Mental Health Coverage Via Telehealth Improving
Medicare continues to focus more attention on telehealth, especially during the pandemic. For 2022, the agency is increasing the availability of mental health services via telehealth.
The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are, CMS Administrator Chiquita Brooks-LaSure said in announcing these changes. This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.
New features include providing certain mental and behavioral health services over the phone. CMS officials say this means that counseling and therapy services, including the treatment of substance use disorders, will be more available, especially in areas where not everyone has access to broadband.
Also in 2022, Medicare will pay for mental health visits outside of the rules governing the pandemic. This means that mental health telehealth visits provided by rural health clinics and federally qualified health centers will be covered.
Editors note: This article was updated with new information.
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How Are Medicare Advantage Premiums Changing For 2023
According to CMS, the average Medicare Advantage premiums is expected to be about $18/month in 2023 , which is down from $19.52/month in 2022 and $23/month in 2020. Average Advantage premiums have been .
The average premiums described above account for all Medicare Advantage plans, including those that dont have integrated Part D coverage. And the overall average is driven down due to the fact that the majority of Advantage enrollees actually have no premiums other than the cost of Part B . If we only consider the Advantage premiums for plans that do include Part D and that do have a premium in addition to the cost of Part B, the average premium is quite a bit higher .
More than 29 million people had Medicare Advantage plans in 2022. Enrollment in these plans has been steadily growing for more than 15 years, and CMS expects that to continue in 2023, with enrollment projected to reach 31.8 million people. The total number of Medicare beneficiaries has been steadily growing as well, but the growth in Medicare Advantage enrollment has far outpaced overall Medicare enrollment growth. In 2004, just 13% of Medicare beneficiaries had Medicare Advantage plans. That had grown to more than 46% by 2022.
Since 2015 The Highest Share Of Medicare Advantage Enrollees Are In Plans That Receive High Quality Ratings
For many years, CMS has posted quality ratings of Medicare Advantage plans to provide beneficiaries with additional information about plans offered in their area. All plans are rated on a 1 to 5-star scale, with 1 star representing poor performance, 3 stars representing average performance, and 5 stars representing excellent performance. CMS assigns quality ratings at the contract level, rather than for each individual plan, meaning that each plan covered under the same contract receives the same quality rating most contracts cover multiple plans.
In 2022, nearly 9 in 10 Medicare Advantage enrollees are in plans with a rating of 4 or more stars, an increase from 2021 and the highest share enrolled since 2015. An additional 3 percent of enrollees are in plans that were not rated because they are in a plan that is too new or has too low enrollment to receive a rating. Plans with 4 or more stars and plans without ratings are eligible to receive bonus payments for each enrollee the following plan year. The star ratings displayed in the figure above are what beneficiaries saw when they chose a Medicare plan for 2022 and are different than what is used to determine bonus payments.
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Changes To Existing Medicare Enrollment Periods
To help people avoid coverage delays, Medicare made changes to when Medicare starts for those who join during their initial enrollment period and the general enrollment period .
| Enrollment period | |
|---|---|
| Coverage started July 1 of that year for anyone who enrolled during the GEP. | Coverage starts on the first of the month after signing up during the GEP. |
The initial enrollment period is a seven-month period surrounding your 65th birthday. The general enrollment period runs from January to March of each year.
Getting Help With Your 2022 Medicare Coverage
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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Medicare Costs Went Up In 2022
The reductions come after more significant increases in costs for 2022, compared to 2021. Then. the premium went up 14.5%, or $21.60. The annual Part B deductible increased $30 in 2022, compared to 2021.
CMS said the 2022 increases were attributed to rising health care costs and expected spending on the newly approved Alzheimers drug, Aduhelm. Aduhelms price tag was then put at $56,000 per person each year. However, drug maker Biogen later cut the annual price to $28,200. And Medicare decided to cover the drug only for people with diagnoses of mild cognitive impairment due to Alzheimer’s who are participating in clinical trials.
According to CMS, lower-than-planned spending on both Aduhelm and other Part B items and services resulted in much larger reserves in the Part B account of the Supplementary Medical Insurance Trust Fund, which can be used to limit future Part B premium increases.
CMS also announced that starting next year, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. The premium in 2023 will be $97.10.
