Right through the Medicare open enrollment period from October 15 to December 7 each and every yr, folks with Medicare can join in a plan that gives Part D prescription drug coverage, both a stand-alone prescription drug plan (PDP) for folks in conventional Medicare, or a Medicare Benefit plan that covers all Medicare advantages, together with pharmaceuticals (MA-PD). In 2023, 50.5 million of the 66 million folks coated by means of Medicare are enrolled in Phase D plans, with greater than part (56%) enrolled in MA-PDs and 44% in PDPs. This factor transient supplies an outline of Phase D plan availability and premiums in 2024 and key tendencies over the years. (An outline of the 2024 Medicare Advantage market may be to be had.) (See Methods field for main points at the research).
Phase D Highlights for 2024
- The common Medicare beneficiary has a number of with regards to 60 Medicare plans with Phase D drug protection in 2024, together with 21 Medicare stand-alone drug plans and 36 Medicare Benefit drug plans. Whilst the marketplace for Phase D protection total stays powerful, the choice of PDP choices for 2024 is decrease and the choice of MA-PD choices is upper than in some other yr since Phase D began. The general choice of PDPs (709) and companies providing those plans (11) have reduced from 2023.
- Medicare beneficiaries who obtain Phase D Low-Source of revenue Subsidies (LIS) could have get right of entry to to fewer so-called “benchmark” PDPs in 2024 than in any yr since Phase D began, with 3 benchmark plans to be had out of the common 21 PDPs to be had total for 2024. Benchmark plans are PDPs to be had to LIS enrollees for no per month top rate. The relief within the choice of benchmark plans for 2024 is in large part the results of PDPs introduced by means of Cigna, Humana, and CVS Well being qualifying as benchmark plans in a long way fewer areas in 2024 in comparison to 2023. An estimated 2.4 million LIS enrollees – part of all LIS enrollees in PDPs – wish to transfer plans all over the 2023 open enrollment length in the event that they need to be enrolled in a benchmark plan in 2024.
- Even though the Inflation Aid Act incorporated a premium stabilizationprovision that capped annual enlargement within the Phase D base beneficiary top rate at 6%, the legislation didn’t follow this 6% cap to person plan premiums that enrollees pay. The Phase D base beneficiary top rate of $34.70 for 2024 is according to standardized bids submitted by means of PDPs and MA-PDs to hide fundamental Phase D advantages in 2024, whilst exact Phase D plan premiums range throughout plans and could also be upper or less than the bottom beneficiary top rate, relying on a number of elements. The estimated moderate enrollment-weighted per month top rate for Medicare Phase D stand-alone drug plans is projected to be $48 in 2024, according to present enrollment, up 21% from $40 in 2023. This build up is pushed by means of upper anticipated plan prices to give you the Phase D get advantages in 2024, together with a brand new cap on enrollees’ out-of-pocket spending above the catastrophic threshold relatively than requiring them to pay 5% coinsurance, as in prior years. After accounting for enrollment alternatives by means of new enrollees and plan adjustments by means of present enrollees, the real moderate weighted PDP top rate for 2024 is perhaps less than the estimated weighted moderate of $48.
- Per thirty days premiums for drug protection are considerably upper for PDPs in comparison to MA-PDs – 5 occasions upper, on moderate, in 2024 (according to unweighted quantities). Whilst the common top rate is projected to extend between 2023 and 2024 for PDPs, it’s anticipated to stay solid (and occasional, and even 0) for MA-PDs. MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums, however there’s no an identical rebate gadget for PDPs.
- Reasonable per month premiums for the 14 nationwide PDPs are projected to vary from underneath $1 to $108 in 2024. Top class variation throughout plans is partly similar as to if plans be offering fundamental or enhanced advantages and the price of advantages introduced, in addition to variation within the underlying prices that plans incur for his or her enrollees. A number of the nationwide PDPs, moderate per month premiums are expanding for 12 PDPs, together with 4 PDPs with will increase more than $20 and three with will increase between $10 and $20.
