A Quick Summary of 2024 Medicare Changes that Affect Dialysis Patients

“Change is the law of life. And those who look only to the past or present are certain to miss the future.”—John F. Kennedy

With that pithy quote, here are the Medicare changes for 2024 to the ESRD PPS, QIP, Part A and B costs, Medicare Advantage plans, Medicare savings programs, Part D—and some Social Security updates, so you can be aware of what has been updated for the year to come.

ESRD Prospective Payment System (dialysis, ESRD-related labs, ESRD-related drugs bundled)

• The base rate is going up to $271.02 (an increase of 2.1%) adjusted for certain patient and facility characteristics applies to patients with ESRD and AKI.

• There is a transitional pediatric add-on of 30% for dialysis in 2024-2026.



• CMS will increase prices for 3 years after the 2-year Transitional Drug Add-On Payment Adjustment (TDAPA) for certain new drugs and biologics ends.

• A new reporting requirement for patients’ time on the machine will be used to estimate treatment costs for future payment changes.

• A new reporting requirement for number of billing units of discarded renal drugs and biologics in single use vials and containers has been postponed until 2025.

• The Transitional Add-on Payment Adjustment for New and Innovative Equipment & Supplies (TPNIES) eligibility does not apply when an applicant does not meet 1 criterion; “newness” is 3 years from the TPNIES application date, and FDA-exempt devices or those lacking FDA marketing authorization do not meet TPNIES newness criteria.

ESRD Quality Incentive Program (QIP)

• CMS is finalizing the following for Payment Year 2026:

• Facility Commitment to Health Equity reporting measure using 5 attestation questions.

• COVID-19 Vaccination Coverage Rate Among Healthcare Personnel reporting measure.

• Conversion of Depression Screening and Follow Up from reporting to clinical measure and revising the scoring methodology to align with current clinical guidelines.

• Removing the Ultrafiltration Rate reporting measure.

• Removing the Standardized Fistula Rate reporting measure.

• CMS is finalizing the following for Payment Year 2027:

  • Addition of Screening for Social Drivers of Health reporting measure for those ≥18 with food insecurity, housing instability, transportation problems, utility help needs and interpersonal safety.

  • Add Screen Positive Rate for Social Drivers of Health reporting measure for those ≥18 with one or more of the 5 drivers above.

Medicare 2024

• Part A costs:

  

  • The premium is free for most who have enough work credits (those with fewer pay $278 or $505, depending on their work credits.)

  • The deductible is $1,632 per benefit period (there can be several benefit periods yearly).

  • Costs for inpatient stays (excluded private duty nursing, in-room TV & phone):

    • 0-60 days, no charge after the Part A deductible is met

    • 61-90 days, $408/day

    • 90-150 days, $816/day

    • >150 days, 100% of charges will be billed

  • Home health, no charge for covered home health and 20% for covered durable medical equipment (wheelchair, walker, etc.)

  • Hospice, no charge for services, up to $5/prescription, 5% for inpatient respite

• Part B costs

  

  • The premium is $174.70 (more with higher income); there remains a 10% per year penalty for late enrollment that can be rolled back if someone is eligible for a new reason.

  • The deductible is $240 yearly.

  • Coinsurance is 20% after deductible if a doctor or other provider accepts the Medicare charge as full payment; or 15% more if they do not.

  • The lab fee is $0.

  • Home health & durable medical equipment are the same as under Part A.

  • For an inpatient hospital stay, the charge is 20% after the deductible for doctors and other providers.

  • For outpatient mental health, the charge is $0 for depression screen, and 20% after the deductible for diagnosis and treatment.

  • For partial hospitalization (mental health), the charge is 20% after the deductible, plus coinsurance for each day.

  • For outpatient hospitalization, the charge is 20% after the deductible, plus a copayment—so outpatient care at a hospital costs more than a doctor’s office.

• Medicare Advantage Plans

  • For premiums & other costs, there is a Part B premium, plan premiums and other costs that vary by plan.

  • The out of pocket limit varies by plan; once met, everything else costs $0.

• Medicare Savings Programs help people in Original Medicare or a Medicare Advantage plan who have lower income and few assets pay Medicare premiums and/or costs.

• Medicare Part D

  • The premium varies by plan; cost more with a higher income in 2022. The premium can be deducted from a Social Security check or paid to the plan.

  • The deductible can’t be more than $545, and plans can charge less.

  • The copay or coinsurance once $5,030 has been paid is 25% of drug costs up to $8,000—then $0 for drugs after that.

  • Insulin covered by Part D costs $35/month.

  • Extra Help saves those with incomes ≤150% of federal poverty and few assets money on premiums and drug costs.

• Other Drug News: The Inflation Reduction Act allowed Medicare to negotiate lower prices on 10 drugs: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica and Stelara. Medicare will negotiate lower prices for more drugs in coming years.

Social Security Updates for 2024

Patients who receive Social Security benefits will get a 3.2% cost of living adjustment:

• The average retired worker will get $1,907.

• The maximum that a worker retiring at full retirement age will receive in 2024 is $3,822. Some get less depending on work earnings. Each year people wait increases their social security retirement income by 8%.

• The average aged couple will get $3,300.

• The average disabled worker will get $1,537 from SSDI.

• The average disabled worker+ spouse + 1 or more children will get $2,720 from SSDI.

• An individual with SSI will get $943.

• A couple both of whom get SSI will get $1,415.

People with disabilities can work. Here are dollar amounts they should be aware of:

• The substantial gainful activity (SGA) for non-blind will be $1,550 (for the blind, it is $2,590). Someone who works less than this amount can keep work earnings and SSDI money. Earning more than this after the TWP and SSDI will stop the checks.

• The trial work period (TWP) will be $1,110. When a disabled worker makes this much or more in a month, it uses up 1 of 9 trial work months.

• The SSI student income exclusion will be $2,290/month (the annual limit is $9,230).