Do You Plan To Continue Working In Your 60s
Working in your 60s will help you maximize your income and savings.
Your benefits are based on your highest 35 years of earnings. Each year of work can add higher earnings to your record by replacing years with low earnings such as those when you were a student, were unemployed, or took time off to care for someone. When you work and wait to claim until age 70, you can increase your monthly benefit by more than 75 percent! Working in your 60s also gives you more time to save on your own for retirement.Review your earnings record on my SocialSecurity.
Working in your 60s will help you maximize your income and savings.
Your benefits are based on your highest 35 years of earnings. Each year of work can add higher earnings to your record by replacing years with low earnings such as those when you were a student, were unemployed, or took time off to care for someone. When you work and wait to claim until age 70, you can increase your monthly benefit by more than 75 percent! Working in your 60s also gives you more time to save on your own for retirement.Review your earnings record on my SocialSecurity.
You can maximize your benefits even if you work fewer hours or stop working.
You can maximize your benefits even if you work fewer hours or stop working.
Consider working in your 60s for an extra boost to your income and savings.
Consider working extra years in your 60s for an extra boost to your income and savings
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How Does The Calculator Estimate My Retirement Benefits Payment
Our simplified estimate is based on two main data points: your age and average earnings. Your retirement benefit is based on how much youve earned over your lifetime at jobs for which you paid Social Security taxes. Your monthly retirement benefit is based on your highest 35 years of salary history. You can get your earnings history from the Social Security Administration .
Your Social Security benefit also depends on how old you are when you take it. You can start collecting at age 62, the minimum retirement age, but youll get a bigger monthly payment if you wait until full retirement age, which is 66 but is gradually moving to 67 for people born in 1960 or after. If you can wait until 70 to start collecting, youll receive your maximum monthly benefit.
A single person born in 1960 who has averaged a $50,000 salary, for example, would get $1,349 a month by retiring at 62 the earliest to start collecting. The same person would get $1,927 by waiting until age 67, full retirement age. And he or she would get $2,389, the maximum benefit on those earnings, by waiting until age 70. Payments dont increase if you wait to collect past 70.
Other factors affecting the size of your benefit include whether youve worked for state or local government for more than 10 years your Social Security payment may be decreased if you paid into the civil service retirement program, for example.
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How Much Will I Pay For Premiums In 2023
Most people will pay the standard amount for their Medicare Part B premium. However, youll owe an IRMAA if you make more than $97,000 in a given year.
For Part D, youll pay the premium for the plan you select. Depending on your income, youll also pay an additional amount to Medicare.
The following table shows the income brackets and IRMAA amount youll pay for Part B and Part D in 2023:
| Yearly income in 2021: single | Yearly income in 2021: married, joint filing | 2022 Medicare Part B monthly premium | 2023 Medicare Part D monthly premium |
|---|---|---|---|
| $97,000 | |||
| $560.50 | your plans premium + $76.40 |
There are different brackets for married couples who file taxes separately. If this is your filing situation, youll pay the following amounts for Part B:
- $164.90 per month if you make $97,000 or less
- $527.50 per month if you make more than $97,000 and less than $403,000
- $560.50 per month if you make $403,000 or more
Your Part B premium costs will be deducted directly from your Social Security or Railroad Retirement Board benefits. If you dont receive either benefit, youll get a bill from Medicare every 3 months.
Just like with Part B, there are different brackets for married couples who file separately. In this case, youll pay the following premiums for Part D:
- only the plan premium if you make $97,000 or less
- your plan premium plus $70.00 if you make more than $97,000 and less than $403,000
- your plan premium plus $76.40 if you make $403,000 or more
You can request an appeal if:
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The Most Commonly Offered Benefit In 2023 Is Telehealth Services
Medicare Advantage supplemental benefits fall into one of two categories: enhanced coverage of a Medicare-covered service, such as a lower deductible or copay, or a non-Medicare covered benefit, such as dental or vision coverage. In 2022, the most widely offered extra benefits in Medicare Advantage Plans according to KFF analysis are:
- Telehealth, offered by 95% of plans
- Fitness, offered by 97% of plans
- Dental, offered by 94% of plans
- Eye exams and glasses, offered by 98% of plans
- Hearing aids, offered by 95% of plans
Other common benefits in 2022 include over-the-counter items in 81% of plans, meal benefits in 67% of plans and transportation benefits in 38% of plans. Only 8% of plans offer bathroom safety and 10 % in-home support benefits, according to KFF analysis.
