Brandy BauerAnn Kayrish

Medicare 2022 Changes

November 4, 2021

Agenda Costs in 2022

Landscape of Part D & MA plans

2022 Changes to Telehealth Benefits

Health & Drug Plan Considerations

Changes Related to Part B Covered

Services

Resources This resource was supported in part by grant 90MINC0002-01-01 from the U.S. Administration for Community Living, Department of Health and Human Services. Points of view or opinions do not necessarily represent official ACL policy.

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2022 Costs

5

Original Medicare Costs: Part A2021 2022

Part A Deductible $1,484 ?

Hospital Copay/Days 61-90 $371 ?

Hospital Copay/Days 91-150 $742 ?

Skilled Nursing Facility Copay/Days 21-

100

$185.50 ?

Part A Monthly Premium (<30 credits) $471 ?

Part A Monthly Premium (30-39 credits) $259 ?

6

Original Medicare Costs: Part B

2021 2022

Part B Deductible $203 ?

Standard monthly premium $148.50 ?

Income Related Monthly Adjustment

Amount (IRMAA): Singles with incomes*

between $88,000 - $500,000+

Between $207.90

and $504.90

?

IRMAA: Couples with incomes* between

$176,000 and $750,000+

Between $207.90

and $504.90

?

* Per 2019 tax returns; singles included married couples filing separately

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Standard Drug Benefit 2022

Benefit Parameters 2021 2022

Deductible Up to $445 Up to $480

Initial Coverage Limit $4,130 $4,430

Out-of-Pocket (OOP) Threshold $6,550 $7,050

Catastrophic OOP Threshold $10,048.39 $10,690.20

Minimum cost-sharing in catastrophic

coverage (generic/brand name)

$3.70/$9.20 $3.95/$9.85

Part D Low-Income Subsidy (LIS/Extra

Help) Deductible (Full/Partial Subsidy)

$0/$92 $0/$99

Source: CMS Announcement of Calendar Year Rates, https://www.cms.gov/files/document/2022-

announcement.pdf, January 15, 2021

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Who Pays What for Part D in 2022

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• In 2019, 1.5 million Medicare beneficiaries (non-LIS enrollees)

had spending beyond catastrophic coverage threshold

• Number has tripled between 2010 and 2019

• $9.9 billion cumulatively spent out of pocket during past decade

Source: Kaiser Family Foundation, https://www.kff.org/medicare/issue-brief/millions-of-medicare-part-d-enrollees-have-had-out-of-

pocket-drug-spending-above-the-catastrophic-threshold-over-time, July 23, 2021

Part D Spending

Landscape of Part D & MA Plans

11

• 23% decrease in the number of prescription drug plans (PDPs)

available across the country (n=766, down from 996 in 2021)

• Typical beneficiary will have choice between 23 plans

o NY has lowest number of offerings, and Arizona the highest

• 42% of enrollees are in a plan with 4 or more stars in 2022

• Average Part D monthly premium nationally is $33/month

o Varies widely, from $5.50 to $207.20

o ¾ of beneficiaries without low-income subsidy will pay higher premiums if

they remain in their current plan

Sources: Kaiser Family Foundation, https://www.kff.org/medicare/press-release/a-record-3834-medicare-advantage-plans-will-be-available-

in-2022-up-8-percent-from-2021-while-the-number-of-medicare-part-d-stand-alone-plans-is-decreasing-mainly-due-to-firm-consolidations/,

November 2, 2021; CMS, https://www.cms.gov/files/document/2022-star-ratings-fact-sheet1082021.pdf, October 8, 2021

2022 Part D Landscape

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• ~13 million receive Extra Help in 2021

• 198 plans available for enrollment of LIS beneficiaries for no

premium (24% reduction over 2021)

• 26% of all PDPs are benchmark plans

• Across the country, benchmark plans range from 4 to 9,

depending on the state (e.g., Alaska 4 and Arizona 9)

• Asset limits for Extra Help in 2022 are $8,400/$12,600

(single/married) for full subsidy; $14,010/$27,950 for partial

subsidy (not including $1500 per person burial allowance)Source: Kaiser Family Foundation, https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-

benefit/, October 13, 2021; CMS, CY2022 Resource Limits Memo, October 25, 2021

2022 Part D Landscape & Extra Help

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• 3,834 MA plans nationally (8% increase over 2021)

o Average person has access to 39 MA plans

o Alaska has 2 (hybrid Medical Savings Accounts); Florida has 583

o 65 counties have no plans

o Over 1,100 Special Needs Plans, including 700 Dual-eligible Special Needs Plans (D-SNPs)

