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Medicare Updates from CMS

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December 9, 2021
December 17, 2021
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Polaris Group
December 17, 2021
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Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts

On November 12, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs and the 2022 Medicare Part D income-related monthly adjustment amounts. For more information on the 2022 Medicare Parts A and B premiums and deductibles please visit the Federal Register.

 

 Medicare Part B Premium and Deductible

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021.

According to Medicare the increases in the 2022 Medicare Part B premium and deductible are due to the rising prices and heath care utilization from beneficiaries. They also cite the increase in the intensity of care provided in the past and anticipated future. Congress added an additional contingency reserve due to the uncertainty regarding the potential use of the Alzheimer’s drug, Aduhelm™, by people with Medicare.

In July 2021, CMS began a National Coverage Determination analysis process to determine whether and how Medicare will cover Aduhelm™ and similar drugs used to treat Alzheimer’s disease. As that process is still underway, there is uncertainty regarding the coverage and use of such drugs by Medicare beneficiaries in 2022. While the outcome of the coverage determination is unknown, CMS’ projection in no way implies what the coverage determination will be but state they must plan for the possibility of coverage for this high-cost Alzheimer’s drug which could, if covered, result in significantly higher expenditures for the Medicare program.

 

Medicare Part B Income-Related Monthly Adjustment Amounts 

A beneficiary’s Part B monthly premium is based on their income. These income-related monthly adjustment amounts affect roughly seven percent of people with Medicare Part B. The 2022 Part B total premiums for high-income beneficiaries can be found on the CMS website.

 

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,556 in 2022, an increase of $72 from $1,484 in 2021. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2022, beneficiaries must pay a coinsurance amount of $389 per day for the 61st through 90th day of a hospitalization ($371 in 2021) in a benefit period and $778 per day for lifetime reserve days ($742 in 2021). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022 ($185.50 in 2021).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be$274 in 2022, a $15 increase from 2021. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $499 a month in 2022, a $28 increase from 2021.

 

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, a beneficiary’s Part D monthly premium is based on his or her income. These income-related monthly adjustment amounts affect roughly eight percent of people with Medicare Part D. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary from plan to plan and roughly two-thirds are paid directly to the plan, with the remaining deducted from Social Security benefit checks. The Part D income-related monthly adjustment amounts are all deducted from Social Security benefit checks. For higher income beneficiaries there is an added monthly adjustment amount which can be found on the CMS website.

 

2022 Annual Update of Per-Beneficiary Threshold Amounts

According to CMS, MLN Matters Number: MM12470, effective January 1, 2022, the KX modifier threshold amounts have not changed for 2022. These amounts are now known as the KX modifier thresholds and are per beneficiary. There is one amount for PT and SLP services combined and a separate amount for OT services. Claims from suppliers or providers for therapy services above these amounts without the KX modifier are denied. The CY 2022 KX modifier threshold amounts are:

  • $2,150 for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined
  • $2,150 for Occupational Therapy (OT) services

Another provision of Section 50202 of the BBA of 2018 adds Section 1833(g)(7)(B) of the Act to maintain the targeted medical review process but at a lower threshold amount of $3,000. This threshold amount is now the Medical Record (MR) threshold amount. One MR threshold amount for PT and SLP services combined and another for OT services. This MR threshold amount will remain at $3,000 until CY 2028 when it will be updated by the MEI.

Changes to amount in controversy (AIC) for appeals in 2022

According to the appeals level process there are two levels for claims in dispute that have a required “amount in controversy” that must be met. The first level is the Administrative Law Judge (ALJ) level and the second is the Federal District Court level. These AICs are recalculated and updated on an annual basis. The AIC for these appeal levels filed on or after January 1,2022 are:

  • ALJ hearing will remain the same at $180
  • Federal district court will remain the same at $1,760

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