Medicare Trends To Watch For 2022: Basics, Changes, And Resources

If nothing else, Robin E. Capone hopes that the attendees of her recent "Medicare Trends of 2022" presentation went away from the informative program knowing that there are many options for the national health insurance program. She also reminded attendees that they were seated within one of the best local resources they could hope for.

Capone, the director of sales for Crowe & Associates, a national insurance company with a local office in Brookfield, spoke at Newtown Senior Center on September 24.

"You will always make the decisions" about Medicare plans and options, Capone said that afternoon. "But we are here to educate you, walk you through every plan, and then you will make the decision."

The annual enrollment period for Medicare opens October 15.

All US citizens and legal residents - who must have lived in the US for at least five consecutive years, including the five years just before applying for Medicare - are eligible for Medicare if they are age 65 or older; younger than 65 but with a qualifying disability; or any age with a diagnosis of end-stage renal disease or ALS.

The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS), a federal agency in the US Department of Health and Human Services (HHS). CMS also works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.

There are multiple parts to the Medicare Plan. Part A pays for hospital care, including hospice.

"You're not paying a premium for that because you paid for that through your working career," Capone said. "If you have ten years or 40 quarters of work under your belt - and it doesn't need to be 40 consecutive quarters - of work experience, your Part A is automatic. You don't apply for it. It's already been applied."

Part B pays for doctor visits and other outpatient care.

"You do apply for this," she explained. "This is your doctor, your bloodwork, your MRIs, your outpatient surgery, that all comes under Part B.

"If we get a shot at our doctor's office, that comes under Part B, not our drug plan," she added.

These two parts are also called "Original Medicare." Original Medicare helps with health care coverage, but enrollees should expect to pay some costs, including monthly premiums, deductibles, copays, and coinsurance. There is no limit on out-of-pocket costs.

Original Medicare does not cover vision, dental, hearing, or prescription drugs. Original Medical is provided by the government.

Medicare Advantage Part C is offered by private insurance companies.

Formed in 2008 under President George Bush, Capone said, the plan is meant to incorporate everything under one roof.

Part C plans generally offer the coverage of Part A and Part B, along with additional benefits.

Medicare Part D, also offered by private companies, covers prescription drugs.

Part D, Capone said, is the most complicated.

"The formularies change all the time," she said. "It's very tough to keep up with."

Part D enrollment can be done as a standalone prescription drug plan, to go with Original Medicare coverage, through a private company; or as part of a Medicare Advantage Part C plan that includes prescription coverage, also through a private company.

"In Medicare Advantage, one of the trends I'm seeing is that we're moving away from HMOs, which is a locked network, and we have more PPO Plans, which means we can go out of network," Capone told the approximately 30 people listening to her on September 24.

‘Advantage Greatly Improved'

When Medicare Advantage was formed in 2008, she said, people were scared.

"The networks were not that great," she said. "They'd get into a plan and their primary care physician might leave, and then they were stuck. People were very much afraid of getting locked into a network that they couldn't deal with.

"That really does not exist today," she said. "The networks are huge and we're seeing more PPOs, so if you don't like a doctor you can go out of network, and there's a little bit of an upcharge but not much."

More good news: brokers and their clients are seeing an increase in $0 premium plans in Medicare Advantage.

"Medicare Advantage includes Part A, Part B, a drug plan, a supplemental, and it's growing, and it does a great job," Capone said, adding more drugs are appearing on Tier 1 and Tier 2 generic lists.

"That's great," she said, "because in many of the Medicare Advantage plans, a Tier 1 drug might be a zero cost. There is an emphasis on adding drugs from the formulary to a Tier 1 and Tier 2."

Capone, who is on the advisory board of the UnitedHealthcare dental plan, said she and others are also seeing more supplemental coverage.

"We're seeing more dental options and dental coverage, more vision coverage, diabetic supplies, and all of that," she said.

Some supplements have also been retired, she said. Retirement funds are precious, she noted - with many in the room nodding along with that statement - and increasing premiums can make a plan become too expensive for many retirees.