Another exciting addition to Medicare Advantage plans in 2022 is the ability of individuals with End-Stage Renal Disease to enroll in Medicare Advantage Plans as of January 1, 2021, says Cynthia Pruemm, investment advisor and founder and CEO of SIS Financial Group in Hoffman Estates, Illinois.
The expanded telehealth benefits can allow seniors who cant get to a doctors office to meet via video conference, which can be safer and more convenient, Pruemm says.
Plan providers may also restrict who has access to these extra benefits, such as by restricting benefits for beneficiaries with certain conditions. So the same provider may offer different benefits to different enrollees.
If You Disagree With Our Decision
If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal. The fastest and easiest way to file an appeal of your decision is online. You can file online and provide documents electronically to support your appeal. You can file an appeal online even if you live outside of the United States.
You may also request an appeal in writing by completing a Request for Reconsideration , or contact your local Social Security office. You can use the appeal form online, or request a copy through our toll-free number at 1-800-772-1213 . You dont need to file an appeal if youre requesting a new decision because you experienced one of the events listed and, it made your income go down, or if youve shown us the information we used is wrong.
If you disagree with the MAGI amount we received from the IRS, you must correct the information with the IRS. If we determine you must pay a higher amount for Medicare prescription drug coverage, and you dont have this coverage, you must call the Centers for Medicare & Medicaid Services to make a correction at 1-800-MEDICARE . We receive the information about your prescription drug coverage from CMS.
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How Can I See My Cost
If you set up your My Social Security account online by Nov. 15, you can now see how much your benefits will be increased for 2023. Just log in to your My Social Security account and check the message center to view the document that has all the details about your new 2023 benefit amount.
The document should tell you how much your monthly benefit is before and after deductions, and when you’ll get your first payment with the COLA increase.
If you didn’t sign up for a My Social Security account, look for the COLA notice you received in the mail in December. The letter discloses your 2023 benefits amount.
Note that your higher Social Security payment will take effect in January 2023. If you’re a Supplemental Security Income beneficiary, your first increased payment was on Dec. 30, 2022.
Get The Latest Medicare Advantage Plan Benefits At Medicaregov Or Through A Local Insurance Agent
Nearly all Medicare beneficiaries have access to at least one Medicare Advantage Plan with extra benefits not available through Original Medicare, KFF reports. Around 99% of beneficiaries can also access telehealth and over-the-counter items, 98% can get a meal benefit and 95% of beneficiaries can get transportation assistance.
To learn about the latest benefits being offered by Medicare Advantage plans, you can go to Medicare.gov. On Medicares website, you can enter in your zip code, county, doctors names and medication and youll be matched up with the best plan options in your area, Pruemm says. Each Medicare Advantage plan has a summary of benefits that will explain what you will pay for each procedure and what your copays will be when picking up your medication.
For individuals that would like more personalized information from a licensed and certified professional, there are agencies in your area that specialize in these types of plans, she says.
If you choose to work with a professional, Jensen says its important to use a local agent because plans are county-specific. A national representative may not be as familiar with all the plans offered in your area.
If you do work with an independent broker, be sure to do your due diligence. Look for an active broker who works with all of the plans so they wont have an incentive to put you into one plan over another.
What should I consider when looking for a Medicare Advantage Plan?
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Who Has The Best Medicare Plan For 2022
Finding the Medicare plan thats best for you means determining your needs and shopping for benefits that will help you stay healthy. The plan that works for a friend or a loved one may not work for you, so its important to understand your options and know which questions to ask when its time. To help, GoHealth has helpful pages on a range of topics, including:
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money. 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.
Potential For Alzheimers Drug Coverage
On January 11, 2022, the Centers for Medicare and Medicaid Services announced their proposal to cover monoclonal antibody medication that targets Alzheimers disease. However, CMS will only cover this medicine if those taking it are in a qualifying clinical trial. At this time, Aduhelm is the only monoclonal antibody medication approved by the Food and Drug Administration.
If the proposal is approved, all qualifying clinical trials will be posted on the CMS website on their Medicare Coverage Center page.
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