• 89% of MA plans include prescription drug coverage

• Average premium submitted by health plans for 2022 is $19/month

o 59% of MA plans will have a $0 premium (beyond Part B premium)

Sources: CMS https://www.cms.gov/newsroom/press-releases/cms-releases-2022-premiums-and-cost-sharing-information-medicare-

advantage-and-prescription-drug, September 30, 2021; KFF, https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-

first-look/, November 2, 2021

2022 Medicare Advantage Landscape

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• 90% of plans offer vision, fitness, telehealth, hearing OR dental

benefits (scope of service varies)

• Plans with at least 4 stars more likely to offer supplemental

benefits, with meals (70%), transportation (40%) being most

frequently offered

• 90% of beneficiaries are currently in a MA-PD with four or more

stars in 2022

• No plans received a low performance icon on Plan Finder this

yearSources: CMS, https://www.cms.gov/files/document/2022-star-ratings-fact-sheet1082021.pdf, October 8, 2021; Avalere Health,

https://avalere.com/insights/more-medicare-advantage-plans-will-offer-non-medical-benefits-in-2022, October 19, 2021

2022 MA Landscape (cont.)

Changes to Telehealth

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One in four Medicare beneficiaries had a telehealth visit between the summer and fall of 2020

Source: Kaiser Family Foundation, https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-

coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/, May 2021

17

• Remain covered until December 31, 2023

• Examples: Emergency department visits, home visits for established patients, discharge day management services

Retain coverage for temporary service on the Medicare telehealth services list

• Covered until the end of the PHE to allow CMS to collect data

• Examples: Home visits for new patients, assessment of tinnitus, ophthalmological service exams for new patients

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

Category 3 telehealth services added during the PHE & considered temporary

Other temporary services added during the PHE

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Authorized permanent coverage of extended virtual check-ins• Communication-based technology

service

• Established patients only

• Initiated by the patient

• In-lieu of in-person visit

• May last up to 20 minutes

• Approved for audio-only or

audio/video communications

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Beneficiary concerns

• Confusion on which services will be permanently available via telehealth

• Standard cost sharing applies for telehealth services and cost sharing maybe more with longer check-in

• Extended virtual check-in may delay next in-person appointment

• Beneficiaries always have the option to be seen in-person and should contact 1-800-Medicare to report access issues

20

Maintaining access to mental health services

Background

• Prevalence of audio-only visits for mental health counseling during the PHE

• Shortage of mental health care professionals

• Inadequate broadband access

• Less critical need for visualization

• Termination could harm access to care

21

Removed barriers for mental and behavioral health telehealth services

• Removed longstanding geographic restrictions

o No longer limited to rural or identified health professional shortage

areas

• Established the patient’s home as an allowable originating site

• Authorized federally qualified health clinics (FQHCs) and rural health clinics (RHCs) to act as distant site providers

• Established permanent coverage for audio-only services

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Permanent coverage for audio-only mental and behavioral health services

1. Limited to diagnosis, evaluation, or

treatment of mental health disorders

2. Patient must be located at his/her

home (as the originating site)

3. Available to established patients only

(in-person visit within the last 6

months)

4. Beneficiaries utilizing audio–only

services must meet face-to face with

provider on a regular basis

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5. Distant site practitioner must have interactive audio-video capabilities

6. Patient drives the decision to use or opt out of the audio-video modality

7. Claim indicates audio-only on the claim

8. RHCs and FQHCs can offer audio-only mental health services after the PHE

Permanent coverage for audio-only mental and behavioral health services (cont.)

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Beneficiary concerns• Beneficiaries can expect to pay all regular copayment and

coinsurance amounts for services delivered via telehealth under both traditional Medicare and Medicare Advantage

• Beneficiaries utilizing audio-only services for mental and behavioral health services mut be prepared to meet with their mental health professional face to face on a regular basis

Health & Drug Plan Considerations

26

Two-tier specialty formulary option for MA-PD and Part D drug plans • Preferred specialty tier must offer lower cost-sharing

• Plans determine which drugs are placed on the preferred

specialty tier

• Plans must allow for exceptions between the two specialty tiers

• CY 2022 specialty drug tier threshold increased from $670 to

$830

Beneficiary concerns: The addition of a new another tier may cause additional confusion for beneficiaries in determining out of pocket drug cost

27

Senior savings model

• Part D and MA-PD plans can participate in model

• $35 max copay for a 30-day supply of some insulin products in deductible, initial coverage, & coverage gap phases of the Part D benefit

