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Are There New Medicare Benefits

What Is The Medicare Deductible For 2022

Medicare Advantage Plans Explained (2022)

The annual Part B deductible has increased to $233 which is $30 more than last year. The standard Part B premium is increasing to $170.10 monthly, which is $21.60 more per month than before.

Part A is free for most people. The Part A deductible increases annually. In 2022, the deductible will be $1,556 for each benefit period. That makes the increase $72 more than last year. But, those who buy into Medicare could pay a full Part A premium of $499 each month. And, those who paid 30-39 quarters could pay $274 per month.

The inpatient hospital benefit period costs are rising slightly for 2022. For days 1-60 beneficiaries will continue to pay $0 each day. Days 61-90 now cost $389 per day. Finally, for days 91 and beyond, youll pay $778 coinsurance for each day. Now, skilled nursing facility copayments also saw an increase days 21-100 cost $194.50 per day.

Is Medicare Advantage Really Free Monthly Plan Premium Explained

You may be surprised to learn that some Medicare Advantage plans have a monthly plan premium of $0. Thats rightzero dollars per month. And that usually includes coverage for services that arent covered under Original Medicare.

For most of us, costs and coverage are the 2 main factors when it comes time to choose a Medicare Advantage plan. Learn more about the $0 monthly premium Medicare Advantage plans, including how they work and how to enroll.

Impact On Other Payers And Beneficiaries

If Medicare core benefits improved supplemental insurance, payers Medigap, employer retiree plans, Medicaid, and others would pay less for covered services. To compute the impact on premiums, we assumed no shift in coverage and used the reduction in claims costs to compute the reduction in premiums. We used a loading factor of 25 percent for Medigap claims, 15 percent for employer-retiree claims, 10 percent for other private, and 5 percent for Medicaid to estimate the reduction in premiums/payments that would result from the shift in costs Medicare. These are same factors used in a recent study based on Office of the Actuary data. We used a load of 5 percent mark-up on claims for Medicare premiums to be conservative and to acknowledge that an out-of-pocket limit might involve higher administrative costs to implement.

To estimate the increased cost of premium subsidies, we identified low-income beneficiaries currently receiving a full subsidy for Part B premiums through Medicaid or Medicare Savings programs. These beneficiaries would be exempt from premium increases associated with the revised benefit design.

The impact on beneficiaries includes a reduction in out-of-pocket costs, reduced Medigap premiums, and employer-sponsored insurance premiums and increased spending on the added Medicare premiums. At the beneficiary level, we computed the net impact using average premium reductions for Medigap and ESI, limited by actual payments for private premiums.

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Medicare Advantage Plan Ratings Are Higher

Medicare Advantage is a bundled alternative to Original Medicare that includes all the coverages of Medicare Part A, Part B and usually Part D. Medicare Advantage plans, also called Medicare Part C, often include additional benefits, such as some cost help with dental, vision and hearing care, fitness memberships, over-the-counter allowances and meal delivery.

Each year, the Centers for Medicare & Medicaid Services assigns every Medicare Advantage plan a star rating, ranking each plan from best to worst . These ratings are based on plans quality of care and measurements of customer satisfaction, and those ratings can change each year.

In 2022, the average star rating for Medicare Advantage Prescription Drug plans is 4.37, compared to 4.06 in 2021. In fact, 68% of Medicare Advantage plans that include prescription drug coverage have received an overall rating of 4 stars or higher for 2022, compared to 49% in 2021, according to the CMS.

Whats New For Medicare In 2022

Infographic: Starting a Medicare Advantage Plan

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Open enrollment for Medicare goes from Oct. 15 to Dec. 7 each year, when Medicare beneficiaries choose their coverage for the next plan year. As Medicare enrollees contemplate their choices for 2022, here are overall Medicare changes to keep in mind.

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Key Points To Remember About Medicare Part A Costs:

  • With Original Medicare, you pay a Medicare Part A deductible for each benefit period.
  • A benefit period begins when you enter the hospital and ends when you are out for 60 days in a row.
  • One benefit period may include more than one hospitalization.
  • Medicare Advantage plans may or may not charge deductibles for hospital stays.

