There are several Medicare changes taking place in 2022, and I’ve read all the fine print to bring you a quick recap. From the major Part B premium increase to the coverage decision for the expensive new Alzheimer’s drug, Aduhelm, here’s what you need to know about Medicare changes in 2022.
KEY 2022 MEDICARE COSTS
Think the cost of gasoline has increased? The 2022 Medicare premiums and costs are significantly higher than in the previous year. Every year the Medicare and You handbook is printed and mailed out before October 1st to all Medicare beneficiaries to help guide them with the Medicare Annual Enrollment Period which ends on December 7th. The handbook typically states a disclaimer that at the time of printing, the premiums, and deductible amounts for Medicare Part A, Part B and Part D were not available. The 2022 Medicare Part A and B premiums and costs were released on Friday, November 12, 2021, with the largest Medicare Part B premium increase ever in America’s history.
HIGHER PART B PREMIUM
The biggest news this year for Medicare beneficiaries is that monthly Part B premiums are jumping. The standard monthly Part B premium increased by $21.60, from $148.50 to $170.10. At 14.5%, this isn’t the highest percentage rate increase in history – increases in 2005, 2010 and 2016 all exceeded it – but $21.60 is the largest increase in terms of dollars.
Almost half of that increase is reportedly the result of a new drug, Aduhelm, which has been approved for the treatment of Alzheimer’s disease. The medication initially had a $56,000 price tag for one year of treatment, but the price dropped 50% on Jan. 1. As a result, the Centers for Medicare and Medicaid Services (CMS) has been asked to reassess the 2022 Medicare Part B premium amount. Depending on the result of the CMS review, Medicare beneficiaries could get some welcome news about a premium reduction.
The Part B premium isn’t the only cost for people on Medicare that is rising in 2022. The Part B annual deductible increased by $30 to $233, and the Part A deductible has gone up by $72 to $1,556. Less than 1% of people pay a premium for Medicare Part A, but for those that do, that’s a sizeable increase. Beneficiaries will pay between $274-$499 per month in 2022 for Part A’s hospital coverage, but again, this effects very few folks.
IRMAA BRACKETS HAVE INCREASED
Medicare beneficiaries with high incomes pay more for Part B and Part D. For 2022, these thresholds have increased to $91,000 for a single person and $182,000 for a married couple (note that this is based on income tax returns from 2020, since those are the most recent tax return on file when 2022 begins; there’s an appeals process you can use if your income has changed since then due to a life event. For 2022, the Part B premium for high-income beneficiaries ranges from $238.10/month to $578.30/month, depending on income (up from a range of $207.90/month to $504.90/month in 2021). The 2022 IRMAA brackets can be viewed at: https://www.medicareresources.org/medicare-eligibility-and-enrollment/what-is-the-income-related-monthly-adjusted-amount-irmaa/
COVID-19 BOOSTER SHOTS
As always, Medicare is offering 100 percent coverage for all COVID-19 testing, including antibody, or “serology” tests. Medicare also covers the COVID-19 vaccine in full. Now that booster shots are needed, Medicare is also offering full coverage. You do need to qualify for the booster shot in order to receive coverage.
Here are the eligibility rules for COVID-19 booster shot coverage:
•If you got a Pfizer or Moderna COVID-19 vaccine and are 65 years or older (or 18 years or older and at high risk for getting severe COVID-19), you can get a booster shot at least 6 months after you complete your second dose of the Pfizer or Moderna COVID-19 vaccine series.
•If you got a Johnson & Johnson COVID-19 vaccine and are 18 years or older, you can get a booster shot at least 2 months after you got your first shot.
MORE OPTIONS FOR MENTAL HEALTH SERVICES
Mental health can be as important as physical health, and Medicare is providing beneficiaries with a new way to get services in 2022. Starting this year, Medicare will cover mental health services provided via telehealth, including audio-only phone calls. This covers diagnosis, evaluation, and treatment of mental health disorders. In a press release announcing the change, CMS administrator Chiquita Brooks-LaSure says: “The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are. This is especially true for people who need behavioral services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”
MORE ACCESS TO PHYSICIAN ASSISTANT SERVICES
Physician assistants can perform many of the same functions as doctors, including diagnosing illness, prescribing medications, and developing and managing treatment plans. But until this year, they couldn’t receive direct payments from Medicare. That changes in 2022, and it should open the door for Medicare beneficiaries to have increased access to these health care professionals.
MORE OPTIONS FOR INSULIN SAVINGS
Unless you use an insulin pump, you’ll pay 100 PERCENT of your insulin costs under Original Medicare, which is one of two main types of Medicare coverage. However, the Part D Senior Savings Model is one way to reduce these costs, and more companies are joining the program in 2022.
Medicare beneficiaries who are enrolled in participating Medicare Advantage plans or Part D plans could see their insulin costs drop to a $35 per month co-payment. Those enrolled in the Extra Help program may have different costs.
More than 500 Medicare Advantage and Part D plans, as well as two additional insulin manufacturers have joined the Part D Senior Savings Model this year. That brings the total number of participating plans to more than 2,100 and offers more chances for seniors who use insulin to save.
PEOPLE WITH ESRD CAN JOIN MEDICARE ADVANTAGE PLANS
In 2022, the 21st Century Cures Act will allow individuals with end-stage renal disease (ESRD) to choose a Medicare Advantage plan regardless of their previous coverage. Previously, individuals with ESRD could only enroll in Medicare plans if there was an ESRD Special Needs Plan available in their area.
MEDICARE ADVANTAGE HOSPICE COVERAGE IS CHANGING
In 2022, participation in the value-based insurance design (VBID) demonstration, known as the Medicare Advantage (MA) hospice carve-in, will nearly double. The demo got off to a small start in 2021, but CMS has announced that 13 Medicare Advantage organizations will participate in the program this year, up from nine in 2021. This raises the number of actual MA plans to 115, up from 53 in 2021. Geographically, the program will be available in 461 counties nationwide, compared to 206 in 2021. Contact your Medicare Advantage plan for more information on this limited pilot project.
(Joel Mekler is a certified senior adviser. Send him your Medicare questions at [email protected])