Latest News on the Medicare Advantage Program

Potential cut in Medicare Part B premiums

For Medicare beneficiaries who are wondering if their Part B premiums could be reduced, the wait continues.

More than three months after Secretary of Health and Human Services Xavier Becerra ordered a reassessment of this year’s standard monthly premium of $ 170.10, a larger-than-expected jump of $ 148.50 in 2021 , it is not yet known when a determination will come and whether it would affect which beneficiaries. pay this year.

“A mid-term reduction in premiums would be unprecedented,” said Tricia Neuman, executive director of the Kaiser Family Foundation’s Medicare policy program.

A spokesman for the Medicare and Medicaid Service Centers said the agency is continuing to review the premium and will announce more information when it becomes available.

About half of the larger-than-expected premium increase in 2022, set last fall, was attributed to the potential cost of covering Aduhelm, a drug that fights Alzheimer’s disease, although actuaries still did not know the details of how it would be covered because Medicare officials were still determining.

By law, CMS is required to set the Part B premium for each year at 25% of the estimated costs that this part of the program will incur. Thus, in its calculation for 2022, the agency had to consider the possibility of broadly covering Aduhelm.

Several weeks ago, CMS officials announced that the program will only cover Aduhelm for recipients who receive it as part of a clinical trial. In addition, the price tag per patient that actuaries had used in their calculation last year was halved, as of Jan. 1, by manufacturer Biogen, to $ 28,000 a year from $ 56,000. dollars.

“Certainly the reason for such a high increase is gone,” said Paul Ginsburg, a senior non-resident member of the Brookings Institution and an expert on health policy. “The question would be what is administratively viable.”

If there is a reduction in the premium, there is also the possibility that it will be applied for 2023 instead of 2022. In the past, there have been year-on-year falls in the Part B premium for a number of reasons, including legislative changes. in how the premium is calculated. .

“If I was managing this, I would be concerned about setting a precedent for mid-year changes,” Ginsburg said.

It is also possible that lower-than-projected spending in Aduhelm may be offset at least in part by increased costs in other areas of Part B coverage, which includes outpatient care and medical equipment. Although Medicare Part D provides prescription drug coverage, some drugs are administered in a doctor’s office, as with Aduhelm, which is delivered intravenously, and therefore covers Part B.

“Although fewer people use Aduhelm than originally planned and at a lower price than previously thought, actuaries may be inclined to consider other changes that could moderate that amount,” Neuman said.

About 6 million Americans suffer from Alzheimer’s, a degenerative neurological disease that slowly destroys memory and thinking skills, and has no known cure. It can also destroy the lives of families and friends of people with the disease.

Most of these patients are age 65 or older and are generally enrolled in Medicare, which covers more than 63 million people. In 2017, about 2 million beneficiaries used one or more of the Alzheimer’s treatments that were available in Part D, according to the Kaiser Family Foundation.

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