Did you know that nearly 34 million Americans are enrolled in Original Medicare? And nearly 32 million are enrolled in Medicare Advantage. So, when changes are made to Medicare, we think it’s important you know what’s coming next.
We call it “Medicare Season,” the time of year when people who are enrolled in Medicare have options to make changes to their plans. There are three of them: when you first sign up, the “Open Enrollment Period” – October 15 to December 7 — and “Special” when certain events happen in your life, like moving to a new location or losing other coverage.
For most people, the Open Enrollment Period is the time when they have an opportunity to address having selected plans that simply don’t work for them. Certain medications, for example, may not be covered in some plans, and if you didn’t know that when you chose your plan or if your medical situation changed, you need to make a change.
There are other changes, those made by our friends in Washington. On January 1, 2025, several changes will happen that may affect you.
We recently posted a blog on a change coming for employees who are receiving health care coverage for prescriptions through their employer. If a business plan’s prescription benefits are not comparable to Medicare Part D, the policy may no longer qualify as a substitute for Part D. Click here to read more on this issue.
The Centers for Medicare and Medicaid Services (CMS) has announced a proposal to allow doctors to be reimbursed for the paid subscriptions and apps they use in order to provide online therapy. If this moves forward, it’s likely that digital therapy programs will be covered if they follow the CMS standards for ongoing behavioral health care treatment.
There are three proposed new payment codes that would be used to reimburse providers for digital therapy sessions. These reimbursements, which are based on the type of services, could range anywhere from $10 to $110 per patient per month.
Finally, insurance giants are pulling back from offering Medicare Advantage plans in neighborhoods where the payments are low and the profits are negligible. Despite their warm and fuzzy commercials, these companies are bottom-line focused, and rate proposals have not been what was desired. Don’t feel too bad, the federal government pays between $500 and $600 billion in Medicare Advantage payments to private health care plans in 2025, according to an April article from The Wall Street Journal.