- Maximum PDP enrollees will face a lot upper charge sharing for manufacturers than for generic medication in 2024, as in prior years, together with coinsurance for non-preferred medication of fifty% (the utmost coinsurance fee allowed for the non-preferred drug tier) in 6 of the 14 nationwide PDPs. PDP enrollees in 9 of the 14 nationwide PDPs will even face coinsurance, relatively than copays, for liked manufacturers, starting from 15% to twenty-five%, and coinsurance for forte tier medication starting from 25% in 7 of the nationwide PDPs to 33% in 2 nationwide PDPs. Coinsurance can imply much less predictable out-of-pocket prices than copayments. In a metamorphosis from prior years, alternatively, beneficiaries in 2024 will now not be required to pay 5% coinsurance when they qualify for catastrophic protection, because of a provision within the Inflation Aid Act that eradicated this cost-sharing requirement.
Phase D Plan Availability
For 2024, the Reasonable Medicare Beneficiary Has Fewer Stand-alone Drug Plan Choices Than in Prior Years however Extra Medicare Benefit Drug Plan Choices
The Phase D marketplace for 2024 gives the common Medicare beneficiary fewer alternatives for drug protection from stand-alone prescription drug plans than in prior years however extra alternatives for protection from Medicare Benefit drug plans. The common Medicare beneficiary has a number of with regards to 60 choices for Phase D protection in 2024, together with 21 PDPs and 36 MA-PDs (Determine 1). Since 2020, the choice of PDPs to be had to the common beneficiary has reduced by means of 25% whilst the choice of MA-PDs has higher by means of 57%.
Of the 21 PDPs to be had to the common beneficiary in 2024, 14 are nationwide PDPs – this is, to be had in all 34 PDP areas national (Appendix Desk 1). This can be a relief of 2 nationwide PDPs from 2023, the results of one plan sponsor (Elixir Insurance coverage) pulling out of the Phase D marketplace solely and an AARP-branded PDP backed by means of UnitedHealthcare now not being introduced in all 34 areas in 2024. The 270,000 enrollees in Elixir’s PDPs (as of March 2023) will want to make a choice a brand new Phase D plan from a distinct plan sponsor all over the 2023 open enrollment length if they would like their Phase D protection to proceed in 2024.
A General of 709 Medicare Phase D Stand-On my own Prescription Drug Plans Will Be Presented by means of 11 Corporations in 2024, the Lowest Collection of PDPs and Corporations Providing Those Plans Since Phase D Began
In 2024, a complete of 709 PDPs will probably be introduced by means of 11 corporations within the 34 PDP areas (plus any other 10 PDPs within the territories), a lower of 92 PDPs (-11%) from 2023, and the bottom choice of PDPs to be had in any yr since Phase D began in 2006 (Determine 2). The choice of corporations sponsoring stand-alone drug plans is reducing from 15 corporations in 2023 to 11 corporations in 2024, the smallest quantity because the Medicare get advantages used to be introduced in 2006.
In spite of the relief in PDP availability total, beneficiaries in each and every state could have a number of a couple of PDPs, starting from 15 PDPs in New York to 24 PDPs in Alabama and Tennessee, plus a couple of MA-PDs introduced on the native degree (Determine 3, Appendix Desk 2).
Even though the Inflation Aid Act incorporated a premium stabilization provision that capped annual enlargement within the Phase D base beneficiary top rate at 6% starting in 2024, the bottom beneficiary top rate isn’t the similar as the quantity that Phase D enrollees pay for protection, and the legislation didn’t cap the expansion in person plan premiums to six%. The Phase D base beneficiary top rate of $34.70 for 2024 is according to standardized bids submitted by means of PDPs and MA-PDs to hide fundamental Phase D advantages in 2024. (Absent the top rate stabilization provision, the 2024 base beneficiary top rate would have higher by means of 20% to $39.35, reflecting a better moderate plan bid for providing Phase D protection in 2024 in comparison to 2023.) Precise Phase D plan premiums for 2024 range throughout plans, could also be upper or less than the bottom beneficiary top rate, and could also be expanding by means of roughly than 6% (and even reducing).
The estimated nationwide moderate per month PDP top rate is projected to be $48 in 2024, a 21% build up from $40 in 2023, weighted by means of June 2023 enrollment. This upper moderate projected top rate is pushed by means of upper anticipated plan prices to give you the Phase D get advantages in 2024, together with a new cap on enrollees’ out-of-pocket spending above the catastrophic threshold relatively than requiring them to pay 5% coinsurance, as in prior years. This modification is according to a provision within the Inflation Aid Act.
