Medicare owes its beneficiaries a refund

Editor’s note: This press statement was received on Jan. 19, 2022.

Medicare beneficiaries may have grounds to ask for a refund on a portion of their 2022 Part B premiums, according to The Senior Citizens League (TSCL), a Washington D.C.-based senior advocacy organization.

“It appears that Medicare is overcharging 57 million older and disabled beneficiaries for their Part B coverage this year,” says Mary Johnson, a Medicare and Social Security policy analyst for The Senior Citizens League.

The increase in Part B premiums in 2022, which covers the cost of doctors and outpatient services, is the highest increase dollar-wise in program history. The base monthly premium increased from $148.50 in 2021 to $170.10 effective this month. About half of that $21.60 per month increase has been attributed to a pricey, and controversial, new Alzheimer’s drug, Aduhelm. Aduhelm which must be administered intravenously in a doctor’s office or outpatient clinic is covered by Part B. Prior to the premium announcement last fall, Medicare Trustees estimated in their annual report that the 2022 premium would increase from $148.50 to $158.50, but said their estimate did not include the potential costs of Aduhelm.

The Part B premium for 2022 was set last fall when Aduhelm was priced at $56,000 per patient. But since then, Aduhelm manufacturer Biogen has cut the price by almost half, to $28,200. The automatic deductions from Social Security benefits for Medicare Part B premiums — which have already started — were based on the cost when Aduhelm was $56,000.

In addition, the likelihood that many Medicare patients will be prescribed Aduhelm in 2022 “is very low,” Johnson points out. Medicare officials have said that it is proposing to restrict coverage of the new drug to patients who are participating in approved clinical trials. “Medicare beneficiaries and their families need to know whether the benefits of this drug outweigh its significant side effects, which can include swelling and bleeding in the brain,” Johnson says.

The trials will take some time to set up, and Medicare will not even finalize its coverage determination for Aduhelm until later this spring. Thus, the number of patients who will actually have access to the drug appears to be quite limited in 2022, Johnson points out. “This is why The Senior Citizens League feels that the 2022 Part B premium was set too high, and that Medicare should lower the Part B premium, perhaps by as much $11.60 per month,” Johnson says. “That would be something neither Medicare nor the Social Security Administration have ever done before, but it would be the right thing to do for older and disabled Medicare beneficiaries — especially now,” Johnson notes. “All consumers are struggling with high inflation, and an extra $11.60 per month might, for example, cover a co-pay on a needed prescription drug actually being taken by a Medicare beneficiary.”

The Senior Citizens League is urging Medicare, the Social Security Administration, and Congress to ensure that the savings generated from the lower Aduhelm price, and the new coverage determination are quickly passed along to Part B beneficiaries before the end of this year.

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