2023-2024 Changes & Updates 

Now that we are starting the last quarter of 2023, it is a good time to review some of the changes that happened this year in Medicare, as well as look forward to upcoming updates for 2024:

1. Monthly Cap on Covered Insulin

Starting in 2023, insulin that is on your plan’s formulary list (the list of covered drugs for a Medicare Advantage plan or Part D plan) must be limited to no more than $35 for a month’s supply. Insulin on the plan’s formulary list is exempt from requiring a deductible before coverage begins.  This $35 limit also applies if your insulin is delivered through a traditional pump, but that would be covered under Medicare Part B (medical coverage), not Part D (drug coverage). 

Non-insulin injectables used to treat diabetes (such as Bydureon, Ozempic, Trulicity, etc.) do not qualify for the $35 cap.

The biggest thing to remember is that not every plan covers every brand of insulin – and that can change from year to year.  Even if your insulin was covered by your Part D plan in 2023, it may not be covered on next year’s formulary.  Each fall between October 15 and December 7 you should make an appointment with a local SHIIP-SMP site for a plan comparison. SHIIP-SMP volunteer counselors can check your Medicare drug coverage and ensure you will be in the 2024 Prescription Drug or Medicare Advantage plan that best meets your needs. 

2. No Cost for Certain Vaccines

In 2023, Medicare updated its coverage for adult vaccines based on new recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP).

Medicare Part B continues to cover these vaccines:

  • COVID-19 (see next section -- “Continued COVID-19 prevention” -- for more details)
  • Hepatitis B (if your doctor says you are medium to high risk)
  • Influenza/flu (once each flu season, meaning you might end up getting two flu shots in a calendar year)
  • Pneumococcal/pneumonia (usually covers the single dose vaccine or the 2-dose series once in your lifetime)

Medicare Part D will continue to cover the TDAP (tetanus-diphtheria-whooping cough) vaccine and is now covering vaccines for shingles and RSV. 

But even though all these vaccines are covered at no cost to you, it still matters how you get the vaccines. 

For example, if you have Original Medicare, you still need to be sure the provider or pharmacy can bill your Part D prescription plan for any Part D vaccines.  You may have to pay for a vaccine administration at the time of service, and later request reimbursement through your Part D plan. 

If you have a Medicare Advantage plan, you would still need to go to an in-network provider for Part B vaccines.  For Part D vaccines, it depends on what you have for Part D coverage with the MA plan.  It always good to check your plan’s Summary of Benefits and Evidence of Coverage first to make sure there aren’t any additional restrictions in order to get these vaccines at no cost. 

3. Continued COVID-19 Prevention

Medicare continues to cover the cost of COVID-19 vaccines and boosters at no cost for anyone on Medicare, and this will continue indefinitely. However, once the federal public health emergency ended in 2023, Medicare stopped regular coverage of over-the-counter COVID-19 tests.

You can still get free COVID-19 diagnostic tests through Medicare Part B when your doctor orders this test and you get the test done by a laboratory (even through a pharmacy or doctor's office). If you’re in a Medicare Advantage plan, your cost sharing may be different and your plan may cover over-the-counter tests as a supplemental benefit.  As always, check the Summary of Benefits or Evidence of Coverage documents for your plan.

4.  Expanded Part D Coverage

Next year, catastrophic level coverage in Part D prescription plans starts when your out-of-pocket spending reaches $8,000. Starting in 2024, if you reach the catastrophic level of coverage, you will no longer have coinsurance or copays for any covered prescriptions for the rest of the calendar year. (By comparison, in 2023, beneficiaries still had a 5% copay for Part D-covered prescriptions once they reached catastrophic coverage.) 

Also starting in 2024, the Low-Income Subsidy (LIS) will be expanded. (LIS is also known as “Extra Help” and helps pays for your Part D premium and drug copays.) If you qualify for LIS in 2024, you are entitled to full benefits in the coming year. (In the past, there were two different levels of Extra Help – partial and full. With this change, anyone eligible for the program will automatically receive full benefits.)

(For more information about expanded Extra Help, visit Saving Money & Medicare)

5. Check Your Mail

This isn’t anything new, but it especially applies right now - make sure you are opening & reading your mail.  This is the time of year you will receive important details about any changes to your coverage and benefits for 2024.

It is important to keep track of mail coming from these places:

  • Centers for Medicare and Medicaid Services (CMS) (also known as “Medicare”)
  • Social Security
  • Additional health insurance (like a Medicare supplement or employer retiree plan)
  • Your drug plan
  • Your Medicare Advantage plan (if enrolled in one) 
  • State of Iowa
  • Department of Human Services (DHS) (also known as “Medicaid”)

Usually, you have limited time to make changes or appeals based on any coverage changes for next year.  So, open your mail as you receive it!
If you have any questions, contact SHIIP-SMP at 1-800-351-4664.