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Announcement of Calendar Yr (CY) 2024 Medicare Benefit (MA) Capitation Charges and Half C and Half D Fee Insurance policies (Mar. 31, 2023); Truth Sheet: 2024 Medicare Benefit and Half D Fee Announcement (Mar. 31, 2023)
Underneath Medicare Half D laws, most group well being plan sponsors providing prescription drug protection to Half D eligible people (together with energetic or disabled workers, retirees, COBRA members, and beneficiaries) should speak in confidence to these people and to CMS whether or not the plan protection is creditable or non-creditable. For protection to be creditable, its actuarial worth should equal or exceed the actuarial worth of outlined customary Medicare Half D protection beneath CMS pointers. In less complicated phrases, this check measures whether or not the anticipated quantity of paid claims beneath the employer’s prescription drug protection is no less than as a lot because the anticipated quantity of paid claims beneath the usual Medicare prescription drug profit.
CMS has launched the next 2024 parameters for the outlined customary Medicare Half D prescription drug profit:
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Deductible: $545 (up from $505 in 2023);
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Preliminary protection restrict: $5,030 (up from $4,660 in 2023);
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Out-of-pocket threshold: $8,000 (up from $7,400 in 2023);
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Whole lined Half D spending on the out-of-pocket expense threshold for beneficiaries who usually are not eligible for the protection hole low cost program: $11,477.39 (up from $10,516.25 in 2023); and
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Estimated whole lined Half D spending on the out-of-pocket expense threshold for beneficiaries who’re eligible for the protection hole low cost program: $12,447.11 (up from $11,206.28 in 2023).
Minimal cost-sharing quantities beneath the catastrophic protection portion of the profit usually are not listed within the 2024 parameters as a result of the Inflation Discount Act of 2022 (see our Checkpoint article) eradicated cost-sharing for lined Half D medication for beneficiaries within the catastrophic part of protection starting in 2024.
EBIA Remark: These parameters shall be utilized by group well being plan sponsors to find out whether or not their plans’ prescription drug protection is creditable for 2024. The data is required for required disclosures to Half D eligible people and to CMS. The annual participant disclosure discover requirement could also be glad by offering a single discover on the similar time every year. As well as, disclosure notices could also be required at different instances (for instance, previous to a person’s Medicare Half D preliminary enrollment interval or upon request from a Medicare Half D eligible particular person―see our Checkpoint Query of the Week). For extra data, see EBIA’s Group Well being Plan Mandates handbook at Sections XXV.C (“Overview of Medicare Half D”) and XXV.D (“What Is Creditable Protection for Functions of the Half D Disclosures?”). See additionally EBIA’s Self-Insured Well being Plans handbook at Sections XVI.E (“Enrollment Supplies”) and XXV.C.3 (“Coordination of Advantages With Medicare Half D (Prescription Drug Profit)”).
Contributing Editors: EBIA Workers.
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