Q. I understand that Medicare’s Open Enrollment began last week and will go until early December. Before I make any decisions. I was wondering if you could tell me about any changes to Medicare that are going to occur in 2022. Thanks so much for your help!A. Medicare’s Open Enrollment runs this year from October 15 through December 7. Now is the time to decide whether switch Medicare health or drug plans for 2022. If you currently have Original Medicare plus a Medicare supplement policy (also called a Medigap policy), during open enrollment you can switch to a different Medicare supplement policy and/or a different Medicare Part D drug plan, without any medical review. If you currently have a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan without any medical review. You can also switch from a Medicare Advantage Plan to Original Medicare plus a Medicare Supplement policy, but this type of switch will typically require a medical review, and your premiums could be greatly increased depending on your current medical condition.
As a general rule, we recommend to our clients turning 65 that they opt for Original Medicare plus a Medicare supplement plan, as these plans offer much greater coverage options than Medicare Advantage plans, although Medicare Advantage plans are typically less expensive. Click here for an excellent chart from CMS explaining the pros and cons of Original Medicare (with a Medicare Supplement) versus Medicare Advantage.
If you’re thinking of possibly switching from Medicare Advantage to Original Medicare with a Medicare supplement, the younger and healthier you are when you do this, the better off you’ll be.
Before finding the best plan for you, reviewing changes that are going to occur in 2022 is a wise idea. These are some of the major changes that will occur next year:
General Telehealth services
The passage of the Consolidated Appropriations Act (CAA) of 2021, along with the recent Centers for Medicare & Medicaid (CMS) regulation changes, have further expanded telehealth coverage in 2022.
– During the height of the COVID-19 pandemic, which CMS refers to as a public health emergency (PHE), a new category of telehealth services was
created called Category 3, which designates that a telehealth service is considered a temporary addition to the Medicare telehealth services list. CMS has decided that all current Category 3
telehealth services will be covered until December 31, 2023. CMS will use the extended coverage period to collect data to determine whether services should be permanently added to the telehealth list.
– A second set of temporary telehealth services did not achieve Category 3 status and coverage is scheduled to expire when the PHE ends. CMS will continue to collect feedback to determine if these services should be considered for a permanent addition to the telehealth list.
– During the PHE, access to telehealth services has been greatly expanded and the patient’s home, regardless of geographic location, has temporarily been allowed as an originating site for telehealth services.
– When the PHE ends, beneficiaries may be uncertain about which services will be permanently available via telehealth. Be sure to check with your provider to ensure it offers the telehealth coverage you desire.
Mental and Behavioral Health Telehealth Services
Long-standing telehealth geographic restrictions have been removed and now allow for coverage for mental and behavioral health services provided via telehealth in all areas, at least under original Medicare. Medicare Advantage plans still generally limit you to receiving services only from doctors that are “in-network.”
Coverage for Audio Only (Telephone) Counseling for Mental Health
Medicare will cover mental health counseling and services provided by phone only when: offered by providers that have capability of providing two-way audio/video technology and only when the beneficiary does not have access to or consent to audio and video communication.
– CMS is currently requiring a face-to-face visit once every 6 months, but the frequency requirement is subject to change. CMS is collecting comments and guidance on the appropriate frequency for the in-person visit requirement.
– In 2022, Original Medicare will cover mental health visits furnished via telehealth by rural health clinics and federally qualified health centers.
– Outpatient treatment programs will also be able to continue to provide audio-only mental health services after the end of the PHE.
Virtual check-ins
Virtual check-ins have been a covered Medicare service during the past few years.
Therapy services
Beginning January 1, 2022, services provided in whole or in part by a physical therapy assistant and/or an occupational therapy assistant will be paid at a reduced rate (85% of 80%) of the applicable Part B fee schedule amount for people with Original Medicare.
Beneficiaries should contact their Medicare Supplement plans for information on co-insurance and copayment for therapy services.