"There were plans that, over 15, 18, 20 years, were going from $130 a month to $430 a month," she said. "That's unaffordable."

Admitting it can be tough for many to keep up with such premiums, Capone offered some comforting advice.

"You have options, always. If you are ever paying more than you can afford," Capone told the group on September 24, "find yourself a broker, someone who can guide you through the process.

"Align yourself with someone you trust," she continued. "You have many options."

In addition, she said, every year there are new Medicare Advantage plans, new drug plans, and new supplement plans.

There are also Medicare Supplement Insurance Plans, or Medigap, which help pay for some of the out-of-pocket costs not covered by Medicare; and Special Needs Plans (SNPs), which have benefits that cover special health care of financial needs, and include prescription drug coverage.

"It's a lot to keep up with," Capone admitted.

Enrollment Periods

A person's Initial Enrollment Period (IEP) is their first change to enroll in Medicare. An IEP is seven months long, and includes the three months before the month a person turns 65, and the three months after their birthday month.

Once Medicare coverage is selected, changes can be made annual during the Medical Open Enrollment, which is October 15-December 7.

CMS recently released the 2022 premiums, deductibles, and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare Open Enrollment to help Medicare enrollees decide on coverage that fits their needs.

The average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, while projected enrollment continues to increase.

The average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021.

There are a few times when a Special Enrollment Period can be accessed. A person may be able to switch their coverage when there are life changes, including retirement and the departure from a health care plan offered by their employer or union or a physical move out of a plan's service area.

"You have flexibility with supplements. You can change supplements throughout the year," Capone explained. "You cannot change Medicare Advantage or Part D until Open Enrollment."

Capone additionally noted that when former President George W. Bush rolled out Part C 13 years ago, he also rolled out the Late Enrollment Penalty.

"When you retire, when you're migrating from group insurance to Medicare, you need to get enrolled in a drug plan so that a penalty is not applied," she said.

"If you're in a plan where you're paying more than you can afford for drugs, come and talk to me," Capone reiterated.

She also strongly encouraged everyone in the room to stay on top of their plans.

"Review your supplements every few years. There are changes to plans and premiums," she reminded them, "especially Part D.

"Part D is the most complicated portion of our Medicare system," she said. "There are tiers, and every insurance company has different tiers, and they uniquely place different drugs on different tiers."

A Part D plan with one private insurance company, she said, and a Part D plan with a different insurance company can show big differences.

Sharing a story of a recent client, Capone told the group about a man who had been paying $2,000 monthly for years for his supplemental plan.

"I did some research and found that he had been paying for drugs that were initially experimental, years ago" she said. "He had had cancer and he was on a very expensive drug. No one ever checked his plan after he enrolled."

Following her homework, Capone said, the man's plan was updated and he is now paying $85 a month.

"That is a great example of staying close to somebody you trust, and staying on top of your plans," she said. "Stay on top of not only your health and your drugs, but the entire Medicare process."

Additional Resources

For questions about Medicare and detailed information about plans and policies, call 800-MEDICARE (800-633-4227), TTY 877-486-2048; both numbers are available 24-7.

The official Medicare handbook for Medicare programs, Medicare & You, is updated annually. Free copies can be downloaded from Medicare.gov (scroll down to Site Menu, then click on Forms, help, & other resources; then "Medicare & You" handbook. Copies can also be requested by calling the Medicare Helpline (above).

Additional information is also available online at MedicareMadeClear.com.

Newtown residents are very lucky, Capone also told those listening to her last month. The town's senior center has hosted educational programs regularly, and is "one of the best centers in the state," she said in closing. She had heard during a recent visit about residents getting frustrated while trying to find answers online or over the phone for Social Security, Medicare, and other programs.

"When something is frustrating you, and you need something to get done, come here to the senior center," she said. "I can't brag enough about this center. They keep rolling out great classes and helping you, in body, mind, and spirit.

"Discuss your problem, and they're going to hook you up with people that can solve that problem, and they'll do it for you quickly."

Located at 8 Simpson Street, Newtown Senior Center can be reached at 203-270-4310. The center is open weekdays from 9 am until 4 pm.