premiums increase for people with higher incomes. For example, individuals who make $97,000 up to $123,000 and couples who make more than $194,000 and up to $246,000 will pay an additional monthly premium of $65.90 for Part B and $12.20 for Part D. Individuals who make $500,000 a year or more will be charged an extra $560.50 a month for Part B and $76.40 for Part D.
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Inflation Reduction Act continues work to lower prescription costs Rising prescription drug costs of prescription drugs have long worried consumers. According to the Centers for Medicare & Medicaid Services, total prescription drug spending in the United States reached $371 billion in 2020. To help address this issue, Congress passed the Inflation Reduction Act in 2022, which aims to lower drug prices through two policies: negotiating prices for high-cost drugs covered under Medicare and requiring drug manufacturers to pay rebates if they increase prices faster than inflation. It also includes provisions such as capping out-of-pocket spending, limiting cost-sharing for insulin and adult vaccines, and expanding eligibility for low-income subsidies. The Inflation Reduction Act limited costsharing for insulin to $35 per month starting in 2023 for Medicare beneficiaries and includes coverage for insulin in Medicare Part D plans and through durable medical equipment under Medicare Part B. A provision to limit
monthly insulin copays for people with private insurance was removed from the bill.
Medicare patients spent $3.4 billion in out-ofpocket costs for the drugs.
President Joe Biden proposed adding 10 commonly used prescription drugs to Medicare’s price negotiation list in August.
Negotiations for the new medications may not take effect for another three years and could face challenges from drugmakers and Republicans.
The proposed drugs include: • Diabetes treatments Jardiance and Januvia. • Autoimmune disease treatment Enbrel. • Heart failure drug Entresto. • Diabetes and heart failure treatment Farxiga. • Blood thinners Eliquis and Xarelto. • Blood cancer treatment Imbruvica • Stelara, an IV treatment for psoriasis and other inflammatory disorders. • Several versions of Fiasp, a fast-acting insulin. According to the Centers for Medicare and Medicaid Services, Medicare paid more than $50 billion for the drugs between June 1, 2022, and May 31.
The government aims to negotiate the lowest maximum fair price to make drugs more affordable, with potential benefits for Medicare beneficiaries and potentially lower premiums for all with drug coverage. Companies that refuse to negotiate will be taxed heavily. The Centers for Medicare and Medicaid Services will meet with drugmakers this fall, hold patient-focused listening sessions, and make the first offers on maximum fair prices by February 2024. It plans to add more drugs to the negotiation list in the coming years.
Make sure your Medicare coverage still serves your needs Fall is the ideal time to consider whether you need to change your Medicare coverage for 2024. The non-profit Kaiser Family Foundation, which specializes in healthcare policy, reported more than 4,000 Medicare Advantage plans were available in 2023 across the U.S. That’s more than double the number available in 2018. With so many options, it’s vital to do research. Start by understanding the differences between original or traditional Medicare and Medicare Advantage plans. Traditional Medicare offers a comprehensive coverage plan that includes multiple parts. Part A covers hospital stays, skilled nursing facility care,
hospice care, and some home healthcare services. Part B covers doctors’ services, outpatient care, medical supplies, and preventive services. Part D covers prescription drug costs. With traditional Medicare, you can access any doctor or hospital across the United States that accepts Medicare without needing a referral for specialist visits. Another option is to choose a Medicare Advantage or Part C plan. Medicare Advantage is a comprehensive plan that typically includes Part A and B and Part D coverage. It often requires using in-network doctors and may have lower out-of-pocket expenses than
4 Medicare Mistakes That Could Cost You By Dr. Matthew Lewis Senior Medical Director of Primary Care with New West Physicians, part of Optum
There are a lot of choices when it comes to Medicare. Here are four common mistakes that you don’t want to make – and the reasons why: 1. Don’t allow automatic plan renewal to make your choice for you.
One of the best times to reevaluate your Medicare plan, make changes or sign up is during Medicare Annual Open Enrollment, October 15 - December 7.
Medicare Part D or Medicare Advantage plans renew every January 1, unless you decide to change it. Automatic renewal may make your life easy, but it might not be the best way to make your Medicare decisions. This is especially true if your health care needs have changed in the last year, if you want more benefits, or if your finances have changed. Plans also may change what they cover from year to year.
traditional Medicare. Additionally, these plans may provide additional benefits such as vision, hearing, and dental services that original Medicare does not cover. While non-emergency coverage may be available out of network with some plans, it usually comes at a higher expense. And seeing a specialist may require a referral. According to experts, evaluating your current plan and its suitability is crucial before considering a switch. Review three critical factors: 1. Medications: Catalog names, dosages, and brand name or generic status of prescribed drugs. Confirm the drugs will continue to be covered by your
2. Don’t ignore your plan’s Annual Notice of Change. This notice explains any changes in your plan benefits and costs for the upcoming year. The changes may affect your health care and your budget, so this notice can help you decide whether to keep your current plan or consider a new one.
plan and the expected costs using the government’s Medicare plan finder tool. 2. Doctors: If you have a Medicare Advantage plan, you must ensure your doctors remain within the network. If you have traditional Medicare, all doctors who accept Medicare are automatically covered. 3. Costs: Compare premiums and out-of-pocket maximums between plans. Consider all expenses, especially for Medicare Advantage plans advertising $0 or low premiums. Also, remember everyone must pay the monthly Medicare Part B premium. People with higher incomes may pay additional costs for Part B.
Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions. Look into them, even if you think you might not be eligible. For more information, call 303-802-1784 to speak with a licensed insurance agent, or visit Optum.com/AEP24CO.
3. Don’t pick a plan because your spouse, relative or friend has it. What works for one person may not fit with the needs of another it’s a good idea to look at all your options, keeping your health care needs and budget at the forefront of your mind. Consider the cost, coverage/benefits, any other coverage you hold, prescription drugs, doctor and hospital choice, quality of care and travel coverage. 4. Don’t assume that you don’t qualify for help with Medicare costs. Several programs offer assistance with Medicare premiums and other costs. In some cases, Medicare Savings Programs may pay Medicare Part A (Hospital
1. Do I have to renew my Medicare plan during annual enrollment? | UnitedHealthcare (uhc.com) 2. Medicare plan Annual Notice of Change: What to look for | UnitedHealthcare (uhc.com) 3. Consider these 7 things when choosing coverage | Medicare 4. Medicare Savings Programs | Medicare
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Let’s talk about better health Medicare Annual Open Enrollment Period Ends December 7 It’s time to start a conversation. During Medicare Annual Open Enrollment, you can choose an Optum doctor who hears what you need and delivers the care you want. Who is part of a trusted, nationwide network of physicians and innovators who specialize in caring for older adults. And who leads a team of professionals with one focus — your healthier life.
To connect with a licensed insurance agent*, call today. Then connect with an Optum doctor near you.
303-802-1784 Optum.com/AEP24CO
*Medicare beneficiaries will be connected with licensed insurance agents who sell Medicare Advantage and Medicare prescription drug plans. ©2023 Optum, Inc. All rights reserved. The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call 1-866-879-1310, Ext. 2279#. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición.1-866-879-1310, Ext. 2279#. (Chinese), 1-866-879-1310, Ext. 2279#
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Inflation, prescription costs push health premiums up in 2024 Coloradans should expect to pay 11% more for health insurance premiums in 2024. Insurers point to inflation and the surge in prescription expenses as factors behind premium hikes. One specific instance is the use of diabetic medication, like Semaglutide, for weight loss, contributing to the overall increase in pharmaceutical costs. The increase for Colorado Option plans — state-designed plans that health insurers are mandated to carry — will be just under 8%. Under the Colorado Option law, 2024 health insurance premiums must be 10% lower than 2021.
Health insurance plans and premiums will be finalized before the November open enrollment period, the Colorado Division of Insurance said. The division expects Colorado Option plan costs to increase by 7.7%, with non-option plans set to increase by 11.1%. Anthem/HMO Colorado, Cigna, Denver Health, Kaiser Permanente, Rocky Mountain HMO, and Select Health will offer health insurance plans statewide in Colorado for 2024. Bright Health, Humana, Oscar Health, and Friday Health Plans left the Colorado market. The division said the six insurance companies plan to offer 371 plans, including 30 Colorado
7 things you need to know about enrolling in Colorado’s health marketplace Who can buy Colorado’s health marketplace insurance?
household earnings, age, and location.
To sign up for private health coverage through Connect for Health Colorado, you must:
When can I enroll in an ACAcompliant plan in Colorado?
• Live in Colorado • Not be incarcerated • Not be enrolled in Medicare How do I qualify for financial assistance? To qualify for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or Colorado’s state-funded cost-sharing subsidies, you must: • Not have access to an affordable employer-sponsored health plan • Not be eligible for Health First Colorado (Colorado Medicaid) or Child Health Plan Plus (CHP+). Subsidies through Connect for Health Colorado depend on your
Colorado’s open enrollment period runs from Nov. 1 through Jan. 15. For coverage to start on Jan. 1, you must complete your application by Dec. 15. Coverage begins Feb. 1 for applications submitted from Dec. 16 to Jan. 15. If you qualify, you can enroll year-round in Health First Colorado (Medicaid) and Child Health Plan Plus (CHP+). How do I enroll in a Colorado Marketplace plan? You have a few options to enroll in an ACA Marketplace/exchange plan in Colorado. You can use Connect for Health Colorado, the state’s health insurance Marketplace, to compare different plans and check your eligibility for financial aid before enrolling during open enrollment or a special enrollment period.
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Option plans and 341 non-Colorado Option plans. About 35,000 Coloradans enrolled in Colorado Option plans for 2023. The Polis administration said the state’s reinsurance program, which helps health insurers pay for their highest-cost claims, will continue to save Coloradans money. On average, health insurance premiums would be 21% higher without the reinsurance program. Most insurers expect COVID-19-related costs to decrease in 2024, except they must start covering COVID-19 vaccine costs.
