Medicare coverage is a vital part of the health care system in the United States. It provides health insurance for people over the age of 65 and some younger people with disabilities.
In this blog post, we will explain what Medicare coverage is and its components. We will also discuss the difference between Original Medicare and Medicare Advantage and mention some of the most relevant new medicare changes for 2022.
Medicare is a U.S. federal health insurance program aimed for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (ESRD)
There are four main parts to Medicare:
- Part A (Hospital Insurance)
- Part B (Medicare Insurance)
- Part C (Medicare Advantage Plans)
- Part D (Prescription Drug Coverage)
What Does Medicare Cover?
Original Medicare, which is Part A (Hospital Insurance) and Part B (Medical Insurance), covers a wide range of services and supplies.
Part A covers: inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B covers: certain doctor’s services, outpatient care, medical supplies, and preventive services.
Part C is also known as Medicare Advantage: This part of Medicare is offered by private insurance companies approved by Medicare. It includes all Parts A and B benefits plus additional benefits such as drug coverage (Part D).
Part D is the prescription drug coverage: It is available through private insurance companies with a contract with Medicare. You can also get Part D by enrolling in a Medicare Advantage Plan (Part C).
Medicare Advantage Plans
Medicare Advantage Plans are an alternative way to get your Original Medicare benefits. These plans are offered by private insurance companies that contract with Medicare. If you’re enrolled in a Medicare Advantage Plan, you usually get your Part A, and Part B benefits through that plan.
You can get drug coverage (Part D) through some Medicare Advantage Plans. Medicare Advantage Plans have to offer at least the same coverage as Original Medicare (Parts A and B). Some plans also cover extra services, like dental, vision, and wellness programs.
What’s The Difference Between Original Medicare And Medicare Advantage?
Original Medicare is a fee-for-service program that gives you the freedom to choose any doctor or hospital that accepts Medicare. You can also see specialists without a referral.
Private insurers offer Medicare Advantage plans and must follow certain rules set by Medicare. These plans typically include Part A, Part B, and usually Part D. Some MA plans also offer extra coverage, like routine vision or dental care.
Medicare Enrollment Period
The Medicare Enrollment Period is the time each year when you can sign up for Original Medicare (Part A and Part B) or make changes to your existing coverage.
If you’re already enrolled in Medicare, the Annual Election Period (AEP) runs from October 15th to December 07th. If you miss your IEP, you can still sign up during the General Enrollment Period (GEP), which runs from January through March 31st each year. However, there’s a late-enrollment penalty if you didn’t sign up for Part B when you were first eligible.
The Most Relevant New Deductible Medicare Changes For 2022
For the most part, Medicare’s benefits will remain unchanged for 2022. While several proposals are in motion, including new hearing benefits and lowering prescription drug prices, they most likely won’t take effect this year.
Some of the most relevant new medicare deductible changes that will take place in 2022 include:
- The standard Part B premium will increase to $170.10 per month. Meaning it will now cost $21.60 more per month than before.
- The annual deductible for Part B will increase from $203 to $233. You pay 20% of covered services once you’ve met the deductible.
- Part A is generally free, but its deductible rises each year. The deductible will be $1,556 per benefit period in 2022. That’s an increase of almost $73 over last year’s increase.
- For 2022, the inpatient hospital benefit period costs are projected to rise modestly. Beneficiaries will continue to pay $0 each day from day 1 through day 60. From days 61 through 90, beneficiaries will be charged $389 per day. Finally, for every additional day beyond 91, you’ll be charged $778 coinsurance.
- Skilled nursing facility copayments also went up; fees for days 21-100 are now $194.50 per day.
- While not every Part D plan has a deductible, the maximum it may be is $480 in 2022, up from $445 in 2019.
- Out-of-pocket costs for Advantage Plans can reach up to $7,550 in 2022, depending on the plan. For out-of-network services, the maximum cap is $11,300.