Evaluating per month premiums for Phase D protection between stand-alone PDPs and MA-PDs presentations the aggressive benefit that MA-PDs have over PDPs relating to the premiums that enrollees pay for drug protection. On an unweighted foundation, per month premiums for drug protection are considerably upper for PDPs in comparison to MA-PDs – 5 occasions upper, on moderate in 2024 ($60 vs. $12) (Determine 4). Additionally, between 2023 and 2024, the unweighted moderate top rate is expanding for PDPs, whilst closing solid for MA-PDs. MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums and/or be offering different further advantages, however there’s no an identical rebate gadget for PDPs. Consistent with MedPAC, Medicare Benefit per month rebates according to enrollee have greater than doubled over the past 5 years, from $95 in 2018 to $196 in 2023.
It’s most probably that, after accounting for enrollment alternatives by means of new enrollees and plan adjustments by means of present enrollees, the real moderate weighted PDP top rate for 2024 will probably be less than the estimated weighted moderate of $48 however neatly above the common MA-PD top rate. In 2023, the enrollment-weighted moderate per month portion of the top rate for drug protection in MA-PDs is $10, compared to $40 for PDPs.
Reasonable Per thirty days Premiums for the 14 Nationwide PDPs Are Projected to Vary from Much less Than $1 to $108 in 2024
PDP premiums will range extensively throughout plans in 2024, as in earlier years. A number of the 14 nationwide PDPs, there’s a distinction of greater than $1,200 in moderate annual premiums between the highest-premium PDP and the lowest-premium PDP. On the prime finish, the per month top rate for Humana Premier Rx Plan (the tenth greatest plan by means of total enrollment) will probably be $108, totaling just about $1,300 every year. On the low finish, the per month top rate for Wellcare Price Script (the second one greatest plan) will moderate $0.40, or $5 every year (Determine 5). Along with Humana Premier Rx Plan, two different nationwide PDPs will fee per month premiums of greater than $100 in 2024: AARP Medicare Rx Most popular, the fourth greatest plan ($106), and CVS Well being’s SilverScript Plus, the 12th greatest plan ($103).
Two-Thirds of Phase D Stand-alone Drug Plan Enrollees With out Low-income Subsidies Will Pay Upper Premiums in 2024 If They Keep in Their Present Plan
Two-thirds of Phase D stand-alone plan enrollees (66%) – 8.6 million of the 12.9 million Phase D PDP enrollees who’re accountable for paying all of the top rate (which excludes Low-Source of revenue Subsidy (LIS) recipients) – will see their per month top rate build up in 2024 in the event that they keep of their present plan, whilst 4.4 million (34%) will see a top rate relief in the event that they keep of their present plan (Determine 6).
In comparison to 2023, extra Medicare Phase D stand-alone drug plan enrollees will see their per month top rate both build up or lower by means of $10 or extra in the event that they keep of their identical plan in 2024 (Determine 7). For 2024, 4.8 million non-LIS PDP enrollees (37%) will see a top rate build up of $10 or extra per thirty days – or no less than $120 extra every year if they continue to be of their present plan – in comparison to 2.1 million enrollees (16%) in 2023.
A number of the 14 nationwide PDPs, moderate per month premiums are expanding for 12 PDPs, together with 7 PDPs (having a mixed 3.9 million non-LIS enrollees) with will increase exceeding $10:
- AARP Medicare Rx Walgreens (+$30, from $30 to $60)
- SilverScript Plus (+$29, from $74 to $103)
- Humana Premier Rx (+$25, from $83 to $108)
- Cigna Further Rx (+$22, from $63 to $85)
- SilverScript Selection (+$16, from $33 to $49)
- Cigna Protected Rx (+$14, from $33 to $47)
- Humana Elementary Rx Plan (+$14, from $37 to $51)
Every other 1.6 million non-LIS PDP enrollees (12%) will see a per month top rate relief of $10 or extra for 2024, in comparison to underneath 150,000 (1%) for 2023. This in large part displays a top rate relief for the second one greatest PDP, Wellcare Price Script, the place the common per month top rate will lower by means of $9, from $10 in 2023 to not up to $1 in 2024. Those quantities are averaged over the 34 PDP areas; enrollees on this plan in 16 of the 34 areas will see a top rate relief of $10 or extra.
