Your Medicare coverage and costs can change each year, so it is important to understand and review your benefits. Here is an overview of changes and opportunities in 2022.
First, let’s discuss the changes in your Medicare costs in 2022.
Medicare Part A covers inpatient hospital services, skilled nursing facility services, home health care, and hospice. Most people do not owe a premium for Part A. If neither you nor your spouse have 10 years of Social Security work credits, however, you may owe a monthly premium of either $274 or $499 per month in 2022, depending on the number of years worked. If you are admitted to the hospital, you will owe a deductible of $1,556. If you have multiple hospitalizations, you may owe the deductible more than once. After you meet your deductible, your first 60 days in the hospital cost $0 per day. If you are hospitalized for more than 60 days, you may owe an out-of-pocket cost each day for your continued hospital stay. If you are admitted to a skilled nursing facility, you will owe $0 per day for the first 20 days. You will then owe $194.50 a day for days 21-100 in 2022, and the full cost of care after day 100. Call your State Health Insurance Assistance Program (SHIP) for more details about Part A costs. Contact your State Health Insurance Assistance Program (SHIP) to see if you are eligible. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Medicare Part B covers out
-patient costs, such as doctor visits and out -patient procedures. 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. Keep in mind that if you have a Medicare Advantage Plan, you may also pay an additional monthly premium for being enrolled in that plan. If you have Original Medicare, you will owe an annual Part B deductible of $233 in 2022. You will continue to owe a 20% coinsurance for most services covered by Part B.
Medicare Part D covers outpatient prescription drugs. In 2022, 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 your Part D plan has an annual deductible, it can be no higher than $480 in 2022. If you and your plan spend $4,430 for covered drugs for the year, in most plans, you will reach what is called the donut hole. In the donut hole in 2022, you will owe 25% of the cost of your drugs. If you spend $7,050 on covered drugs in 2022, you will enter what is called catastrophic coverage. Then, you will owe 5% of the cost of each drug, or $3.95 for generics and $9.85 for brand-name drugs—whichever is greater—in 2022.
If you have a Medicare Advantage Plan, the amount you owe varies by plan. Contact your plan or review the Annual Notice of Change (ANOC) that you should have received in September for more information about your Medicare costs. If your income is limited, you may qualify for help. Contact your State Health Insurance Assistance Program (SHIP) to see if you are eligible. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Next, let’s discuss potential opportunities to change coverage in 2022.
You may have the opportunity to change your coverage in 2022 outside of Medicare’s Open Enrollment Period, depending on your circumstances.
• If you have a Medicare Advantage Plan, you may be able to use the Medicare Advantage Open Enrollment Period (MA OEP) to switch from your Medicare Advantage Plan to another Medicare Advantage Plan or to Original Medicare with or without a prescription drug plan. The MA OEP occurs each year from January 1 through March 31. Changes made during this period are effective the first of the following month. You may only make one change during this period, so it is important to enroll in the Medicare Advantage or Part D plan you wish to have, which will automatically disenroll you from your previous Medicare Advantage Plan. You do not have to separately disenroll.
• If you have Extra Help in 2022, you have a Special Enrollment Period (SEP) to enroll in a Part D plan or switch between plans. Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. The Extra Help SEP is available once per calendar quarter for the first three quarters of the year, which are: January through March, April through June, and July through September. If you use this SEP to change your coverage, the change will become effective the first of the month following the month that you make the change.
• If you qualify for another Special Enrollment Period, you may be able to change your coverage. There are several situations when you might qualify for an SEP. For example, if you move outside your plan’s service area, if your Medicare Advantage Plan terminated a significant amount of its network providers, or if you enroll in certain State Pharmaceutical Assistance Programs. To use an SEP, contact 1-800-MEDICARE and explain your situation. If you have questions about your SEP eligibility, contact your State Health Assistance Program (SHIP). Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Finally, it is important to understand that the public health emergency may affect your coverage in 2022.
Due to the COVID-19 public health emergency, or PHE, certain flexibilities have been in place and some restrictions lifted in 2020 and 2021. Examples of these flexibilities include expanded coverage of telehealth services and coverage for 90-day supplies of prescription drugs when requested. As of December 17, 2021, the PHE declaration will be in place through January 16, 2022. The PHE declaration has been extended multiple times previously, but there is no indication that it will again be extended. If the PHE expires, many of the current flexibilities and lifted restrictions may expire as well. Congress and the Centers for Medicare & Medicaid Services are working to extend some of these flexibilities, regardless of the PHE status, so details of how these Medicare coverage rules will change are still being discussed. To stay up to date on this evolving conversation, pay attention to the news, your local State Health Insurance Assistance Programs, and the Centers for Medicare & Medicaid Services (CMS).
Still have questions?
Your SHIP is here for you! You can contact your SHIP for questions about your Medicare costs and coverage and any Medicare problems that arise. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.)
Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).