Changes to Beneficiary Coinsurance Associated with Colorectal Cancer screening
CMS is establishing a special circumstances coinsurance rule that will eventually eliminate the coinsurance payment when a growth or polyp is found and removed as part of a screening colonoscopy or flexible sigmoidoscopy procedure. The coinsurance amount will be waived regardless of whether tissue is removed during the procedure. The coinsurance reduction will be phased in during an eight-year period as follows:
• 20% for 2022
• 15% for 2023-2026
• 10% for 2027-2029
• No copayment beginning in 2030
Changes to Medicare Part D
Many Medicare Part D plans place drugs on different “tiers” that determine what percentage patients pay in cost-sharing. Patients typically pay 25% to 50% of the cost for drugs on the highest-priced specialty tier — and all drugs on the specialty tier have the same level of cost-sharing.
Starting in 2022, CMS will allow Medicare Part D plans to have a lower “preferred” specialty tier. This means plans can negotiate with drug makers to get better discounts on specialty tier drugs in exchange for being listed on the “preferred” tier. Plans can then pass the savings along to patients.
Changes to the Medicare Plan Finder for the 2022 Open Enrollment
As of last month, the following updates have been made to Medicare Plan
– The mymedicare.gov website has been discontinued in favor of a single Medicare.gov website;
– Logged in users can save pharmacy and drug lists;
-Plan filters now appear horizontally across the page;
– In-network pharmacies are now indicated.
Special Election Periods (SEPs)
If you have recently moved, retired, lost coverage, or entered a nursing home, you may be eligible for a new Medicare Supplement Plan or a new Medicare Advantage plan based on a “qualifying life event” that creates a Special Enrollment Period (SEP).
CMS recently added a note on the Medicare.gov website about Special Election Periods that reads “if you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder, call 1-800-Medicare and explain your situation.”
The addition of the note on the Medicare.gov website provides an opportunity for more beneficiaries to know about and utilize a Special Election Period.
Review Your Options for Open Enrollment
Given these changes that are due to happen in 2022, it’s important to review your coverage options. Here are a few reasons why:
– New, more affordable Medicare plans may be available. Check if other plan options could better meet your needs or lower your out-of-pocket costs.
– Your needs may change. You may find you’re going to the doctor more or less often, the prescription drugs you take may be different, or you may need better access to health care services.
– Benefits and costs can vary. Not all Medicare coverage options offer the same benefits. Plan benefits and costs can change from year to year.
Need Help Navigating Medicare? We can help!
At the Farr Law Firm, we are always looking for ways to better serve our clients, and we’re excited to introduce you to our newest relationship focused solely on your Medicare health plan and drug plan needs. We are now working with the excellent team at Medicare Together because of their knowledge, experience, and dedication to client service. All the services provided by Medicare Together are provided at absolutely no cost to you. The experienced team of advisors at Medicare Together can help you navigate the numerous aspects of Medicare. Click here for last Monday’s article about our new affiliation with Medicare Together and be sure to read our Monday newsletter series about Medicare for more information.
Medicare Doesn’t Cover Nursing Homes – Now is Also the Time to Plan for Long-Term Care
Just as it is important to sign up for Medicare on time and make changes during open enrollment, it is also important to plan for long-term care. More than two-thirds of us will need some sort of long-term care in the future, but Medicare will NOT cover the costs.
Medicare Part A provides coverage for short-term stays in skilled nursing facilities, but only for rehabilitation for people who continue to improve, or for those who need skilled nursing care such as assistance with complex wound dressings, tube feedings, or rapidly changing health status. If you only require custodial care, such as help with bathing, dressing, and eating, that is considered long-term care and not healthcare, and is not covered by Medicare.
If you or a loved one is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for an initial consultation:
Medicare Planning Fairfax: 703-691-1888
Medicare Planning Fredericksburg: 540-479-1435
Medicare Planning Rockville: 301-519-8041
Medicare Planning DC: 202-587-2797
About Evan H Farr, CELA, CAP
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