Supplemental Benefits Are Not The Only Thing To Consider When Choosing A Medicare Advantage Plan
Medicare Advantage Plan supplemental benefits can be an important factor when choosing between plan providers as the benefits and degree of coverage offered by each plan will vary. Its important that you understand the pros and cons of the Medicare Advantage plan you are considering since you can only enroll and disenroll during the annual enrollment period.
That said, the extra benefits are not the only things to consider. When looking for Medicare Advantage Plans there are several things to keep in mind. First, make sure the plan offers coverage for the medications you use and contracts with your doctor, Jensen says.
You should also keep in mind that while the majority of Medicare Advantage Plans are HMOs, some plans are available as PPOs or HMO-POS, Jensen says. HMOs typically have a network of doctors and medical facilities that are covered under the plan. To get insurance coverage, you generally must use one of these in-network providers. With an HMO-POS, you have the option of paying more for an out-of-network provider.
PPOs give more flexibility in seeing specialists and out-of-network doctors, but they often have higher premiums than either HMO or HMO-POS plans. Jensen doesnt normally recommend PPOs because of their higher out-of-pocket costs.
If somebody wants to consider a PPO Medicare Advantage Plan, they should really be looking at Medicare Supplement plans as well, she says. A Medicare Supplement plan can offer flexibility and is worth a comparison.
What Is The Medicare Deductible For 2023
The annual Medicare Part B deductible has decreased in 2023 to $226, which is $7 less than last year. The standard Part B premium is lowered to $164.90 monthly, which is $5.20 less per month than before.
Medicare Part A is does not have a premium for most people. However, the premium does increase each year. In 2023, the Medicare Part A deductible will be $1,600 for each benefit period. That makes the increase $44 more than last year. But, those who buy into Medicare could pay a full Part A premium of $506 each month. And, those who paid 30-39 quarters could pay $278 per month.
The inpatient hospital benefit period costs are rising slightly for 2023. For days 1-60 beneficiaries will continue to pay $0 each day. Days 61-90 now cost $400 per day. Finally, for days 91 and beyond, youll pay $800 coinsurance for each day. Now, skilled nursing facility copayments also saw an increase days 21-100 cost $200 per day.
Are Part A Premiums Increasing In 2023
Roughly 1% of Medicare Part A enrollees pay premiums the rest get it for free based on their work history or a spouses work history. Part A premiums have trended upwards over time and they increased again for 2022.
For 2022, the Part A premium for people with 30+ quarters of work history is $274/month, up from $252/month in 2021. And for people with fewer than 30 quarters of work history, the premium for Part A is $499/month in 2022. These amounts are projected to increase to $279/month and $508/month, respectively, in 2023 but again, we wont know the final numbers until the fall of 2022.
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Medigap Plans F And G High
Medigap Plans F and G offer high-deductible plans in some states. With these plans, you must pay coinsurance, copayments, and deductibles up to the deductible amount, which is $2,490 in 2022up from $2,370 in 2021.
Once you reach the deductible, the plan covers any costs for Medicare-approved services. Because of potentially high out-of-pocket costs, the premiums are typically much lower than for the standard Plan F or G options.
How Is Capital Health Plan Getting Better
Capital Health Plans Medicare Advantage has achieved Medicare’s score of 4.5 out of 5 stars for plan year 2023.
Eligible Medicare recipients generally can enroll any time of the year, and not just during the Annual Enrollment period.
When you choose Capital Health Plan Advantage Plus or Preferred Advantage you can personalize your coverage with the NEW MasterCard CHP Choice Card.
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New Medicare Costs For 2022
Every year, Medicare makes changes to its costs and coverage. In 2022, Medicare beneficiaries can expect to see changes in costs to their Original Medicare premiums and deductibles. Its important to know what these new costs will be for the upcoming year so you can better prepare and adjust your budget if need be.
Here are the 2022 costs you will expect to see.
How Are Medicare Advantage Premiums Changing For 2023
According to CMS, the average Medicare Advantage premiums for 2022 is about $19/month , which is down from about $21/month for 2021, and $23/month in 2020. Average Advantage premiums have been . The average Medicare Advantage premium for 2023 will be published in the fall of 2022.