Alternatively, you can seek assistance from an insurance broker or certified enrollment assistant to enroll in a Connect for Health Colorado plan. For further support, contact Connect for Health Colorado’s call center at 855-752-6749 (TTY line: 855-346-3432). How can I find affordable health insurance in Colorado? The Affordable Care Act offers income-based subsidies to help lower health coverage costs for eligible individuals through Connect for Health Colorado. These subsidies and federal costsharing reductions are available to those who choose a Silver-level plan and have a household income below 250% of the poverty level. Colorado also provides additional cost-sharing subsidies to some silver-plan enrollees, including undocumented immigrants, through a separate public benefit corporation. Eligible individuals can also enroll in free or low-cost coverage through Health First Colorado or CHP+. How many insurers offer Marketplace coverage in Colorado? Six insurers will offer health plans through Connect for Health Colorado for 2024: • Anthem • Cigna • Denver Health
• Kaiser • Rocky Mountain Health Plans • SelectHealth What health insurance resources are available to Colorado residents? Connect for Health Colorado: This is the state’s marketplace/ exchange. Residents can use Connect for Health Colorado to enroll in individual/family health plans, receive income-based subsidies, and enroll in Health First Colorado. You can contact Connect for Health Colorado at 855-752-6749. Colorado Division of Insurance: Regulates the insurance industry in Colorado and assists consumers and businesses with insurance-related questions and concerns. Colorado Department of Health Policy and Financing (HCPF): Administers Medicaid (Health First Colorado), Child Health Plan Plus (CHP+), and other health care programs. Colorado Senior Health Care and Medicare Assistance: A service for Colorado Medicare beneficiaries and their caregivers, providing information and assistance with questions related to Medicare eligibility, enrollment, and claims.
SUNDAY, NOVEMBER 12, 2023
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Find the Right Medicare Insurance Agent for You
During Medicare’s Annual Enrollment Period (AEP)—October 15 through December 7—an insurance agent can help you understand your options and determine the right plan for your health needs. Here are some tips to help you find the right agent for you. Understanding the different types of agents There are several different types of insurance agents that can help you during AEP.
• Carrier agents work for an insurance carrier such as Humana and only sell this carrier’s insurance plans in their specified geographic region. • Independent agents work for themselves or an independent insurance brokerage. They contract with multiple carriers in a certain geographic region. • Third-party call center agents work for companies who contract with a wide range of carriers in multiple geographic regions. If you like to develop personal relationships with service providers and want additional help understanding or using your plan throughout the year, you might like working with a carrier or independent agent best. If you want to have a lot of options to choose from, and do not need help understanding or using your plan, you might consider an
independent or third-party call center agent. What to look for in an agent When considering an agent, ask yourself: • Do you want someone who is more relationship based, or would you prefer a more hands-off approach with a call once or twice a year? • Do you need extra support to understand and use your plan benefits, or do you prefer to be more self-directed? • Do you want someone who can help connect you to community resources or would you rather do that research on your own? Ask prospective agents about their communication style and process to decide whether or not they might be right for you. How to find an insurance agent Ask your friends and family if they can recommend any Medicare insurance agents. You can also research agents using a search engine or on social media platforms like Facebook. Agents are under strict rules about when and how they can reach out to you, so you should call or email them if you are interested in working with them.
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Working with an insurance agent can help you: • Find the right plan and pricing for your healthcare needs. • Determine monthly premium costs as well as your copay, deductibles and maximum outof-pocket costs per year. • Understand your key plan benefits and how to maximize them. • Connect to community resources for your non-clinical needs and determine your eligibility for additional government services. • Understand which providers and facilities are in your plan’s network. • Find doctors in your area with Humana’s Find a Doctor tool. Because they help people like you every day, insurance agents can be a great resource during AEP and all year long. Learn more at healththatcares.com/humana-agents. Call a licensed sales agent 1-844-224-8993 (TTY:711) Monday–Friday 8 a.m.–8 p.m.
Doctors who get to know your story, not just your symptoms. As each of us gets older, what we need for our healthcare changes— sometimes more than once. That’s why Humana has providers in our network that specialize in geriatric care. We connect you with doctors who take time to get to know you, offering care that evolves alongside you and a dedicated team who prioritizes your whole health.
An emphasis on treating every patient with respect and compassion
A professional care team that takes the time to listen
Care beyond the clinical, with mental health and social wellness support
Visit HealthThatCares.com or scan the QR code to learn more about the doctors in our network Call a licensed Humana sales agent 1-844-224-8993 (TTY:711) Daily, 8 a.m.–8 p.m.
Other Providers are available in our network. Provider may also contract with other plan sponsors. Important! At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries comply with applicable Federal Civil Rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, marital status or religion. ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-855-360-4575 (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingü.stica. Llame al 1-800-706-6167 (TTY: 711). 繁體中文 (Chinese): 注意：如果您使用繁體中文，您可以免費獲得語言援助服務 。請致電 1-855-360-4575 (TTY: 711)。 Y0040_GHHLZH6EN_C
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