Every year, there are changes in Medicare. While rising premium rates grab most of the headlines, often there are other changes in medications and health care technology that improve and expand Medicare coverage.
If you get your health insurance through Medicare—like more than 62 million other Americans, including Social Security Disability recipients who we help at Nash Disability Law —here are four improvements which may benefit you in 2022:
No. 1: More Options for Insulin Savings
One in every three Medicare beneficiaries has diabetes, and more than 3 million of them use insulin, which can be a critical component of managing their condition. Previously, under traditional Medicare plans, unless you used an insulin pump, you had to pay 100% of your insulin costs.
In 2021, Medicare launched a voluntary program called the “Part D Senior Savings Model” which offered Medicare Part D plan options to lower out-of-pocket costs for insulin.
The Senior Savings Model has been a success for Medicare, for pharmaceutical companies, for health plans and for patients. In 2022, more than 500 new Medicare Advantage and Part D prescription drug plans, and two new pharmaceutical manufacturers of insulin, are joining the Part D Senior Savings Model.
Now, with more than 2,100 drug plans to choose from, Medicare beneficiaries have even more opportunities to lower their out-of-pocket costs for insulin. Medicare beneficiaries who are enrolled in participating Part D plans or Medicare Advantage plans could see their insulin costs drop to a $35 per-month copayment.
Enrollment in the Senior Savings Model is not automatic. You must opt in. To find insurance companies participating in the Senior Savings Model, go to Medicare.gov and use the site’s plan finder. The tool allows you to screen for the Medicare Part D and Medicare Advantage plans with Part D coverage offered in your area.
When using the tool, enter the list of medicines you take, including insulin. Then, to narrow your search for the Senior Savings Model plans, click on “Filter Plans,” and check the insulin savings box.
In most cases, you can only make changes to your Medicare Part D prescription drug coverage during Fall Open Enrollment (October 15 through December 7). Your new coverage begins January 1 of the following year. Under certain circumstances, you may be eligible to use a Special Enrollment Period (SEP) to make changes to your Part D coverage. To learn if you are eligible to make changes to your Medicare Advantage or Medicare prescription drug coverage under the SEP rules, click here.
No.2: Expanded Mental Health Options
In 2022, Medicare beneficiaries will have greater access to mental health services. The new Medicare coverage will bring certain counseling and therapy services directly into patients’ homes via audio-only telephone calls.
One example of expanded mental health options is a greater effort to address the nation’s opioid addiction crisis. Since 2020, Medicare has covered the cost of opioid treatment programs, and starting this year these programs will be available to more individuals through phone calls. This is especially beneficial to vulnerable populations in rural areas which have poor broadband internet access.
No. 3: Increased Number of Covered Telehealth Services
During the COVID-19 pandemic, the use of telecommunications and information technology to provide access to health services was unprecedented.
According to Medicare statistics, telehealth use went from 1% of visits to 80%. Although it is unlikely that telehealth activity will continue at this pace, the technology has forever changed medical care.
Responding to this change, Medicare Part B still covers certain telehealth services. A telehealth visit is treated the same as if you went to an in-person outpatient visit. The types of telehealth services that are covered include:
For 2022, Medicare has added cardiac services and cardiac rehabilitation to the list of telehealth services that are eligible for Medicare reimbursement.
Medicare payments to health care providers for covered telehealth services will continue at least through the end of 2023 to allow the agency more time to evaluate if these telehealth services will become a permanent part of Medicare coverage.
No. 4: Greater Access to the Services of Physician Assistants
Although physician assistants (PAs) can perform many of the same functions as doctors, up until this year they were not allowed to bill Medicare for services normally covered under Part B.
This restricted patients’ access to PAs. Now PAs can bill Medicare directly and Medicare is authorized to make direct payments to physician assistants. As a result, all Americans with Medicare Part B have greater access to PA professional services.
For assistance with your Medicare coverage, you may contact Asta Draksaite from Benefits Age, an independent broker’s office, at A_DRAKSAITE@BENEFITSAGE.COM or at 847-397-5300. Asta was the author of our guest column: If You Are Disabled, Here’s what You Need to Know about Medicare – Nash Disability Law.