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Low Or $0 Monthly Premium Medicare Advantage Plans Can Add Up To Real Savings

With , rather than pay your medical bills directly, the federal government contracts with private insurance companies to administer your plan. You still have all the rights and benefits that come with Original Medicare, but private insurerslike Humanacompete for your business with low premiums and added benefits.

Extra Benefits For Medicare Advantage Enrollees

LOWER INSULIN COSTS: Trump talks new optional Medicare benefit & protecting diabetic seniors

Since 2019, some Medicare Advantage plans have offered extra health-related benefits coverage of over-the-counter medications, in-home support services, nutrition counseling and transportation to medical appointments to people with chronic conditions. Last year the benefits expanded to include nonmedical services, such as meal delivery, transportation to the grocery store and even pest control.

Need Help With Medicare?

Weve seen a lot of expansion in the number of plans that offer these benefits and the breadth of their offerings, says Tom Kornfield, senior consultant at Avalere, a health care consulting firm.

Now, 19 percent of Medicare Advantage plans offer supplemental benefits to people who are chronically ill, according to the CMS. Next year, 25 percent will offer these benefits. The benefits may sound generous, but they can be limited.

They vary dramatically, and they can be very different than they sound, says Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. A Center for Medicare Advocacy study found that one plan limited in-home support services to 12 visits a year and another plan covered a home health aide who could assist with the activities of daily living for only four four-hour shifts after a patient is discharged from the hospital. The number of trips to doctor appointments or the store included in a plan also is usually restricted.

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New Medicare Marketing & Sales Rules For 2023

Producersnew compliance rulesdefinition of a TPMO includes independent agents and brokersRequired DisclaimerWe 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.Recording Sales Calls

Scenario : Entering Back Into A Benefit Period

Youre in the hospital for about 10 days and then are discharged home. Unfortunately, you get sick again 30 days after you were discharged. You go back to the hospital and require another inpatient stay.

Because you were admitted back to the hospital within 60 days of your previous visit, youre still in the same benefit period as before.

Again, youll be paying into the same deductible as the first visit, unless it was already met during that time. It will count as day 11 of your coinsurance-free coverage .

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Scenario : Transfer To A Different Facility

After a fall, you need inpatient hospital care for 5 days. Your doctor sends you to a skilled nursing facility for rehabilitation on day 6, so you can get stronger before you go home.

When youre transferred to the skilled nursing facility, youre in the same benefit period as when you were in the hospital for the fall.

You will continue paying toward the deductible that applied at the hospital unless you already met it. At that point, youd have 55 days before coinsurance fees kicked in.

How To Apply Online For Just Medicare

Understand Medicare

If you are within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.

To find out what documents and information you need to apply, go to the .

Also Check: Medicare Benefit Policy Manual Chapter 1 Section 10

Medicare Advantage Plans Cover All Medicare Services

Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding clinical trials, hospice services, and, for a temporary time, some new benefits that come from legislation or national coverage determinations. Plans must cover all emergency and urgent care and almost all medically necessary services Original Medicare covers. If youre in a Medicare Advantage Plan, Original Medicare will still help cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.

The plan can choose not to cover the costs of services that aren’t

under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like fitness programs and some vision, hearing, and dental services. Plans can also cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations. Most include

Already Enrolled In Medicare

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

  • Fax or mail your CMS-40B, CMS-L564, and secondary evidence to your local Social Security office .
  • Note: When completing the forms CMS-40B and CMS-L564

    • State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
    • If possible, your employer should complete Section B.
    • If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
      • Income tax form that shows health insurance premiums paid.
      • W-2s reflecting pre-tax medical contributions.
      • Pay stubs that reflect health insurance premium deductions.
      • Health insurance cards with a policy effective date.
      • Explanations of benefits paid by the GHP or LGHP.
      • Statements or receipts that reflect payment of health insurance premiums.

    Some people with limited resources and income may also be able to get .

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    How Do Medicare Advantage Plans Work

    A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

    These “bundled” plans include

    , and usually Medicare drug coverage .

