Key takeaways:
New federal and state healthcare laws going into effect in 2024 will provide enhanced consumer protections for people with commercial health insurance, Medicare, and Medicaid.
Starting in 2024, Medicare Part D enrollees are no longer subject to a 5% coinsurance in the catastrophic phase.
Updates to price transparency laws will also expand access to information about standard charges at hospitals and cost-sharing estimates for health insurance plans.
In 2024, new healthcare laws will crack down on Medicare Advantage plan marketing tactics and limit spending for people with Part D plans who face high costs for medications.
A new prior authorization rule will require most health plans to give specific reasons for denying coverage and expedite the prior authorization process. And price transparency rules around hospital charges and health insurance plan cost-sharing will be expanded.
In addition to a mandate ensuring 12-month continuous coverage for children enrolled in Medicaid programs nationwide, there are also new state laws that will improve access to healthcare for consumers.
New Medicare marketing guidelines in 2024
In the U.S., an estimated 66 million people are enrolled in Medicare. When it comes time to join, you can choose between original Medicare (Part A and/or Part B) or a private Medicare Advantage plan. You may also choose to buy a Medicare Part D prescription plan if you have original Medicare or your Medicare Advantage plan doesn’t include medication coverage.
During Medicare open enrollment in the fall and Medicare Advantage open enrollment, which takes place the first three months of the year, the TV airwaves are flooded with Medicare ads. In recent years, promotions for Medicare Advantage plans have helped convince about half of enrollees to choose these private alternatives to original Medicare. (That’s compared to less than one-third of enrollees who chose Medicare Advantage a decade ago.) But some of this marketing has been identified as aggressive and misleading.
In 2024, the Centers for Medicare & Medicaid Services (CMS) is introducing new marketing rules for private Medicare plans, namely Medicare Advantage plans. For instance, these health plans will no longer be allowed to:
Send representatives to your home uninvited
Market their plan or enroll new people during an educational event such as a health fair or conference
Permit agents to steer enrollees into plans that don’t meet their health and/or financial needs
Use misleading language or official Medicare logos to market private plans
Suggest that their contact number is the official 1-800-MEDICARE (1-800-633-4227) hotline
Imply that consumers are missing out on benefits they are entitled to receive if they choose original Medicare instead of a Medicare Advantage plan
According to KFF, consumers should be careful about choosing a plan simply because its marketing says it’s endorsed by a celebrity, mentions benefits without discussing quality ratings, or shows images of active older adults.
Medicare Part D changes
In 2024, Medicare Part D prescription medication coverage costs more than in previous years. On average, enrollees are facing higher deductibles, increased initial coverage limits, and higher out-of-pocket spending thresholds. But one positive change is that enrollees who enter the catastrophic phase won’t have to pay anything for their covered Part D medications for the rest of the year.
That’s because the 5% coinsurance enrollees previously paid in the catastrophic phase, which occurs after a high spending threshold has been reached, has been eliminated. People who take high-cost medications but don’t have a Part D Extra Help low-income subsidy are expected to save thousands of dollars because of this.
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Also, in 2024, eligibility for the Extra Help subsidy has been expanded to people whose household income is up to 150% of the federal poverty level.
New rule for annual review of prior authorizations
In some cases, health insurance plans require a prior authorization for certain medications or services. This process, during which the plan conducts a review to determine whether it will cover the medication or service, can cause a delay in care.
A new rule in 2024 requires health plans to give specific reasons for denying coverage and expedite the prior authorization process. The new guideline applies to these types of health plans:
Medicare Advantage plans
Medicaid or Children Health Insurance Program (CHIP) fee-for service and managed care plans
Affordable Care Act marketplace plans
Price transparency
Price estimation tools from hospitals and health plans can help you calculate your healthcare costs in advance. To ensure that these tools benefit consumers, federal law mandates:
Hospital price transparency: Since 2021, hospitals have been required to publish standard charges for services that can be scheduled.
Health plan price transparency: Since 2022, health insurance plans have been required to publish price information on certain covered treatments, services, and medications on their websites. In 2023, insurance plans had to provide online cost-sharing estimates for 500 shoppable services.
The following are new CMS requirements going into effect in 2024.
Hospital prices
Starting in 2024, hospitals must:
Use standardized CMS templates: This measure should ensure that price estimates appear in similar formats across hospital websites, making these files more readable and easier to compare.
Include a link to standard charges on their website: These links may lead to a cost-estimator tool or similar resource.
Certify that their data is accurate and complete: This means that they must provide an entire list of all standard charges.
