Prescription Drug Part D TrOOP (true out-of-pocket) maximums will increase from $7,400 to $8,000 for 2024. A provision of the Inflation Reduction Act (IRA) will enhance coverage such that Medicare participants who reach the TrOOP, or catastrophic coverage phase, will no longer be responsible for any Part D out-of-pocket drug costs. Copayments for certain services will increase slightly for low-income subsidy-eligible Medicare enrollees.
Medicare Coordinator Program (MCP)
Beginning Jan. 1, 2024, Medicare participants who reach the catastrophic coverage phase will no longer be responsible for any Part D out-of-pocket drug costs. Because of this change, the catastrophic coverage special payments benefit that provides additional reimbursement beyond the Health Reimbursement Arrangement (HRA) funding will end on Dec. 31, 2023.
UC Medicare Choice
Learn more about what's changing for UC Medicare Choice PPO members who see UCSF Health providers.
For the 2024 plan year, state-licensed Marriage and Family Therapists (MFTs) and Marriage Family and Child Counseling (MFCC) Therapists may submit claims directly to UHC for reimbursement.
Kaiser Senior Advantage
The Post-discharge Meal Delivery Program for members with a principal diagnosis of congestive heart failure will be discontinued.
For all non-Medicare plans, FDA-approved over-the-counter contraceptive drugs and devices will have $0 cost-share and no prescription requirement. Coinsurance will be eliminated for in-network vasectomy services (deductible applies for CORE and UC Health Savings Plan members).
UC Blue & Gold HMO
- Behavioral health services under your Health Net plan will no longer be administered through Managed Health Network (MHN). You will see references instead to Health Net Behavioral Health. There will be no change to your current providers, the provider network, or the coverage and services available. You will continue to have the same wide network of counselors, therapists and other professionals offering both in-person and virtual visits.
- The ShareCare diabetes prevention program will replace Omada.
- Leapfrog, Cal Hospital Compare, and Sapphire will be available as hospital advisor tools, replacing WebMD.
Kaiser HMO
Optum Behavioral Health (which offers behavioral health services in addition to Kaiser) will:
- Eliminate the copay for outpatient intensive ABA therapy for Autism Spectrum Disorder.
- Offer a 12-month membership at no cost to their Self Care mobile app, with curated content to support teens
UC Health Savings Plan
- UC Health Savings Plan in-network deductible will increase to $1,600 for individuals and $3,200 for families. The out-of-network deductible will increase to $2,600 for individuals and $5,200 for families.
- The maximum contribution to the Health Savings Account is increasing from $3,850 to $4,150 for individual coverage and from $7,750 to $8,300 for family coverage. People age 55 and over can make an additional “catch-up” contribution of $1,000, using the HSA, Life Insurance Voluntary Disability and AD&D Change Form.
- Health Flexible Spending Account (FSA) participants will have the option to switch to UC Health Savings Plan without losing their carryover FSA balance (up to $610).