Unintended or intended consequences? Medicare Upgrades Could Disqualify Your Private Plan

[Duaine]

If you are employed in a job that provides health insurance past age 65, you can delay signing up for Medicare without penalty, as long as certain conditions exist. In the case of prescription drug coverage, the plan has to pay on average as much as the standard Medicare prescription drug coverage.

With improvements coming to Part D going into effect January 1, some employer plans that qualified as "creditable" because their benefits were at least as good as those offered by Part D before the changes may no longer be eligible. For instance, starting January 1, the out-of-pocket maximum under Part D will be $2,000 a year.


If a private plan doesn't cap the amount policyholders have to pay at $2,000 or less a year, the policy may not suffice as a substitute allowing beneficiaries to delay enrolling in Part D without a penalty.

[EXTERNAL LINK] - Medicare Upgrades Could Disqualify Your Private Plan

 

[MedicareWAA]

Pretty sure this won't apply to 2025. I remember reading an article saying govt was going to be more forgiving at first so as to minimize disruption and chaos.

 

[Chazm]

Yeah me too. It's not happening next year

 

[Tscholar]

so we're going to have to ask people what their prescription drug maximum is? most people do good to know the name of the carrier and that's all they know!

 

[Fisher]

so we're going to have to ask people what their prescription drug maximum is? most people do good to know the name of the carrier and that's all they know!

Did you skip over the 2 responses above your question that state this will not be a concern for 2025?

 

[Tscholar]

Did you skip over the 2 responses above your question that state this will not be a concern for 2025?

No, I didn't skip over that, but if and when it applies, it will still be a pain!

 

[Fisher]

No, I didn't skip over that, but if and when it applies, it will still be a pain!

Maybe you'll hit the Powerball before 2026 rolls around.

 

[Tscholar]

Pretty sure this won't apply to 2025. I remember reading an article saying govt was going to be more forgiving at first so as to minimize disruption and chaos.

The major carriers will have creditable coverage tools available no later than mid-September 2024. So, this may apply to 2025 afterall...

Medicare Part D Changes: Considerations for 2025 and Beyond | OneDigital

The IRA introduced the first major changes to Medicare Part D since its inception in the Medicare Modernization Act. These changes are going to make Medicare Part D plans much more beneficial to Medicare participants. However, the changes will also have a significant impact on employer sponsored...

www.onedigital.com

 

[somarco]

The law of unintended consequences . . .

Congress critters passed the pork filled IRA without consider the ramifications such a law would have on Part D or EGH/ERISA plans. With this being an election year no one in DC will want to "fix" this problem until next year.

Of course, often the cure is worse than the original "fix".

Problems created by DC are never corrected overnight and our clients may have to deal with this for a while.

FWIW, this problem is starting to appear in the MSM, so someone up there may have to face the torch & pitchfork crowd before too much time has passed.