• Reduced copay does not apply in the catastrophic phase

• Model benefits are available to beneficiaries without LIS

• Participating plan filter has been removed from MPF

https://innovation.cms.gov/innovation-models/part-d-savings-model

28

Special circumstances special enrollment period (SEP)

• Not a new SEP for Medicare Advantage plan or prescription drug plan choice/enrollment

• Additional information on SEP added to medicare.gov website

29

Updates to Medicare Plan Finder Ability to save pharmacy and drug lists for logged in users

More prominent filter to include SNPs in search results

Removal of Insulin/senior savings program filters for MA and PDP

In-network pharmacy identifiers

Improved readability for mobile-phone users

Improved print function on plan comparison and detail pages

Increased prominence of key costs on plan detail page

New pharmacy drug cost comparison table on plan detail page

Anonymous users can email drug comparison results

30

• SSA recently clarified that COVID-19 related unemployment assistance and economic impact payments do not count as income for SSI benefits

• Extra Help benefits follow SSI rules

https://secure.ssa.gov/apps10/reference.nsf/links/09302021025535PM

https://www.ssa.gov/coronavirus/categories/monthly-benefits-and-other-financial-help/

COVID-19 stimulus payments do not count as income for Part D Extra Help

Changes Related to Part B Covered Services(PFS)

32

• Flyers sent to beneficiaries

• Part B and Part D IRMAA amount

identified

• Better distinction between the

letter “O” and zero

• Removing option to change of

name, address and reporting of

death option. Instructed to

contact SSA

Subhead

Redesigned Medicare premium bill (CMS-500)

33

Reduced payment rates for physical therapy & occupational therapy assistant services

• Payment rate is 85% of 80% of applicable Part B fee schedule

amount

• Applies to all outpatient services - physician offices, rehab

facilities, SNF, hospital outpatient departments

Beneficiary concerns:

Beneficiaries should talk with the prescribing physician with any

concerns about therapy services received and to Medicare or

MA plan for questions on co-insurance or copayment amounts

34

Physician assistant services

• Physician assistants may directly bill

Medicare for services furnished under

Medicare Part B

Beneficiary concerns:

Beneficiaries will want to ensure that the PA is a participating

Medicare provider and will bill Medicare for servicers rendered.

35

Change to coinsurance associated with colorectal cancer screenings

• Gradual elimination of the coinsurance payment when a growth or

polyp is found and removed as part of a colonoscopy screening

• Coinsurance to reduced over an eight-year period:

o 20% for 2022

o 15% for 2023-2026

o 10% for 2027-2029

o 0% for 2030

36

Reminder on CMS policy on diagnostic testing

• Medicare will pay for one COVID-19 diagnostic test, one

influenza test and one respiratory syncytial virus (RSV) test

without a physician/practitioner order

• All subsequent tests must be pursuant to an order to be

reimbursable by Medicare

• The interim policy rule was published in the Federal Register

September 2, 2020

(https://www.federalregister.gov/documents/2020/09/02/2020-

19150/medicare-and-medicaid-programs-clinical-laboratory-

improvement-amendments-clia-and-patient)

Resources(PFS)

38

• Open Enrollment Toolkit: https://ncoa.org/article/medicare-

open-enrollment-toolkit

• 2022 Medicare Changes fact sheet: https://bit.ly/3a2jT42

• Part D Cost Sharing Chart:

https://www.ncoa.org/article/medicare-part-d-cost-sharing-

chart

• Who Pays What in Part D in 2022 (former donut hole

illustration): https://www.ncoa.org/article/donut-hole-part-d

Resources from NCOA

39

• CMS landscape of plans by state:

https://www.cms.gov/files/document/92921-state-state-fact-sheets-2022-

medicare-advantage-and-part-d-landscape-final.pdf

• Medicare Advantage and Part D Final Rule 2022:

https://www.cms.gov/newsroom/fact-sheets/contract-year-2022-

medicare-advantage-and-part-d-final-rule-cms-4190-f2-fact-sheet

• Medicare Physician Fee Schedule:

https://www.federalregister.gov/documents/2021/07/23/2021-

14973/medicare-program-cy-2022-payment-policies-under-the-

physician-fee-schedule-and-other-changes-to-part

• Consolidated Appropriations Act of 2021:

https://www.congress.gov/bill/116th-congress/house-bill/133/text

Resources from CMS/SSA

Brandy Bauer

brandy.bauer@ncoa.org

Ann Kayrish

Ann.Kayrish@ncoa.org

Contact

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