What is the 2024 Medicare Advantage/Part D Final Rule?

The 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) is a comprehensive set of changes to the Medicare Advantage and Part D prescription drug programs that took effect on January 1, 2024. Here's a summary of some key points:

Improvements for beneficiaries

• Expanded access to low-income subsidies: Individuals with incomes up to 150% of the federal poverty level are now eligible for the full low-income subsidy (Extra Help) for prescription drugs.
• Streamlined prior authorization: Medicare Advantage plans must now follow clearer and more consistent prior authorization procedures, making it easier for beneficiaries to get the care they need.
• Enhanced transparency: Plans must provide beneficiaries with more information about their coverage, including publicly accessible internal coverage criteria.
• Increased focus on behavioral health: The rule encourages Medicare Advantage plans to offer more comprehensive behavioral health coverage.
• Improved quality of care: The rule implements new quality measures and payment adjustments to incentivize plans to provide high-quality care.

Changes for plans:

• Stricter marketing guidelines: Plans must now adhere to stricter marketing rules to prevent misleading or deceptive advertising.
• Stronger accountability for improper payments: CMS will begin recovering improper payments made to Medicare Advantage plans through audits.
• New payment methodologies: The rule introduces new payment methodologies for Medicare Advantage and Part D plans, aimed at improving accuracy and efficiency.

Here are some resources where you can learn more about the final rule:

• CMS Press Release: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f
• If you would like to learn more about the final rule and how that may affect you Click Here and a licensed agent will be in contact.