Are You Aware Of The Medicare Advantage and Part D Final Ruling

The final rule for the Medicare Advantage and Part D program for 2024, released in April 2023, brought several changes impacting both Medicare Advantage plans and the standalone Part D prescription drug plans. Here's a breakdown of the key points relevant to Part D:

Expanded Access to Extra Help:

• The rule implements provisions of the Inflation Reduction Act of 2022, expanding eligibility for the Extra Help low-income subsidy program. This means more individuals with limited income and resources will qualify for assistance paying for their prescription drugs under Part D.

Permanent LI NET Program:

• The Limited Income Newly Eligible Transition (LI NET) program, which provides temporary Part D coverage for low-income individuals who recently became eligible for Medicare, is now permanently established. This ensures continuity of coverage for these individuals and eliminates the worry of losing coverage when the temporary program period ends.

Insulin Price Caps:

• The rule implements a maximum copayment of $35 per month for a defined set of insulin products covered under Part D. This significantly reduces the cost burden for beneficiaries who rely on insulin to manage their diabetes.

Improved Prior Authorization:

• The rule aims to streamline prior authorization processes for Part D medications. This includes:
• Reducing the use of prior authorization for certain categories of drugs, such as those for chronic conditions.
• Establishing clear timelines for processing prior authorization requests.
• Providing beneficiaries with more information about the reasons for prior authorization denials and their appeal rights.

Other Changes:

• The rule also makes various technical and administrative changes to the Part D program, such as:
• Updating the Medicare drug price list (Average Sales Price) for 2024.
• Modifying the Medicare prescription drug star rating system.
• Clarifying coverage for certain categories of drugs.

Overall, the final rule for Part D in 2024 aims to improve access to affordable prescription drugs for Medicare beneficiaries, particularly those with low incomes or chronic conditions. It's important for individuals enrolled in Part D to familiarize themselves with these changes and how they might impact their coverage and costs.

Here are some resources for further information:

• CMS Fact Sheet on the 2024 Medicare Advantage and Part D Final Rule: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f
• Medicare.gov: https://www.medicare.gov/
• National Council on Aging: https://www.ncoa.org/index.htm
• Many individuals qualify for these benefits and are unaware if you would like to check your eligibility click here and a licensed agent will be in contact