Health insurance plan prices
In 2024, insurance plans must provide cost-sharing estimates for all covered services.
Children’s continuous coverage for Medicaid and CHIP
In previous years, if a child had Medicaid or CHIP and their family or household experienced a change in income, the child’s coverage could be dropped in some states. Starting January 1, 2024, states must provide 12 months of continuous coverage for Medicaid and CHIP enrollees under age 19, regardless of income changes and other factors.
Research has shown that uninterrupted coverage translates to better health outcomes and that children who are disenrolled from coverage for even part of a year have poorer health than those with continuous coverage.
New state laws effective in 2024
Here’s a sampling of new state laws that are designed to expand healthcare coverage and access in 2024.
Illinois: Requiring breast milk donation information
To increase the amount of human milk available for premature infants in Illinois, a new state law is requiring hospitals to provide information to people giving birth about donating milk to nonprofit milk banks.
Pennsylvania: Eliminating cancer screening out-of-pocket costs
In Pennsylvania, 2024 marks the first full year that health plans are required to fully cover preventive cancer screenings for high-risk individuals. Under the new law, qualifying individuals will not face out-of-pocket costs for:
Genetic testing and counseling for hereditary breast cancer, such as cancer linked to BRCA genes
Genetic testing for hereditary ovarian cancer
Genetic testing for hereditary prostate cancer
Supplemental breast screenings for people who have a high lifetime risk of breast cancer
Texas: Expanding Medicaid postpartum coverage
Medicaid pays for about 4 of every 10 births in the U.S. Federal law requires Medicaid to cover new birthing parents for 60 days after they deliver. But a provision in the American Rescue Plan Act of 2021 also gives states the option to extend postpartum coverage to 12 months to improve maternal health outcomes.
In the last 2 years, postpartum coverage has been increased to 12 months in almost every state. Beginning March 1, 2024, Texas — where half of births are covered by Medicaid — will join this majority.
The bottom line
In 2024, new healthcare laws focusing on marketing practices, prior authorizations, and price transparency will provide more consumer protections for people with commercial health plans, Medicare, and Medicaid.
In addition to a mandate ensuring 12-month continuous Medicaid coverage for children nationwide, there are state laws going into effect that will expand no-cost coverage for certain cancer screenings, 12-month postpartum coverage for birthing parents, and access to information about donating breast milk.
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References
Biniek, J. F., et al. (2023). Half of all eligible Medicare beneficiaries are now enrolled in private Medicare Advantage plans. KFF.
Biniek, J. F., et al. (2023). How health insurers and brokers are marketing Medicare. KFF.
Brantley, E., et al. (2021). Continuous eligibility for Medicaid associated with improved child health outcomes. Medical Care Research and Review.
Brooks, T., et al. (2021). Continuous coverage in Medicaid and CHIP. Georgetown University Health Policy Institute, Center for Children and Families.
Centers for Medicare & Medicaid Services. (2023). Consumers.
Centers for Medicare & Medicaid Services. (2023). Hospital price transparency.
Centers for Medicare & Medicaid Services. (2023). Hospital price transparency fact sheet.
Centers for Medicare & Medicaid Services. (2023). Transparency in coverage.
Centers for Medicare & Medicaid Services. (2023). Use of pricing information published under the transparency in coverage final rule.
Centers for Medicare & Medicaid Services. (2024). CMS finalizes rule to expand access to health information and improve the prior authorization process.
Cubanski, J., et al. (2023). Changes to Medicare Part D in 2024 and 2025 under the Inflation Reduction Act and how enrollees will benefit. KFF.
Governor Josh Shapiro. (2023). Governor Shapiro signs the first bill of his administration: Landmark, bipartisan legislation to provide breast cancer screenings for free in Pennsylvania.
Harper, K. B. (2024). Feds approve 12 months of Medicaid coverage for low-income Texas moms. The Texas Tribune.
HealthCare.gov. (n.d.). Federal poverty level (FPL).
KFF. (2024). Medicaid postpartum coverage extension tracker.
LegiScan. (2023). Illinois House Bill 2519.
Medicaid.gov. (n.d.). Continuous eligibility.
Medicare.gov. (n.d.). Help with drug costs.
Medicare.gov. (n.d.). Marketing rules for health plans.
Pennsylvania General Assembly. (2023). 2023 Act 1.
U. S. Department of Health and Human Services. (2023). HHS takes action to provide 12 months of mandatory continuous coverage for children in Medicaid and CHIP.
