If ever there was a year to scrutinize your Medicare Advantage Plan choices, this is it.
Costs in most plans are rising, but seniors will need to look carefully to figure out how and where they will be charged more.
A drop in the average premium for Medicare Advantage plans can be deceiving. Premiums will be lower in 2022 at $19 per month, compared to $21.22 in 2021.
But where costs are rising is the drug plans. The average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021. In addition, in some plans, drugs will move into different tiers of coverage, making them more expensive for the consumer
“Everything has gone up a dollar or two here or there,” said Edith Gooden-Thompson, who oversees Medicare counseling for the SHINE program offered by the Area Agency on Aging Broward. “It does pay for people to take a look to see if they can improve their lot.”
“The drug costs seem to be going up and that’s important to consider,” Gooden-Thompson said. “People are asking me about the cost of going to a specialist because that seems to be going up too. This is an important year to really look at everything.
Seniors have until Dec. 7 to make their choices that go into effect Jan. 1. Medicare health and drug plan costs and covered benefits can change from year to year even within the same plan. Experts recommend reviewing your plan and your choices annually to decide on the options that best meet your health needs for that particular year.
In South Florida, there are more choices of plans this year. You can choose from 65 plans in Broward County compared with 53 plans last year. In Palm Beach County, you can choose from 49 plans, one more than last year. There are more special needs plans, too — 50 in Broward compared to 39 last year, and 46 in Palm Beach compared to 37 last year.
When you shop for plans, you will need to have a list of your medications and check the deductibles. In 2022, most Medicare Advantage insurers are waiving cost-sharing requirements for COVID-19 testing, vaccines and some treatments.
In choosing a plan, your key selection criteria should be whether it covers your medications and your current doctors and how much your co-pay is for those benefits, says Dave Rich, CEO of Ensurem, a Florida-based insurance technology and product distribution firm. “I hate to see someone change plans because someone entices them with vision or hearing benefits. Those are a small part of the overall costs.”
Rich said other considerations should be whether a prescription medication changes from being tier one or two to become a specialty drug. “In that case, it could be substantially more expensive from one plan to another.”
He noted that in 2022, deductibles for Medicare Part A (hospitalization) and Part B (visits to doctors and testing) have increased, as have the Part B and recommended Part D premium.
In Florida, here are the noteworthy changes:
- There are 583 Medicare Advantage plans available in 2022, compared to 526 plans in 2021 — a 10% increase in plan options.
- The average monthly Medicare Advantage premium changed to $8.54 in 2022, up from $8.36 in 2021.
- Seven plans will offer the Medicare hospice benefit.
- EIght stand-alone Medicare prescription drug plans and 244 Medicare Advantage plans with prescription drug coverage will offer lower out-of-pocket insulin costs
- Everyone with a stand-alone Medicare prescription drug plan will have access to a plan with a lower premium than what they paid in 2021 — $7.70 is the lowest monthly premium for a stand-alone Medicare prescription drug plan
- Express Scripts, which had three stand-alone drug plans in Florida (these plans are statewide), will not serve Florida in 2022.
- Lasso Healthcare Growth, which became the state’s first Medicare Advantage Medical Savings Account plan in PY2021, will be back in Broward and Palm Beach counties in PY2022.
- Doctor’s HealthCare Plans, out of Coral Gables, will be offering a plan in PY2022 for the first time in Broward and Palm Beach. They are offering a special needs plan, DrPlus-B, in Broward for local low-income seniors dually eligible for both Medicare and Medicaid.
“Florida has the most plans and most payers, which is good news for beneficiaries,” said Aetna Chief Medicare Officer, Jim McCunney. “Think about your physical and emotional needs as you explore your options.”
For example, McCunney said, if you travel often, you might want to explore a plan such as Aetna’s PPO offerings that include a benefit called multistate travel with in-network coverage. Or if you feel socially isolated, you might seek a plan that offers companion care.
Aetna has more plans this year offering services beyond clinical care such as healthy foods or utilities benefits cards, or fall prevention benefits, McCunney said.
The extended telehealth benefits that allow seniors to receive care and mental health services in a virtual format from their own homes continue to remain a part of many of the plans. “I can never see that going away,” McCunney said. “One of the positive things coming out of the pandemic is great access to care from the convenience of your home.”
Another change in the 2022 Medicare Advantage options comes in the drug plans within a feature often referred to as the “doughnut hole.” This is the time period when the cost of medications reaches a specific level, and you are in what is called a coverage gap. Historically when this happened, your drug costs would rise dramatically. This year, the Medicare Part D change is raising the amount of money it takes to reach this gap — so it will take longer to reach. The amount it took to reach this gap in 2021 was $4,130 and it has been raised in 2021 to $4,430. In 2022, you leave the doughnut hole — and enter the catastrophic coverage level — when your spending reaches $7,050.
Jane Sung, a senior strategic policy adviser for AARP, advises looking at the details of what’s being covered and not just at the premiums, “A lot of MA plans this year highlight zero-dollar premiums but if you just look only at that, you might not look at what’s covered, and what doctors are in the network and details under the services.”
Sung said anyone with Medicare who also has a drug plan needs to review it every fall, “even if you are happy with your existing coverage, look at whether there are changes that might result in big costs at the pharmacy.”
Health reporter Cindy Goodman can be reached at email@example.com.
- Make sure this Medicare open enrollment period is actually for you.
Medicare open enrollment is for people who have already enrolled in Medicare. It does not apply to Medigap plans, which provide supplemental insurance coverage for Original Medicare’s out-of-pocket costs
If you are enrolled, you can switch from Original Medicare to Medicare Advantage — or the other way around, and switch from one Medicare Advantage plan to another, or from one prescription drug plan to another.
- Take time to compare options.
“If you don’t take a little time to compare options during open enrollment, you’re probably leaving money on the table,” said Louise Norris, a licensed broker and analyst for medicareresources.org
- Don’t overlook changes in your own situation.
Your medical or financial situation may very well have changed over the past year, and that means it’s likely your coverage needs have also changed. You may find you need a plan that better fits your budget, or you may find you’re now willing and able to pay for more robust coverage.
- Don’t focus on the premium alone.
Each part of Medicare has costs that go along with it — either in the form of premiums, out-of-pocket costs when you need medical care, or both — and those costs are always changing. But along with premiums, look into a plan’s out-of-pocket costs, including copayments, deductibles and coinsurance costs.
- Don’t assume your provider networks and drug costs will stay the same.
Along with premium changes, provider networks for these plans and prescription drug costs also change, meaning your doctors and preferred pharmacy might not continue to be in-network with your current plan.