Your Medicare costs and coverage can change every year; this year is no exception. Here is an overview of changes and opportunities to consider.
Medicare Part A
Part A inpatient hospital services, skilled nursing facility services, home health care and hospice are covered by Medicare Part A. Most people do not owe a premium for Part A. If you have less than 10 years of Social Security work credits, you may owe a monthly premium, depending on the number of years worked. If you are admitted to the hospital, you will owe a deductible of $1,556 per benefit period. If you have multiple benefit periods in a year, you may owe the deductible more than once.
After you meet your deductible, there is no additional coinsurance for your first 60 days in the hospital. For days 61 through 90 the coinsurance is $389, and for days 91through 150 the coinsurance is $778 per lifetime reserve day. You have 60 lifetime reserve days that can only be used once.
If you are admitted to a skilled nursing facility, you will owe $0 per day for the first 20 days and $194.50 per day for days 21 through 100. If you have secondary coverage such as a retiree plan or a Medigap policy, these deductibles and coinsurance maybe covered. Contact the Medicare Information Office if you have additional questions on a particular situation.
Outpatient and prescription drug costs
Part B outpatient costs such as doctor visits and outpatient procedures are covered by Medicare Part B. In 2022, the standard Part B premium is $170.10 for people with a yearly income equal to or below $91,000 for a single person or $182,000 for a married couple. If your income is higher than that, you may pay a higher premium. The annual Part B deductible is $233 in 2022. You will continue to owe a 20% coinsurance for most services covered by Part B.
Part D outpatient prescription drugs are covered by Medicare Part D. This year, the national average premium for a Part D prescription drug plan is $33.37 per month. Your particular costs vary based on your plan and your prescription drug needs.
If you and your plan spend $4,430 for covered drugs for the year, in most plans, you will reach what is called the coverage gap commonly referred to as the “donut hole”. At that point, you will owe 25% of the cost of your drugs.
If you and your drug plan spend $7,050 on covered drugs in 2022, you will enter what is called catastrophic coverage. Then, you will owe the greater of either 5% of the cost of each drug, or $3.95 for generics and $9.85 for brand-name drugs.
Changing your coverage
You may be able to change your coverage outside of autumn’s Open Enrollment Period, depending on your circumstances. If you think a government employee made a mistake while assisting you, contact 1-800-MEDICARE (1-800-633-4227) and explain your situation. You may be approved to change your coverage. If you have Extra Help, an assistance program that helps pay for Part D prescription drug costs, you can make one change per quarter for the first three quarters of the year. You may qualify for a Special Enrollment Period, such as leaving active employment where your employer provided healthcare insurance, or if you recently moved to Alaska and previously had a Medicare Advantage plan where you previously resided.
Beware red flags
Part D prescription drug plans are administered, marketed and sold by private companies. Plan representatives, agents and brokers must follow federal guidelines when marketing to you. These guidelines protect you from manipulative or deceptive sale and enrollment tactics that can lead to marketing violations by a plan. Here are some red flags:
• You signed up for a plan after being told by an agent or company that certain services or prescriptions were covered, but after enrolling, you discovered they were not covered by that plan.
• A company represented itself as coming from or sent by Medicare, Medicaid or the Social Security Administration.
• You received an unsolicited phone call or text from a plan with which you have no prior relationship, you have asked not to contact you, or from which you disenrolled.
• An agent discussed other insurance products, such as life insurance or annuities, during a visit or meeting that was scheduled to only discuss a Part D or Medicare Advantage product.
Due to the COVID-19 public health emergency, certain flexibilities have been in place and some restrictions lifted during the past two years. Examples of these flexibilities include expanded coverage of telehealth services and coverage for 90-day supplies of prescription drugs when requested. Changes may occur during 2022 in continued response to the pandemic.
For answers to these or to any Medicare-related questions, please feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.