Over part (56%) of non-LIS enrollees (7.3 million) are projected to pay per month premiums of no less than $40 in the event that they keep of their present plans, or just about $500 every year, together with 2.1 million (16% of non-LIS enrollees) projected to pay per month premiums of no less than $100, or no less than $1,200 every year. Those estimates are upper than the similar estimates for 2023, when 40% of non-LIS PDP enrollees (5.3 million) have been projected to pay no less than $40 per thirty days, together with 1.6 million paying $100 or extra, in the event that they stayed of their plans.
Phase D Enrollees Pay A lot Upper Value Sharing for Manufacturers and Non-preferred Medicine Than for Generic-Tier Medicine, and a Mixture of Copays and Coinsurance for Other Formulary Tiers
In 2024, as in prior years, Phase D enrollees will face a lot upper cost-sharing quantities for manufacturers and non-preferred medication (which is able to come with each manufacturers and generics) than for medication on a generic tier, and a mixture of copayments and coinsurance for various formulary tiers. The standard five-tier formulary design in Phase D contains tiers for liked generics, generics, liked manufacturers, non-preferred medication, and forte medication.
Amongst all PDPs, median same old charge sharing in 2024 for various kinds of medication is (Determine 8):
- Generics: $0 for liked generics and $5 for different generics
- Most popular manufacturers: a copayment of $47 or coinsurance of 21% for liked manufacturers (up from $44/17% in 2023)
- Non-preferred medication: 46% coinsurance for non-preferred medication, which is able to come with each manufacturers and generics (an build up from 45% in 2023; the utmost allowed is 50%)
- Distinctiveness medication: 25% coinsurance for forte medication (the similar as in 2023; the utmost allowed is 33%)
A number of the 14 nationwide PDPs, 9 PDPs will fee $0 for liked generics in 2024, however copays of $40 to $47 or coinsurance of 16% to twenty-five% for liked manufacturers, and coinsurance starting from 39% to 50% for non-preferred medication; 6 out of the 14 nationwide PDPs are charging the utmost 50% coinsurance for non-preferred medication. Coinsurance for forte tier medication levels from 25% to 33% in those plans, with 7 of the 14 nationwide PDPs charging 25% and a pair of charging 33%. (Plans that fee the entire deductible quantity can not fee greater than 25% for forte tier medication.)
Low-Source of revenue Subsidy Plan Availability
In 2024, a Smaller Collection of Phase D Stand-On my own Drug Plans Will Be Top class-Loose to Enrollees Receiving the Low-Source of revenue Subsidy Than in Any Yr Since Phase D Began
Throughout the Phase D LIS program, enrollees with low earning and modest property are eligible for help with Phase D plan premiums and value sharing. More than 13 million Part D enrollees are receiving LIS, together with 8.3 million (62%) in MA-PDs and 5.2 million (38%) in PDPs.
In 2024, a smaller choice of PDPs will probably be premium-free benchmark plans – this is, PDPs to be had for no per month top rate to Medicare Phase D enrollees receiving the Low-Source of revenue Subsidy (LIS) – than in any yr since Phase D began, with 126 premium-free benchmark plans, or not up to 20% of all PDPs in 2024 (Determine 9). The choice of benchmark plans to be had in 2024 will range by means of area, from two to seven (Appendix Desk 2).
PDPs providing fundamental advantages qualify to be benchmark plans if they have got premiums under the benchmark quantity in a given area. The benchmark is calculated as a weighted moderate of the beneficiary premiums for fundamental drug protection introduced by means of each PDPs and MA-PDs in a given area (calculated ahead of taking MA rebates into consideration). (MA-PD premiums are incorporated on this calculation even if MA-PDs don’t qualify as benchmark plans.)
The relief within the choice of benchmark plans for 2024 is in large part the results of PDPs introduced by means of Cigna, Humana, and CVS Well being qualifying as benchmark plans in a long way fewer areas in 2024 in comparison to 2023: Cigna Protected Rx (from 34 all the way down to 16 areas); Humana Elementary Rx Plan (from 27 all the way down to 11 areas); and CVS Well being’s SilverScript Selection (from 34 all the way down to 11 areas).