Medicare’s New Benefits
Some of the biggest changes to Medicare in 2022 include new benefits for enrollees. These benefits include:
New Mental Health Coverage
Medicare continues to push for telehealth in the wake of the pandemic, as evidenced by its recent policy change. The agency plans to expand access to mental health services via telehealth in 2022.
This is great news for beneficiaries who live in rural areas or who have difficulty leaving their homes. With this expansion, more people will be able to get the mental health care they need.
Additional Insulin Coverage
All Americans will be able to enroll in Part D “enhanced” plan that is part of a CMS program that limits the cost of certain insulins to $35 per month this year.
Potential Alzheimer’s Drugs Coverage
The Centers for Medicare and Medicaid Services published their recommendation to cover monoclonal antibody drugs that target Alzheimer’s disease on January 11th, 2022. This is part of the potential newly covered Medicare Services for 2022. However, CMS will cover this medicine only if those using it participate in a qualifying clinical study.
Medicare Advantage Changes
This year, one of the most significant changes to the Medicare Advantage premium is that it dropped from $21.22 to $19. Medicare Advantage offers more comprehensive coverage than original Medicare. This includes everything that Original Medicare does and often provides benefits such as dental, hearing, and vision.
One of the reasons the average premium dropped this year may be due to increased competition from private insurers. Enrollment in Part C plans is projected to reach 29.5 million people in 2022, up from 26.9 million in 2021.
Donut Hole Changes
The “donut hole” is the coverage gap in Medicare Part D, where enrollees pay 100% of their prescription drug costs. Part D enrollees receive a discount on their drugs when they reach the initial coverage limit to close the donut hole. The Bipartisan Budget Act of 2018 closed the donut hole by phasing it out over a period of several years.
If you’re in a donut hole, you’d have had to pay 25% of the cost of your prescription until 2020. After that, your out-of-pocket spending will need to reach $7,050 in 2022 (up from $6,550 in 2021 and significantly higher than 2019’s $5,100).
Because of the COVID-19 epidemic, some unanticipated Medicare modifications will continue until the pandemic runs its course. These changes include:
- Medicare will have greater flexibility to reimburse telehealth services under this bill.
- Home health services provided by physician assistants, nurse practitioners, and certified nurse specialists must be authorized for Medicare certification.
- Medicare will pay more for COVID-19-related hospital stays and durable medical equipment as a result of the bill.
Will Medigap Plans C and F be available in 2022?
No, plans C and F will no longer be available to new enrollees as of January 1st, 2022. This is because the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that all Medigap plans cover the Part B deductible ($203 in 2020), and plans C and F do not cover this deductible.
Those who were enrolled in plans C or F prior to December 31st, 2019, can keep their coverage. However, those who became eligible for Medicare on or after January 01st, 2020, will not be able to enroll in these plans.
Medicare Advantage Plans Are Now Available To People With ESRD
ESRD, or end-stage renal disease, is a condition in which the kidneys can no longer function properly. This can happen because of kidney disease or an injury to the kidneys. People with ESRD need dialysis or a kidney transplant to survive.
In the past, people with ESRD could only get Medicare coverage through Original Medicare. However, starting in 2022, they will be able to enroll in Medicare Advantage plans as well. Private insurance companies offer Medicare Advantage plans and have different benefits than Original Medicare.
We’ll Help You Stay Up To Date With Medicare
Keeping up with the constant Medicare changes can feel overwhelming. But staying on top of your coverage is important to make sure you have the best possible care. Our team at Nesso Senior Benefits is here to help you understand your Medicare options and find the perfect plan for your needs.
We ensure that our clients’ individual health insurance needs are covered and that they know all the available information regarding their Medicare insurance so they can make educated decisions about their health.
No matter your situation, our experts at Nesso Group will help you get the right coverage for your needs. Get in touch with us today to learn more about how we can assist you in navigating your coverage alternatives and selecting a plan that meets all of your requirements.