The average premiums described above account for all Medicare Advantage plans, including those that dont include 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. 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.
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The Share Of Eligible Medicare Beneficiaries Enrolled In Medicare Advantage Has More Than Doubled Since 2007
In 2022, nearly half of eligible Medicare beneficiaries 28.4 million people out of 58.6 million Medicare beneficiaries overall are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has more than doubled from 2007 to 2022 . KFF now calculates the share of eligible Medicare beneficiaries enrolled in Medicare Advantage, meaning they must have both Part A and B coverage. This affects both 2022 data as well as trends over time. The share would be somewhat smaller if based on the total Medicare population that includes 5.7 million beneficiaries with Part A only or Part B only who are not generally eligible to enroll in a Medicare Advantage plan. See methods for more details.
Between 2021 and 2022, total Medicare Advantage enrollment grew by about 2.2 million beneficiaries, or 8 percent a slightly slower growth rate than the prior year . The Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61 percent by 2032 .
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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The Share Of Medicare Beneficiaries In Medicare Advantage Plans Varies Widely Across Counties
The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across counties. For example, in Florida, 56% of all Medicare beneficiaries in the state are enrolled in Medicare Advantage, ranging from 19% in Monroe County to 78% in Miami-Dade County. In Ohio, 52% of all Medicare beneficiaries are enrolled in Medicare Advantage, with the share ranging from 30% in Mercer County to 64% in Stark County .
In 2022, one in five Medicare beneficiaries live in a county where at least 60 percent of all Medicare beneficiaries in that county are enrolled in Medicare Advantage plans . That is substantially more than in 2010 when just 3 percent of the Medicare population lived in a county where 60 percent or more of Medicare beneficiaries were enrolled in a Medicare Advantage plan . Many counties with high Medicare Advantage penetration are centered around relatively large, urban areas, such as Monroe County, NY , which includes Rochester, and Allegheny County, PA , which includes Pittsburgh. However, some urban areas, such as Baltimore City, MD , Charleston, SC , and Cook County, IL have lower Medicare Advantage enrollment.
Change In Star Ratings Increases And Other Benefit Changes
- Just half of Medicare Advantage plans with prescription drug coverage received ratings that will earn them bonuses for the 2023 plan year, down from nearly 70% in the current year.
- Starting April 1, people with traditional Medicare may pay a lower co-insurance for some Part B drugs if the drugs price increases faster than the rate of inflation in a benchmark quarter.
- The drug coverage gap will begin once you reach your Medicare Part D plans initial coverage limit of$4,660 in 2023, up from$4,430 in 2022. The gap closes when you spend a total of $7,400 out of pocket, up from $7,050 in 2022.
- The maximum out-of-pocket limit for Medicare Advantage plans in-network is increasing to $8,300 from $7,550 in 2022. For out-of-network, the limit is $11,300. Some plans may have maximum out-of-pocket amounts below these limits.
- The average Medicare Advantage premiums in Florida are projected to rise slightly, going from $8.36 in 2021 to $8.54 in 2022.
- 627 Medicare Advantage plans are available in Florida in 2023, compared to 583 plans in 2022.
- 23 stand-alone Medicare prescription drug plans are available to Floridians in 2023 $8.40 is the lowest monthly premium for a standalone Medicare prescription drug plan.
- The average monthly Medicare Advantage plan premium in Florida will rise slightly to $9.41 in 2023 from $8.86 in 2022.
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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.
Who Qualifies For Healthy Food Card Benefit
If you qualify for a Dual-eligible Special Needs Plan , you may have access to a healthy food card. A D-SNP is a type of Medicare Advantage Special Needs Plan that offers benefits and services to individuals who qualify for both Medicare and Medicaid. These plans cater to dual-eligibles and offer lower overall costs, including savings on prescriptions, doctor visits, and more.
TIP: Learn more about dual-eligible special needs plans.
