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What Medicare Recipients Need to Know in 2022

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Medicare Announces 2022 Part A and Part B Costs

The Centers for Medicare & Medicaid Services (CMS) recently announced the 2022 costs for Medicare Part A and Part B.  These costs take effect January 1, 2022.

Medicare Part A

Medicare Part A covers inpatient hospital care, care in a skilled nursing facility (up to 100 days), some home health care, and hospice services.  The costs next year will be:

  • Premium: Most people get Part A for free because they, their spouse, or in some cases their parent, have paid Medicare taxes while working.  However, for those who must buy Part A, the monthly premium in 2022 can be as much as $499.
  • Hospital Stay: The inpatient deductible is $1,556 per benefit period.  If someone is in the hospital longer than 60 days, their cost-sharing will be: $389/day for days 61-90 and $778/day for days 91-150.
  • Skilled Nursing Facility Stay: Medicare can cover up to 100 days in a skilled nursing facility when someone meets the criteria for Medicare to pay for this care.  There is no cost for care for the first 20 days.  For days 21-100, the beneficiary will have a daily co-pay of $194.50.
     

Medicare Part B

Medicare Part B covers outpatient care such as doctor visits, outpatient hospital services, diagnostic tests, ambulance services, durable medical equipment, mental health services, and more.  The costs next year will be:

  • Premium: Everyone on Medicare is subject to a monthly Part B premium.  In 2022, the standard premium will be $170.10/month (up from $148.50 in 2021). Most people will pay this premium amount next year.
    • A small percentage of Medicare beneficiaries will pay a slightly lower amount because of Medicare's hold-harmless provision.  This rule protects people who have their Part B premium deducted from their monthly Social Security check from a Part B premium increase that would exceed their Social Security benefits increase, to avoid leaving these beneficiaries with a lower net Social Security benefit in 2022 than they received in 2021.  Despite the big jump in the Part B premium for 2022, the Social Security cost-of-living adjustment (COLA) is expected to cover the increased Part B premium for most beneficiaries. This is because the 5.9 percent Social Security COLA for 2022  is the highest increase in more than thirty years.   
    • People with higher incomes pay a higher premium.
    • As a reminder, people with limited incomes and resources can qualify for Medicaid to pay their Part B premium through the Medicare Savings Programs or “Medicare Buy-In”.

 

  • Other Part B Costs in 2022: The annual deductible will be $233.  That is the amount Medicare beneficiaries must pay for services before their Part B coverage kicks in.  After that, Original Medicare covers outpatient physical and mental health services at 80 percent and the beneficiary pays the remaining 20 percent.
     

Medicare beneficiaries are responsible for paying the monthly Part A (if any) and Part B premiums regardless of how they get their Medicare – whether through Original Medicare or a Medicare Advantage plan.  Individuals with Original Medicare (who use the red, white and blue card when getting care) and no additional insurance are subject to the Part A and B deductibles and co-insurance amounts described above.  Those in a Medicare Advantage plan pay the deductibles, co-insurance and co-pays set by their plan.  Dual eligibles with Medicare and Medicaid insurance use their Medicaid coverage to pay their Part A and B deductibles, co-insurance and co-pays and should only be charged the small Medicaid co-pay that applies to the service they get.

More information about Medicare Part A and B costs in 2022 can be found here.

Resource Limits to Qualify for Extra Help and Medicare Savings Programs in 2022 Announced 


The resource limits to qualify for programs that help people with Medicare costs are increasing slightly next year.  Starting January 1st, the resource limits for Extra Help with Medicare Prescription Drug Costs (also called the Low-Income Subsidy or “LIS”) will be:

  • Full Extra Help: $9,900 (single); $15,600 (married)
  • Partial Extra Help: $15,510 (single); $30,950 (married)
     

NOTE: These figures include a $1,500 per person disregard given when applicants mark on the application that they expect to use some of their resources for funeral/burial expenses.

The Extra Help program lowers people’s Medicare Part D costs.   The amount of help someone gets depends on their income and resources or whether they get any Medicaid coverage. More information about qualifying for Extra Help can be found here and here.

