Aetna Medicare Give Back Benefit

How Is Medicare Part D Prescription Drug Coverage Changing For 2023

For stand-alone Part D prescription drug coverage, the maximum allowable deductible for standard Part D plans is $480 in 2022, up from $445 in 2021. This will increase to $505 in 2023.

And the out-of-pocket threshold will increase to $7,400 in 2023, up from $7,050 in 2022. The copay amounts for people who reach the catastrophic coverage level in 2021 will increase slightly, to $4.15 for generics and $10.35 for brand-name drugs. Beneficiaries with higher-cost drugs will continue to pay 5% of the cost during the catastrophic coverage phase . But cost-sharing in the catastrophic coverage phase will cease altogether as of 2024, thanks to the Inflation Reduction Act.

The Inflation Reduction Act will also start to benefit Medicare Part D enrollees right away in 2023. Recommended vaccines covered under Part D will no longer have cost-sharing . And all Part D plans will have to provide all of their covered insulin products with copays of no more than $35/month .

The Affordable Care Act closed the donut hole in Medicare Part D, so there is no longer a hole for brand-name or generic drugs: Enrollees in standard Part D plans pay 25% of the cost until they reach the catastrophic coverage threshold. Prior to 2010, enrollees paid their deductible, then 25% of the costs until they reached the donut hole, then they were responsible for 100% of the costs until they reached the catastrophic coverage threshold.

How Common Are Medicare Part B Give Back Plans

Medicare Part B Give Back plans are becoming more common as time goes on. In 2022, these plans are available in 48 states. Many major insurance carriers offer this benefit to make their plans more appealing.

Check the Medicare Plan Finder to learn whether insurance carriers offer Medicare Part B Give Back plans in your area. Check the details page for each listed plan to see whether it provides the Part B premium reduction.

Who Is Eligible For The Medicare Part B Giveback

Itâs worth noting that not everyone is eligible for a Part C plan that offers a Part B Premium Giveback, sometimes also called the Medicare give back benefit. In fact, there are two factors that may not allow you to find one of these plans. The first of these deals with how you currently pay for your Medicare Part B premium. In order to qualify for a plan with a Part B Giveback, you need to pay for your Part B premium on your own. This means that if you receive assistance from Medicaid or programs like Medicare Savings Plans youâre not eligible for the giveback benefit. The upside to this news is that youâre not eligible for it because youâre already receiving help, so you may not need it.

Not every plan offers a Part B Premium Giveback, and not every area has plans that offer the giveback either.

The other factor of eligibility has to do with location. Not every plan offers a Part B Giveback, and not every area has plans that offer the give back benefit either. This is dependent on zip code and the array of plans offered. Currently, most zip codes have at least one plan with a Part B Premium Giveback, but if youâre in a location that doesnât, you wonât be able to enroll in that type of plan that offers it. That said, itâs rare that there isnât one in your area, so as long as youâre enrolled in Medicare and pay for your own Part B premium, thereâs a good chance you can find a plan featuring the giveback.

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Downsides To The Medicare Giveback Benefit

While the giveback benefit can help save you money, there are a few things to be aware of when considering enrolling in an MA plan that offers it.

• Availability. One of these plans may not be available in your area.
• Possible reduction in benefits. MA plans cover everything Original Medicare does and more, typically including coverage for things like routine dental, vision, and hearing. However, some plans that offer a premium reduction benefit eliminate those other benefits to make up for the lower premium. You should weigh the loss of these benefits with the premium savings you’d get.
• May not save you money in the long run. Plans that offer a premium reduction may have a higher annual deductible, co-pays, or co-insurance. They may also have a smaller network of providers, and you’d have to pay more to see someone out-of-network.
• Givebacks vary. While you could get a premium reduction of the full $170.10, it could also be as low as $1. That may not be worth it depending on the other costs and benefits offered or not offered by the plan.
• Giveback amounts could change. MA plans are offered by private insurance companies that set their own fees and costs, and they can change them each year. This means the premium reduction could also change from year to year.

There are so many factors in choosing the right Medicare Advantage plan for your unique needs. That’s the true value of using a Medicare agent.

Ial Medicare Part B Premium Reimbursement

Service retirement and disability benefit recipients who are enrolled in an STRS Ohio medical plan and provide proof of Medicare Part B enrollment may receive partial reimbursement to offset the standard monthly premium charged by Medicare for Part B coverage.

Partial reimbursement of the benefit recipient’s future standard Medicare Part B premium cost will begin after STRS Ohio receives proof of Medicare Part B enrollment. If STRS Ohio receives proof by the 15th of the month, partial reimbursement will begin the first of the following month. If verification is received after the 15th of the month, partial premium reimbursement will begin the first day of the second following month. Partial reimbursement is not applied retroactively based on your Medicare effective date. You will receive reimbursement for future monthly premiums only after you submit proof of Medicare Part B coverage.