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Can I Use My Healthy Food Card At Walmart
Walmart operates more than 10,000 locations in 24 countries, so many people rely on their local store for household needs and grocery shopping. Walmart is a participating provider for many providers, including Humana, CarePlus, United Healthcare and other insurance companies.
If you are enrolled in a Dual-eligible Special Needs Plan, check your plans specific benefits to find out where you can use your healthy food card. If you live near a Walmart, you may be able to use your benefits while you shop there.
Special Needs Plans Offer Extras
A type of Medicare Advantage plan called a Special Needs Plan provides coverage for certain groups of people, such as those who are enrolled in both Medicare and Medicaid and those who have chronic conditions. A chronic condition SNP offers coverage to those who have diabetes, end-stage renal disease, heart disease, chronic obstructive pulmonary disease and other illnesses.
These plans must provide prescription drug coverage, and they usually offer extra benefits, such as lower copayments for specialists and medications. Many dont charge an additional premium aside from the usual Part B premium.
SNPs also may provide a care coordinator who can answer your questions, help you monitor your condition, get the right prescriptions, schedule preventive services and ensure that you keep your doctor appointments. If you have traditional Medicare, your doctor can coordinate your medical care, but not all physicians provide this service. Medicare is trying to expand chronic care management services by providing additional reimbursement to clinicians who offer them.
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Access To Medicare Advantage Plans By Plan Type
As in recent years, virtually all Medicare beneficiaries have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas and the vast majority of beneficiaries in non-metropolitan areas . In non-metropolitan counties, a smaller share of beneficiaries have access to HMOs or local PPOs , and a slightly larger share of beneficiaries have access to regional PPOs .
New Market Entrants And Exits
Medicare Advantage continues to be an attractive market for insurers, with 20 firms entering the market for the first time in 2022, collectively accounting for about 19% of the growth in the number of plans available for general enrollment and about 6% of the growth in SNPs.
Thirteen new entrants are offering HMOs available for individual enrollment. Nine of the new entrants are offering SNPs seven firms are offering D-SNPs for people dually eligible for Medicaid, one firm is offering a C-SNP for people with select chronic conditions, and one firm is offering an I-SNP.
Three of the new firm entrants are offering plans in Massachusetts, two are offering plans in California, Florida, North Carolina, South Carolina, and Utah, and the remainder are offering plans in at least one of thirteen other states .
Seven firms that previously participated in the Medicare Advantage market are not offering plans in 2022. Six of the firms had very low enrollment in 2021, while one firm had no enrollment in 2021. Two of the seven exiting firms offered plans in California.
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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.
Increased Number Of Covered Telehealth Services
As the COVID-19 pandemic stretches on, the need for telehealth services has followed suit. Medicare coverage has responded positively to this need and continues to grow because of it. However, it hasnt yet been determined how long these benefits will remain, as many covered services have been labeled by the Centers for Medicare and Medicaid Services as only temporary.
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Medicare Advantage In 202: Premiums Out
Medicare beneficiaries have the option of receiving their Part A and Part B Medicare benefits through a private Medicare Advantage plan. The federal government contracts with private insurers to provide Medicare benefits to enrollees, and plans are required to meet federal standards. For example, Medicare Advantage plans are required to provide an out-of-pocket limit, and may provide additional benefits or reduced cost sharing compared to traditional Medicare. They are also permitted to limit provider networks, and may require prior authorization for certain services, subject to federal standards. This brief provides information about Medicare Advantage plans in 2022, including premiums, cost sharing, out-of-pocket limits, supplemental benefits, prior authorization, and star ratings, as well as trends over time. A companion analysis examine trends in Medicare Advantage enrollment.
What Is The Healthy Food Card
Nutrition is integral to good health, but optimal nutrition is cost-prohibitive for some Medicare beneficiaries. To help lower the costs of healthy food for individuals who live on limited income and resources, many Medicare Advantage Special Needs Plans offer healthy food cards.
This benefit allows plan enrollees to get a monthly allowance for food, which offsets your grocery bill at the checkout counter of participating stores.
TIP: Are you looking for a Medicare plan that offers nutritional benefits like the healthy food card? Use our plan finder tool to find the benefits you want at a price you can afford.
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