Original Medicare & Medicare Advantage: What’s New in 2022

Original Medicare & Medicare Advantage: What's New in 2022

The most significant change for Medicare’s almost 64 million members in 2022 will be higher premiums and deductibles for medical services under the federal government’s healthcare insurance program for adults (65 and older) and persons with disabilities.

In 2022, Medicare’s benefits will essentially remain the same. So, let’s check out the changes that Medicare is bringing in 2022.

Part B: Most Significant Increase Ever

In 2022, the monthly premium for Part B, which includes doctor visits and other outpatient treatments, such as diagnostic screenings and lab testing, will be $170.10, up to $21.60 from 2021. The largest-ever monetary increase was occurred due to three factors:

  • Rising healthcare costs, some of which were credited to COVID-19 treatment.
  • Because of the pandemic, Congress intervened to dramatically cut the scheduled 2021 Part B premium rise (which AARP fought hard for). But, lawmakers directed CMS to begin repaying the reduced cost in 2022.
  • Since Medicare covers Aduhelm, a new Alzheimer’s medicine, CMS decided to set aside money in its reserves. Aduhelm’s yearly fee was initially set at $56,000 per year. However, under pressure from health advocates, Biogen, the drug’s producer, reduced the yearly price to $28,200 after CMS established the Part B premium. In the context of the price drop, advocates have pushed CMS to reduce the Part B premium rise.

The 5.9% rise in Social Security’s yearly cost-of-living adjustment (COLA) will somewhat offset the Part B premium increase. Notably, the premium for Social Security beneficiaries enrolled in Medicare is withheld from their monthly payment. However, not everyone registered in Medicare is yet receiving Social Security benefits. Therefore, the amount of the COLA rise that participants will get will be determined by the quantity of their monthly Social Security benefit.

Deductibles Also Rising

This annual Part B deductible will be $233, up to $30 from last year. In addition, the inpatient deductible that beneficiaries must pay for each hospital admission under hospitalizations, hospice care, and some nursing facilities — all covered by Medicare Part A — will be $1,556, up to $72 from 2021.

The deductibles, copays, and other costs that beneficiaries must pay for prescriptions under the Medicare Part D prescription drug vary depending on the plan they select and where they reside. However, the federal government capped the Part D yearly deductible, and it cannot exceed $480 in 2022.

More Help with Insulin Costs

Patients in every state will be able to enroll in Part D “enhanced” plan that participates in a CMS initiative that caps the cost of certain insulins at $35 per month this year. The program started in 2021, but the number of plans is growing. 2,159 Part D plans have decided to participate this year. This program is available to beneficiaries enrolled in either traditional Medicare or a Medicare Advantage plan.

Mental Health Coverage via Telehealth

During the pandemic, Medicare continues to place a greater emphasis on telehealth. The organization plans to expand telemedicine to provide mental health care by 2022.

In announcing the revisions, CMS Administrator Chiquita Brooks-LaSure talked about how the pandemic exposed the shortcomings of our present health care system and how crucial it is for us to adopt innovative ways to provide treatments to patients regardless of their location. She also emphasized increasing people’s access to telehealth and other care delivery alternatives for those in need of mental health services.

Providing specific mental and behavioral health treatments over the phone is one of the new features. According to CMS officials, this implies that counseling and therapy services, including drug abuse treatment, will be more widely available, particularly in limited broadband connection locations.

Also, in 2022, Medicare will cover mental health visits outside of the pandemic rules. So, in a nutshell, mental health telehealth visits (provided by rural health clinics and federally qualified health centers) will be covered by Medicare.

New Market Entrants and Exits

With 20 insurers joining the market for the first time in 2022, Medicare Advantage continues to be a lucrative market for insurers, accounting for around 19 percent of the rise in the total number of plans accessible for general enrollment and nearly 6% of the growth in SNPs (Special Needs Plans). In addition, thirteen new entrants are now providing individual enrollment in HMOs.

Three of the new firms provide plans in Massachusetts, two in California, Florida, North Carolina, South Carolina, and Utah, while the rest offer policies in at least one of thirteen other states (Arizona, Indiana, Louisiana, Maryland, Michigan, Minnesota, Montana, New Hampshire, North Dakota, South Dakota, Oklahoma, Rhode Island, and Texas).

In 2022, seven companies participating in the Medicare Advantage market will no longer provide plans. In 2021, six businesses had very low enrollment, while one (Sunrise Advantage Plan) had no enrollment. In addition, two of the seven exiting firms provided plans in California.

Medicare Advantage: Extra Benefits in 2022

Medicare Advantage plans can offer additional assistance not accessible via regular Medicare, considered “mainly health-related,” and they can utilize rebate dollars (including bonus payments) to help cover the cost of these additional services. CMS expanded the definition of “primarily health-related” at the beginning of 2019 to allow Medicare Advantage plans to include more supplementary benefits. However, specific subgroups of beneficiaries, such as those with diabetes or congestive heart failure, may be excluded from receiving these additional benefits, resulting in different benefits accessible to different members.

Fitness, dentistry, vision, and hearing were the most common supplementary benefits given in the past. In 2022, more than 90% of individual insurance plans will have vision, fitness, telehealth, hearing, or dental coverage. The breadth of specific services varies, even though these advantages are broadly available. A dental benefit, for example, may cover merely cleanings or provide complete treatment, with a yearly restriction on the amount reimbursed by the plan.

Conclusion

In 2022, there are more Medicare Advantage plans available than in any previous year. Twenty insurers are joining the Medicare Advantage market for the first time, while seven insurers are quitting, indicating that the sector remains appealing and profitable for insurers. 

In 2022, more than 99 percent of Medicare Advantage enrollees will have access to one or more plans comparable to previous years. With more companies offering SNPs, there may be greater attention on how successfully Medicare Advantage plans serve high-need, vulnerable members. In addition, the number of people enrolled in Medicare continues to rise. Insurers appear to be responding by expanding the number of plans and options available.

If you need any assistance regarding finding a suitable Medicare plan or are willing to change your Medicare plan, Simpler Horizons Insurance Services will assist you. Our licensed agents specializing in Medicare will take you to the easiest route to Medicare. 

Schedule a call with us today!

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