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How Is Medicare Changing In 2022?

How Is Medicare Changing In 2022?

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Medicare is constantly making changes, and 2022 is no exception.  

From the largest Medicare Part B premium increase in history to anticipation of Aduhelm coverage, here are several Medicare changes to expect for 2022.

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1. Medicare Part B Premium Increases 14.5%

The Medicare Part B premium is increasing in 2022 by 14.5%, the highest premium increase our office has ever seen.

In 2021, the Part B premium is $148.50. In 2022, the Part B premium will be $170.10, a $21.60 increase.

If you meet different income thresholds, you pay more for Medicare Part B. This is called an Income-Related Monthly Adjustment Amount (IRMAA). These adjustments affect about 7% of people with Medicare Part B.

The income thresholds went up slightly – the first adjustment tier is now greater than $91,000 (individual) and $182,000 (joint tax returns):

The Part B deductible is also increasing from $203 in 2021 to $233 in 2022.

Clients who have a Medicare Supplement Plan F do not pay a deductible, so they won’t be impacted. Also, clients with a Medicare Advantage (MA) plan aren’t affected by the Part B deductible. Your MA plan has its own deductible.

Clients with a Medicare Supplement Plan G and Plan N will be subject to the $233 Part B deductible in 2022.

2. Medicare Part A Costs Increase For 2022

Your Medicare Part A deductible (your hospital insurance) was $1,484 in 2021. It is increasing by $72 to $1,556 in 2022. Almost all of our clients do not pay the Medicare Part A deductible, because all of the Medicare Supplement plans we sell cover it.

The same goes for Medicare Advantage plans – these plans have their own deductible.

Medicare Part A also has daily coinsurance, and it has increased slightly for 2022. You can see the 2021 vs. 2022 cost-sharing in the following chart:

About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.  

For the 1% of folks that do pay the Part A premium, it has increased slightly to $499/month in 2022, a $28 increase from 2021. If you had at least 30 quarters of coverage or were married to someone who did, you can buy Part A at a reduced rate of $274 in 2022, a $15 increase from 2021.

3. Continued Lower Insulin Costs

Starting January 1, 2021, you have been able to join a drug plan that offers extra benefits for insulin.  

The Part D Senior Savings Model is available to all people with Medicare. Plans that participate offer many types of insulin at a maximum copay of $35 for a 30-day supply. This offers a savings up to $446 per year.

This savings model will continue until December 31, 2025. This test contributes to the modernization of the Part D benefit and better access to prescriptions for those on Medicare.

For 2022, the following pharmaceutical manufacturers have agreed to participate in the savings program:

  • Eli Lilly and Company
  • MannKind Corporation
  • Mylan Specialty L.P., a Viatris Company
  • Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  • Sanofi-Aventis U.S. LLC

MannKind Corporation and Mylan Specialty L.P. are both new additions for 2022 – we’re excited that this program continues to expand.

4. Continued Telehealth and Virtual Coverage

In 2020 and 2021, Medicare rapidly expanded their coverage of telehealth and virtual care.

What’s new for 2022 is they are finally encouraging more physicians to offer telehealth services by paying them more for it (CMS Press Release).

In addition, for the first time outside of the COVID-19 public health emergency (PHE), Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including audio-only telephone calls, expanding access for rural and other vulnerable populations.

5. Continued COVID-19 Coverage

Most services and tests related to COVID-19 are covered in full by Medicare, and that is expected to continue into 2022. That includes COVID-19 antibody tests, COVID-19 lab tests, COVID-19 vaccines, and COVID-19 booster shots.

In addition, Medicare will cover monoclonal antibody treatments, though you must meet certain conditions to qualify.  

You can always stay up-to-date on COVID-19 and Medicare here: https://www.medicare.gov/medicare-coronavirus

6. Cognitive Assessment Coverage

New for 2022 is Medicare’s coverage of a cognitive assessment to look for signs of dementia, including Alzheimer’s disease.

Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, or making decisions about your everyday life. Conditions like depression, anxiety, and delirium can also cause confusion, so it’s important to understand why you may be having symptoms.

Medicare covers a separate visit with your regular doctor or a specialist to do a full review of your cognitive function, establish or confirm a diagnosis like dementia, including Alzheimer’s disease, and develop a care plan. You can bring someone with you, like a spouse, friend, or caregiver, to help provide information and answer questions.

Medicare Part B’s deductible and coinsurance applies.

7. Bariatric Surgery Coverage

Also new for 2022 is some bariatric surgical procedure coverage, like gastric bypass surgery and laparoscopic banding surgery. Patients must meet certain conditions related to morbid obesity to qualify.

9. Part D Catastrophic Coverage Threshold Increasing to $7,050

In 2022, the Part D (drug coverage) catastrophic coverage threshold will increase from $6,550 to $7,050.

Once you reach this threshold, you’re eligible for the catastrophic benefit period, where coinsurance is only 5% of the cost of the drug or $3.95/$9.95 (generic/brand name).

10. Aduhelm Coverage Decision

CMS says the major Part B premium increase for 2022 is due to rising prices, higher utilization, and the uncertainty of Aduhelm, the expensive new Alzheimer’s drug that Medicare is currently reviewing.  

In early 2022, we expect to get a coverage decision from Medicare regarding the $56,000 Alzheimer’s treatment. If Medicare decides to cover it, it will be under Medicare Part B.

We won’t know how the financial burden of this drug may affect the Medicare program until the coverage decision is made. We will keep you updated – be sure to like us on Facebook to get updates!

11. 2022 Medicare & You Handbook

Every year, CMS releases a new Medicare handbook. You can get the digital copy here: 2022 Medicare & You Handbook.

This handbook outlines many of the changes discussed in this article, including COVID-19 coverage, cognitive assessment information, and more.

Conclusion

Medicare is always making changes, and it’s important to understand how your out-of-pocket costs may increase. The good news is Medicare continues to expand coverage, and 2022 is no exception.

If you need Medicare help, call our office at 217-423-8000 to schedule an appointment with a licensed insurance agent.

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Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.