If you are eligible to receive a Medicare Part B premium reimbursement through more than one Ohio public retirement system, specific guidelines apply. Its your responsibility to contact STRS Ohio to determine which system is responsible for providing your reimbursement you may not receive more than one Part B premium reimbursement. Please call STRS Ohio for Medicare Part B premium reimbursement guidelines.

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How Much Is The Part B Giveback

Since this is not a benefit from the Federal Medicare Program but instead of a Medicare Advantage health insurance plan, the amounts can vary. Some plans offer a small amount, sometimes $10 per month or less, and others give back all or most of your Medicare Part B premium.

The amount you receive as a Part B give back benefit is determined by where you live, whats offered, and which plan you choose.

Examining The Medicare Part B Premium Giveback

Emily MarkovicSr. Copywriter

The standard monthly Part B premium cost for beneficiaries in 2022 is $170.10 . Wouldnât it be nice if your clients could get some of that money back? Good news, this is a possibility!

Listen to this article:

Below is an overview of the Medicare Part B Premium Giveback. If youâre an agent selling Medicare, youâll definitely want to make sure you know the ins and outs of this plan benefit.

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How Do Beneficiaries Receive The Funds

The Part B Giveback is credited monthly on the beneficiariesâ Social Security check. Judy Gee, a Broker Relationship Manager with Humana, explains that it can take a few months for the Giveback to be processed which could result in the member receiving a lump sum amount on their Social Security check to include the months prior to activation. Then, the specific dollar amount of the benefit will be credited monthly through Social Security.

For example, during Annual Enrollment Period , a beneficiary is enrolled in an MA plan featuring a $50 Part B Giveback. Their coverage goes into effect, January 1, however it will take two months for the Giveback benefit to become active. The first Social Security check upon successful enrollment and active coverage will include $100 . Moving forward, the beneficiary will see the designated $50 Giveback on their check each month.

Just the same as activation of the benefit, deactivation of the Giveback can take a few months. So, if it takes two months for the disenrollment to be acknowledged by CMS and Social Security, the member will receive a check with the overpayment for the two months subtracted.

Editorâs Note: This post was originally published in February 2020 has been updated to reflect current statistics.

Medicare Advantage Part B Give Back Program Benefits

Lindsay MalzoneReviewed by Licensed Insurance Agent: Rodolfo MarreroHomeFAQsPart C

When you approach your Medicare years, you hear commercials and advertisements constantly to entice Medicare beneficiaries to different Medicare Advantage plans. One of the most exciting and misrepresented benefits you hear about is the Medicare Part B give back program.

And its no surprise why. Who wouldnt want to lower their monthly premiums as everything rises?

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Whats The Best Way To Compare Medicare Advantage Plans

When comparing Medicare Advantage plans, there are two main things to consider: cost and coverage. For cost, consider the total amount that you’ll pay for health care and insurance. In some cases, you’ll get a better deal by paying more for a policy that has better benefits, helping you to save on health care. For coverage, make sure a plan gives you strong benefits in the areas you expect to need the most, such as diabetes care, prescription drugs or inpatient surgery.

This Search Uses The Five

Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?

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Switch Your Plan Not Your Doctor

Though you have a new plan option, chances are you may be able to continue seeing your doctors. This is because this plan is the Aetna Medicare Plan with an extended service area . This is a type of Medicare Advantage plan. With this type of plan you pay the same cost for any doctor or hospital, according to the costs listed on the plan benefits summary. The provider must be eligible to receive Medicare payment and accept the Aetna plan.

Instructions on how to use Aetna Medicare Advantage provider search »

• Step 1: After clicking on Find your provider, choose 2022 Medicare plans you through your employer
• Step 2: Enter your home zip code OR city, state then select from the drop-down
• Step 3: Choose select plan to find providers
• Step 4: Choose Medicare Advantage with Prescription Drug plan
• Step 5: Under PPO section Select Aetna Medicare Plan with Extended Service Area *
• Step 6: Then choose medical and click continue to find care at the bottom right of your screen to find providers

*As a member of the Aetna Medicare Plan with an Extended Service Area , you can receive services from any provider that is eligible to receive Medicare payment and is willing to treat you. Your cost share will be the same as in-network care. Out-of-network providers are under no obligation to treat Aetna members, except in emergency situations.

Best Medicare Advantage Provider For Low Out

Medicare Advantage plans can be relatively low-cost, many with zero premiums. But the trade-off can come in the form of higher out-of-pocket costs. When evaluating the price of a plan, consider all the costs, not just the .

Pay special attention to the maximum out-of-pocket cost, which sets the cap on how much youll have to pay for covered services in a given year. To find the best plan with lower MOOPs, MoneyGeek looked at highly rated national carriers offering Medicare Advantage plans in at least 25 states and MOOPs in the bottom 75th percentile.

Based on those criteria, MoneyGeek identified Aetna Medicare as the best option.