On moderate (weighted by means of 2023 Medicare enrollment), LIS beneficiaries have 3 benchmark plans to be had to them out of the common 21 PDPs to be had total for 2024 – the bottom moderate choice of benchmark plan choices in any yr since Phase D began. All LIS enrollees can make a choice any plan introduced of their space, but when they join in a non-benchmark plan, they should pay some portion in their selected plan’s per month top rate.
In 2024, part (49%) of all LIS PDP enrollees who’re eligible for premium-free Phase D protection (2.4 million LIS enrollees) pays Phase D premiums averaging $15 per thirty days until they transfer or are reassigned by means of CMS to premium-free plans. Amongst this organization are the 1.9 million LIS enrollees in Cigna Protected Rx, Humana Elementary Rx Plan, or CVS Well being’s SilverScript Selection within the areas the place those PDPs will now not qualify as benchmark plans. Those enrollees will wish to transfer plans for 2024 in the event that they need to stay in a benchmark (premium-free) plan.
The total marketplace for Phase D protection stays powerful according to the whole choice of plan choices, however fresh years have noticed a rising divide within the Phase D plan marketplace between stand-alone PDPs, the place the choice of plans has usually been trending downward over the years together with a discount in PDP enrollment, and MA-PDs, the place plan availability and enrollment have skilled stable enlargement.
The common weighted per month top rate for PDPs in 2024 will build up considerably over the 2023 quantity (according to present enrollment), whilst premiums for drug protection introduced by means of MA-PDs are prone to stay solid (and occasional or 0). Provisions within the Inflation Aid Act to make the Phase D get advantages extra beneficiant – such because the removal of the 5% coinsurance requirement for catastrophic protection taking impact in 2024 – will lend a hand decrease out-of-pocket prices for enrollees, however with those adjustments, it might turn out to be more difficult for some Phase D plan sponsors to provide low-priced protection, in particular sponsors of stand-alone drug plans. MA-PD sponsors have a aggressive benefit on this regard as a result of they may be able to use rebate dollars from Medicare payments to lower or eliminate their Part D premiums. The top rate imbalance between PDPs and MA-PDs may well be exacerbated as plans think larger legal responsibility for prime drug prices above the catastrophic threshold in 2025 with a $2,000 cap on out-of-pocket spending. To stay Phase D premiums low within the face of emerging prices for the elemental Phase D get advantages, Medicare Benefit plans would possibly finally end up the usage of extra in their rebate bucks to shop for down the Phase D top rate. This is able to imply much less rebate cash to be had for different get advantages improvements or decrease income, relying at the quantity of rebates plans obtain one day.
The expanding availability of low- or zero-premium MA-PDs, mixed with the aggressive marketing of Medicare Advantage plans and the enchantment of different options of those plans, akin to supplemental advantages, may just tilt enrollment much more against Medicare Benefit plans one day. Tracking tendencies in Phase D plan availability and enrollment may just tell policymakers in making an allowance for whether or not or how to verify endured availability of competitively priced stand-alone Phase D drug plans for the thousands and thousands of Medicare beneficiaries in conventional Medicare.
Juliette Cubanski is with KFF. Anthony Damico is an unbiased contractor.
|This research makes a speciality of the Medicare Phase D stand-alone prescription drug plan market in 2024 and tendencies over the years. The research makes a speciality of the 18.3 million enrollees in stand-alone PDPs (as of March 2023). The research excludes 24.8 million MA-PD enrollees (non-employer), and any other 3.9 million enrollees in employer-group best PDPs and three.5 million in employer-group best MA-PDs for whom plan top rate and advantages knowledge are unavailable.
Knowledge on Phase D plan availability, enrollment, and premiums have been gathered from a collection of information information launched by means of the Facilities for Medicare & Medicaid Products and services (CMS):
On this research, top rate and deductible estimates are weighted by means of June 2023 enrollment until in a different way famous. Share and greenback variations are calculated according to non-rounded estimates and in some circumstances fluctuate from percentages and greenback variations calculated according to rounded estimates offered within the textual content.