Upcoming Medicare Changes: What to Expect in 2022

• With 2022 right around the corner, the Centers for Medicare & Medicaid Services (CMS) are beginning to announce the new Medicare initiatives they are launching in the new year. 

• Cost is a major factor to consider when enrolling in Medicare or switching Medicare plans. Learn more below about the changes in plan costs to Medicare Part A, B, C, and D.

• In 2022, a wide variety of new services will be introduced to Medicare coverage, such as new vaccinations, diagnostic tests, COVID-19 measures, and more.

In 2022, the Centers for Medicare & Medicaid Services (CMS) are introducing some new initiatives to improve Medicare healthcare plans. Certain new initiatives include the implementation of Drug Management Programs (DMPs) with Medicare Part D (prescription drug coverage), the launch of a new Medicare comparison tool for nursing homes, the re-launch of ​“Champions for Coverage,” and including End-Stage Renal Disease (ESRD) patients in Medicare Advantage (MA) eligibility.

Mandatory Implementation of Drug Management Programs (DMPs)

Beginning in 2022, all Part D sponsors will be required to implement DMPs as a part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Putting these DMPs in place will require providers to screen their patients for substance use disorder if they are prescribed opioids. Screenings will include providers gauging their patients’ risk for developing a substance use disorder, evaluating their patients’ pain levels, providing information on non-opioid treatment options, and more. If a provider sees it necessary, they may refer their patients to substance use treatment therapy.

COVID-19 Vaccination Compare Tool for Nursing Home Searches

CMS recently launched a new comparison tool to aid enrollees in their search for new nursing homes and care centers. The tool uses data collected from CMS’s COVID-19 Nursing Home Data to show patients the amount of vaccinated patients and staff within certain nursing homes. This tool will help guide patients when deciding on which facility they’ll move to.

Re-Launch of ​“Champions for Coverage”

In 2022, CMS is re-launching their ​“Champions for Coverage” initiative that provides enrollees with information about the Medicare Health Insurance Marketplace. Currently, the program includes more than 1,000 local organizations that educate enrollees on their coverage options through Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

Medicare Advantage Options for End-Stage Renal Disease (ESRD) Patients

A recent change in Medicare Advantage eligibility occurred in 2021 for ESRD patients. Under the terms of the 21^st Century Cures Act, those with ESRD gained the ability to enroll in a Medicare Advantage plan (MA plan or Medicare Part C plan). As a result of this eligibility change, CMS expected over 40,000 ESRD patients to enroll in 2021 alone.

2022 kicks off a variety of cost revisions when it comes to Medicare premiums, deductibles, and more. For reference, Medicare Part A refers to Medicare’s hospital insurance, Medicare Part B refers to Medicare’s medical insurance, Medicare Part C refers to MA plans, and Medicare Part D refers to prescription drug coverage.

Note: To learn more about the different parts of Medicare, visit this source.

Medicare Part A

The projected costs for Medicare Part A in 2022 are as follows:

• Part A Premium: $274 a month (previously $259/​month) for those who worked and paid Medicare taxes for between 7.5 and 10 years. $499 a month (previously $471/​month) for those who have worked and paid Medicare taxes for less than 7.5 years.

• Part A Deductible: $1,556 in comparison to $1,484 in 2021.

• Part A Coinsurance: For days 61–90 in the benefit period, the coinsurance will be $389 per inpatient day (previously $371 per day). For days 91 and on in the benefit period, the coinsurance will be $778 per inpatient day (previously $742 per day).

Medicare Part B

The projected costs for Medicare Part B in 2022 are as follows:

• Part B Premium: $158.50 a month compared to $148.50 in 2021.

• Part B Deductible: $217 in comparison to $203 in 2021.

Medicare Part C

According to CMS, the amount of MA plans offering supplemental benefits will increase from 19% to 25% in 2022 with premiums dropping from $21.22 per month (2021) to $19 per month (2022).

Medicare Part D

The CMS announced that Part D premiums are expected to increase from $31.47 per month (2021) to $33 per month (2022).

A variety of new services will be available to Medicare enrollees beginning in 2022 along with new specifications for routine services.

Medicare & COVID-19 Services

In an effort to assist Medicare enrollees during the COVID-19 pandemic, coverage for various COVID-19 services will be included in 2022 plans. Certain services will include:

• Vaccinations: All FDA-authorized COVID-19 vaccines will be covered by Medicare. Enrollees should be sure to bring their Medicare card with them when attending their vaccine appointment to ensure the provider bills Medicare.

• Diagnostic Tests: FDA-authorized tests that check patients for COVID-19 diagnosis are covered by Medicare when patients receive them from a laboratory, pharmacy, doctor, or hospital. 

• Antibody Tests: FDA-authorized tests that check enrollees for a past COVID-19 immune response are covered by Medicare.

• Monoclonal Antibody Treatment: FDA-authorized treatments for those fighting COVID-19 are covered by Medicare as long as the patient is seeking care from a Medicare provider or supplier. 

• Booster Shots: All FDA-authorized booster shots for COVID-19 are covered by Medicare.

Note: Coverage surrounding COVID-19 tests and treatments may change when the public health emergency wanes. To learn more about Medicare’s response to the COVID-19 pandemic, visit this source.

New Additions to the ​“Welcome to Medicare” Preventive Visit

When an enrollee first joins Medicare, they are allowed to receive a ​“Welcome to Medicare” preventive visit within the first 12 months of their Part B enrollment. This visit includes a review of the enrollee’s medical history along with an explanation of the various preventive services recommended for them. 

Starting in 2022 the medical history review will also include a screening for substance use if the patient is prescribed opioids. This screening comes as a result of CMS’s push for DMPs with Medicare Part D and will require providers to review their patients’ risk factors for opioid use, evaluate the patients’ pain levels, provide information on non-opioid treatment options, and refer patients to a specialist if needed. If the provider sees it necessary, they may also refer the patient to seek treatment therapy for substance use disorder.

New Additions to the Yearly ​“Wellness” Visit

After the 12 months of initial enrollment in Part B, patients are allowed to receive a yearly ​“wellness” visit. During this visit, providers and their patients will discuss the patient’s personalized preventive care plan as a result of their health needs and risk factors. 

Similar to the ​“Welcome to Medicare” preventive visit, starting in 2022, patients prescribed opioids will be screened for substance use disorders by their providers during wellness visits. In addition to this new initiative, patients will also be required to perform a cognitive assessment at their wellness visits starting in 2022. These cognitive assessments will unveil early signs of dementia or Alzheimer’s disease, such as difficulty with:

• Memory

• Learning New Things

• Concentrating

• Managing Finances

• Making Daily Decisions

Medicare covers in-depth assessments of cognitive function through separate visits as well where signs of dementia, depression, anxiety, or delirium are monitored and analyzed more thoroughly.

Aside from new COVID-19 coverage and additives to the annual wellness visit, Medicare plans are including new services such as:

• Bariatric Surgery: Certain bariatric procedures like gastric bypass surgery and laparoscopic banding surgery will be covered by Medicare if the patient meets certain conditions linked with morbid obesity.

• Blood-Based Biomarker Tests for Colorectal Cancer Screenings: Certain screenings for colorectal cancer are covered by Medicare to assist patients with finding precancerous growths or targeting cancer discovery early. Certain screenings include barium enemas, colonoscopies, flexible sigmoidoscopies, and more. In 2022, blood-based biomarker tests will also be included in Medicare’s coverage if patients are between 50–85, show no symptoms of colorectal disease, and are at average risk for colorectal cancer.