Aetna Medicare

Aetna Medicare earns an average of 4.3 stars out of 5.0 in Medicare Star Ratings. More than two-thirds of Aetnas low MOOP plans have no monthly premium. Virtually all cover dental and vision care, and 100% offer hearing benefits.

Copayments, coinsurance and any other costs you pay before you satisfy your deductible all count toward the MOOP. But monthly premiums, drug costs and the cost of services provided by providers who dont participate with your health plan do not.

A low MOOP plan protects you from out-of-pocket costs, which can be high even with a $0 premium plan. Low premiums are often offset with higher deductibles, copayments and coinsurance. A lower MOOP will set the ceiling on your out-of-pocket costs.

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Give Back Eligibility And Medicare

If youre eligible for Medicare and you have Part B medical insurance, then theres a cost for Part B, and the cost for Part B can change every year.

For most people on Medicare, the Part B premium is either deducted from your Social Security benefit every month or you pay it another way such as through your bank account.

If you enroll in a Medicare Advantage Plan that offers a Give Back benefit, then you will see a reduction in your Part B monthly premium.

This will be for every month that youre enrolled in that plan. The plans can change every year, so you need to be aware that the Give Back benefit could change as well.

How To Get A Give Back Benefit

So how do you get a Give Back benefit? Well it depends on the area where you live and whether or not there is a Medicare Advantage Plan that offers this benefit. With Medicare Advantage Plans, in order to enroll, you have to reside in the service area of the plan.

If there are no plans that offer a Give Back benefit then you wont be able to get it unless you moved to another area where one of the plans are available.

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Will There Be Inflation Adjustments For Medicare Beneficiaries In High

Medicare beneficiaries with high incomes pay more for Part B and Part D. But what exactly does high income mean? The high-income brackets were introduced in 2007 for Part B and in 2011 for Part D, and for several years they started at $85,000 .

But the income brackets began to be adjusted for inflation as of 2020. For 2022, these thresholds increased to $91,000 for a single person and $182,000 for a married couple .

For 2023, the projection is that the IRMAA brackets will start at an income of $97,000 for a single individual a significant increase from 2022, driven by the higher-than-normal inflation weve seen in 2022.

For 2022, the Part B premium for high-income beneficiaries ranges from $238.10/month to $578.30/month, depending on income . These may or may not increase for 2023 details will be finalized in the fall of 2022.

As part of the Medicare payment solution that Congress enacted in 2015 to solve the doc fix problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees. These new brackets took effect in 2018, bumping some high-income enrollees into higher premium brackets.

And starting in 2019, a new income bracket was added on the high end, further increasing Part B premiums for enrollees with very high incomes. Rather than lumping everyone with income above $160,000 into one bracket at the top of the scale, theres now a bracket for enrollees with an income of $500,000 or more .

Should You Consider A Medicare Give Back Plan

Medicare Part B Give Back plans offer immediate plan benefits, but they could be more expensive than some other Medicare plan options in the long run. Furthermore, these plans arent available in every zip code or with all insurance providers.

You should do your research to see whether a Medicare Part B Give Back plan and the benefits it offers are the best option for you. While they are not an option for everyone, you may find that a Medicare Part B Give Back plan helps you access the health services you need for less.

Zia Sherrell is a digital health journalist with over a decade of healthcare experience, a bachelors degree in science from the University of Leeds and a masters degree in public health from the University of Manchester. Her work has appeared in Netdoctor, Medical News Today, Healthline, Business Insider, Cosmopolitan, Yahoo, Harper’s Bazaar, Men’s Health and more.

When shes not typing madly, Zia enjoys traveling and chasing after her dogs.

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Best For Customer Satisfaction: Kaiser Permanente

• Highest average NCQA rating nationwide

• Five-star Medicare rating

• #1 in J.D. Powerâs U.S. Medicare Advantage Study

• Lowest deductibles, on average, compared to all other major providers

• Only available in 8 states and D.C.

• Only offers HMO plans

• No transportations benefits

Kaiser Permanente customers are very happy with their plans. All Medicare Advantage plans receive five stars from Medicare, which is the highest rating available. And the average NCQA rating is 4.75 out of 5 stars, making Kaiser Permanente the highest-rated Medicare Advantage provider by the National Committee for Quality Assurance. The company also took top billing in the 2022 J.D. Power U.S. Medicare Advantage Study, beating the runner up by 20 points.

Not only this, but compared to the other largest players, Kaiser Permanente drug deductibles are the lowest nationwideâ only $5.60, on average, for 2023. One reason the company can keep member costs low may be that it only offers HMO plans for Medicare coverage, which means youâll need to stay strictly in-network. And unlike every other provider on this list, Kaiser doesnât cover transportation costs to health-related appointments.

You need to reside in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, or the District of Columbia to be eligible for coverage.

Read more in our Kaiser Permanente Medicare review.