The resource limits for the Medicare Savings Programs are also increasing starting January 1st.  These programs help people pay their Medicare premiums and may also help pay the Medicare Part A and Part B deductibles and co-insurance if the person has very low income.  The resource limit for the Medicare Savings Programs in 2022 will be $8,400 (if single) or $12,600 (if married).  More information about qualifying for the Medicare Savings Programs can be found here and here.

Individuals who need help applying for Extra Help or the Medicare Savings Programs are encouraged to call PA MEDI at 1-800-783-7067.  Once the 2022 Federal Poverty Level figures are announced early next year, PHLP will update its publications about qualifying for Extra Help and the Medicare Savings Programs.  Stay tuned to future newsletters and be sure to check the Resource Library section of our website next year to see the updated fact sheets.

Reminders about Medicare Part D

 

Availability of Transition Refills

Medicare Part D Plans can change their formularies each year and sometimes people do not realize that a medication they take is no longer covered or requires authorization to be covered until they try to get their medications refilled in the new year. Since the Medicare Open Enrollment Period ended on December 7th, people generally can no longer change their drug plan for coverage starting January 1st. However, if people find out early next year that their Part D or Medicare Advantage plan no longer covers their prescription drug, they should be aware that transition refills (also known as transition fills) are available. 

If someone takes a medication that is no longer covered by their Part D plan, or requires special authorization to be covered, they can get a transition refill at the start of the new year. The transition refill typically provides a one-time, 30-day supply of a drug that a Medicare beneficiary was already taking.  This gives the Medicare beneficiary time to talk with her doctor and either seek a formulary exception, get prior authorization, or switch to a drug that the plan covers.   Transition refills will not cover new medications people are prescribed.

All stand-alone Part D plans and Medicare Advantage plans that include drug coverage must make transition refills available.  When someone uses her transition refill, she should be told at the pharmacy that her medication was covered temporarily.   Medicare beneficiaries in this situation should also quickly receive a letter from their Part D plan explaining that they have used their transition fill, why their prescription drug is not covered, and what their options are going forward.

 

Opportunities to Change Plans after January 1st

Although most people on Medicare can only change their health and drug plans during the Annual Open Enrollment Period (October 15th through December 7th), there are some enrollment opportunities that people can use to make changes to their Medicare coverage next year if needed. 

Medicare Advantage Open Enrollment Period

One option for making an enrollment change after January 1st is the Medicare Advantage Open Enrollment period, which runs from January 1st through March 31st.  This enrollment period allows people who are enrolled in a Medicare Advantage plan on January 1st to switch to another Medicare Advantage plan (with or without drug coverage) or disenroll from their Medicare Advantage plan and return to Original Medicare.  Anyone choosing to return to Original Medicare during this period will be able to join a stand-alone prescription drug plan for Part D coverage.  Only one change may be made during this period.  Any change made during this period will become effective the first day of the next month.

Special Enrollment Period for Dual Eligibles and people with Extra Help

Dual eligibles (those eligible for both Medicare and Medicaid) and other individuals who are eligible for Extra Help with their Part D costs have a special enrollment period to change their Medicare health or drug plan once a quarter during each of the first three quarters in a calendar year. Changes made during this period will start the first of the next month. 

Other Special Enrollment Periods (SEPs)

There are a number of other SEPs that exist for various circumstances that people can use to make coverage changes during the year.  Common ones include when people move, when people lose Medicaid coverage, or when people lose other prescription coverage and need to enroll in Part D. 

A special enrollment period may be available for those who received inaccurate or misleading information while using the Medicare Plan Finder to choose their 2022 Medicare coverage or if they were given misleading information by someone like an agent or broker and ended up enrolled in a plan that does not meet their needs.  To use this SEP, the Medicare beneficiary should call 1-800-MEDICARE to explain their circumstances and request to change plans using this Special Enrollment Period.  For more information about Medicare enrollment periods and other SEPs that may be available, see Medicare’s publication on this topic here. 

We encourage readers who have questions about using these enrollment periods to make changes to their coverage or who have questions about getting a transition refill to call PA MEDI at 1-800-783-7067.