    Insulin Savings Program Expands

    Understanding the New Medicare Benefits Ahead of the Annual Enrollment Period

    One in every 3 Medicare beneficiaries have diabetes, and 3.3 million beneficiaries use one or more types of insulin, according to the Centers for Medicare and Medicaid Services . The Part D Senior Savings Model, which became available this year, provides insulin with no more than a $35 copayment for each months supply through participating Part D prescription drug plans and Medicare Advantage plans with drug coverage. More than 2,100 Part D and Medicare Advantage plans will participate in the program in 2022, an increase of over 500.

    Keep in mind, youll have to check a plans benefits before signing up, because some Part D and Medicare Advantage plans dont participate in the insulin savings program and some types of insulin arent covered, says Laura Friedman, vice president of regulatory affairs at the American Diabetes Association.

    When choosing a plan, be sure to compare the costs of all your medications, not just the insulin.

    While an individuals insulin may be less expensive with the program, in some cases their other medications might turn out to be more expensive, Friedman says. So we encourage everyone to determine their total medication cost before switching to a new plan. To compare the total cost of premiums and copayments for your medications and the plans available in your area, visit Medicare.gov.

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    How We Conducted This Study

    All estimates are based on analysis of the 2012 Medicare Current Beneficiary Survey , with population and spending projected to 2016, based on enrollment and cost trends in the national health expenditure accounts. The MCBS includes 11,299 respondents, with population weights to make them representative of the entire Medicare population, including disabled under-65 and institutionalized beneficiaries.

    In addition to information reported by beneficiaries on access, use, and out-of-pocket spending on premiums and services, the MCBS cost and use files include incurred liability for Medicare covered benefits, use of Medicare covered services, and spending for Medicare premiums based on administrative data. MCBS includes premiums paid for Medicare and private plans as well as services not covered by Medicare such as dental, hearing, and long-term care services. The database has sufficiently robust sample sizes to permit analysis of subgroups by income and coverage.

    The reforms we specified would lower patient liability. The database enabled estimates of the shift in claims costs to Medicare and the associated reduction in payments by supplemental payers and beneficiaries.

    Hospital Costs With Medicare Advantage May Be Different

    Medicare Advantage plans are an alternative to Original Medicare . They are offered by private insurance companies approved by Medicare.

    Medicare Advantage plans set their own cost-sharing terms and may or may not charge deductibles for hospital stays. Some plans may charge a flat amount per hospitalization up to a set number of days. Other plans may charge a copay or coinsurance amount for each day in the hospital.

    Medicare Advantage plans include hospital and medical insurance all in one plan. Costs, coverage and other details are explained in plan materials. You can get specific plan information by calling the insurance company offering the plan or by visiting the companys website.

    Also Check: Medicare Coordination Of Benefits Phone Number For Providers

    Can I Still Buy Medigap Plans C And F

    As a result of the Medicare Access and CHIP Reauthorization Act of 2015 , Medigap plans C and F are no longer available for purchase by people who become newly-eligible for Medicare on or after January 1, 2020. People who became Medicare-eligible prior to 2020 can keep Plan C or F if they already have it, or apply for those plans at a later date, including for 2022 coverage.

    Medigap Plans C and F cover the Part B deductible in full. But other Medigap plans require enrollees to pay the Part B deductible themselves. The idea behind the change is to discourage overutilization of services by ensuring that enrollees have to pay at least something when they receive outpatient care, as opposed to having all costs covered by a combination of Medicare Part B and a Medigap plan.

    Because the high-deductible Plan F was discontinued for newly-eligible enrollees as of 2020, there is a high-deductible Plan G available instead.

    Getting Help With Your 2022 Medicare Coverage

    Medicare Advantage

    Understanding when you can enroll for Medicare, what coverage you might need and how much it may cost you can be overwhelming. With the current Medicare changes for 2022, you also might benefit from switching plans or enrolling in additional coverage.

    If you feel overwhelmed by your options, talk with a Medicare advisor to help you through the decision-making process. They can ensure youre getting the best coverage at the best price. An advisor can also talk you through whats available with different plans, how certain benefits can assist your specific needs and explain enrollment dates and deadlines.

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