Look for higher premiums and deductibles in the new year, but also more help with insulin, mental health
The biggest change Medicare’s nearly 64 million beneficiaries will see in the new year is higher premiums and deductibles for the medical care they’ll receive under the federal government’s health care insurance program for individuals age 65 and older and people with disabilities.
Medicare’s benefits will remain largely the same in 2022. As the new year begins, Congress is still debating several proposals that would change the face of Medicare, including adding a hearing benefit and several proposals to lower the price of prescription drugs, including capping out-of-pocket costs in Part D plans. But even if Congress adopts these changes, they wouldn’t take effect this year.
Largest Part B increase ever
The monthly premium for Part B, which covers doctor visits and other outpatient services, such as diagnostic screenings and lab tests, will be $170.10 in 2022, up $21.60 from the 2021 monthly charge. Centers for Medicare & Medicaid Services (CMS) officials say this largest-ever dollar increase was necessary because of three factors:
- Rising health care prices, some of which were attributed to COVID-19 care.
- Because of the pandemic, Congress acted to significantly lower the planned 2021 Part B premium increase (something AARP fought hard for), but lawmakers directed CMS to begin paying back that reduced premium starting in 2022.
- CMS decided it needed to set aside money in its reserves in the event that Medicare covers Aduhelm, a new Alzheimer’s drug. The annual price for Aduhelm was originally set at $56,000. But after CMS set the Part B premium, Biogen, the drug’s manufacturer, cut the annual price to $28,200 under pressure from health advocates. Advocates have urged CMS to lower the Part B premium increase in the face of that price cut.
The Part B premium increase will be somewhat offset by the 5.9 percent increase in Social Security’s annual cost-of-living adjustment (COLA). Social Security beneficiaries enrolled in Medicare have the premium deducted from their monthly check. However, not everyone enrolled in Medicare is getting Social Security benefits yet, and how much enrollees will end up seeing of the COLA increase will depend on the size of their monthly Social Security benefit.
Deductibles also rising
The annual Part B deductible will be $233 this year, an increase of $30.
For Medicare Part A, which covers hospitalizations, hospice care and some nursing facility and home health services, the inpatient deductible that enrollees must pay for each hospital admission will be $1,556, an increase of $72 over 2021.
The deductibles and copays and other charges beneficiaries must pay for prescriptions under the Part D prescription drug benefit will vary based on what plan they choose and where they live. But the federal government does cap the Part D annual deductible, and in 2022 it cannot exceed $480.
More help with insulin costs
This year, enrollees in every state will be able to sign up for a Part D “enhanced” plan that is participating in a CMS program that caps the cost of some insulins at $35 a month. The program began in 2021, but the number of plans available is expanding. This year, 2,159 Part D plans have agreed to participate. Beneficiaries who are enrolled in original Medicare or a Medicare Advantage plan can sign up for this program.
Mental health coverage via telehealth improving
“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.
Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.