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Tag: Medicare Part B

  • Social Security benefits should increase modestly in 2025

    Social Security benefits should increase modestly in 2025

    Social Security benefits should increase modestly in 2025. Andy Markowitz reports for AARP that we won’t know for sure what the Social Security cost of living increase will be in 2025 until October. But, preliminary numbers suggest an increase of close to three percent.

    In July, the Consumer Price Index was up 2.9 percent from the year before. The federal government bases its Social Security increase on the rise in the Consumer Price Index in July, August and September. Inflation is slowing down, so the increase in Social Security benefits may be closer to 2.6 percent.

    Prices remain high for lots of goods and services that older adults and people with disabilities need, including food and health care. So, some experts believe that August and September inflation numbers could bring up the Social Security COLA to as much as 3.25 percent.

    If Social Security benefits rise 2.9 percent, people will see, on average, an increase of $54 in their Social Security benefits, to $1,924, beginning in January. Survivor benefits would increase by $44 to $1,552, on average. Social Security Disability Insurance benefits (SSDI) would increase $45, on average, to $1,583.

    Social Security benefits are, thankfully, inflation-protected. Unfortunately, the cost-of-living increase calculation is based in large part on the basket of goods people under 65 purchase and not exclusively on the basket of goods older adults and people with disabilities need. Consequently, if health care costs rise faster than other goods, the Social Security adjustment is often not as large as it needs to be to make people with Medicare whole.

    In their 2024 Annual Report, Medicare’s Trustees predicted that the monthly Medicare Part B premium would increase from $174.70 to $185 in 2025. So, if the Social Security COLA increases by $54, on average, people will only see a $43.70 increase in their benefits. The other $10.30 will be deducted from their Social Security checks to cover the additional portion of their Medicare Part B premium.

    Here’s more from Just Care:

  • What are your Medicare premiums in 2024?

    What are your Medicare premiums in 2024?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, more than 20 percent of their medical and inpatient costs out of pocket (or through Medigap or Medicaid,) as well as most or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2024. Here’s what you need to know.

    Part B premiums in 2024:
    In 2024, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $103,000 or less pay a monthly Part B premium of $174.70, an increase of $9.80.

    People with incomes above $103,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $244.60 a month, if their income is above $103,000 and no more than $129,000.
    • $349.40 a month, if their income is above $129,000 and no more than $161,000.
    • $454.20 a month, if their income is above $161,000 and no more than $193,000.
    • $559 a month, if their income is above $193,000 and less than $500,000.
    • $594 a month, if their income is $500,000 or more.

    For couples with combined incomes of $386,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $386,000 and less than $750,000 each pay a $559 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $594 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $240, an increase of $14 from the annual deductible of $226 in 2023.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2024 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month, the same as in 2023; if you don’t have at least 30 quarters, the premium is $505 a month, a $1 decrease from 2023.
    • The Medicare Part A inpatient hospital deductible is $1,632, in 2024 an increase of $32 from 2023, and  coinsurance for hospitalizations after day 60 is $408 a day in a benefit period; coinsurance for lifetime reserve days is $816 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $204, an increase of $4.00 from $200 in 2023.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    Here’s more from Just Care:

  • Bernie Sanders blasts drug manufacturers for the “unconscionable” price of Alzheimer’s drug

    Bernie Sanders blasts drug manufacturers for the “unconscionable” price of Alzheimer’s drug

    CNBC.com reports that Senate HELP committee chair, Bernie Sanders, is blasting drug manufacturers Eisai and Biogen for setting the price of its Alzheimer’s drug  at a level that will prevent people with Medicare from being able to get it. He wants the US Department of Health and Human Services to lower the price of Leqembi down from its “unconscionable” current price of $26,500 a year. 

    Like Aduhelm, Leqembi is a prescription drug administered by a physician and therefore covered under Medicare Part B. Medicare covers 80 percent of the cost, and individuals must pay 20 percent coinsurance. People’s annual out-of-pocket costs for Leqembi alone would be more than $5,000, unless they have Medicare supplemental coverage.

    Right now, the price of Leqembi will drive up Medicare spending significantly, along with Medicare Part B premiums. It will also contribute to the erosion of the Medicare Trust Fund. Medicare will be spending more than it spent on the three most costliest Part B drugs in 2021.  And, though the government has the right to negotiate drug prices for the Part B and D drugs it spends the most on, it will not be able to negotiate the price of Leqembi for 13 years, given restrictions on drug price negotiation in the Inflation Reduction Act.

    As I wrote earlier this year when the FDA approved Leqembi, “Keep in mind that after the FDA approved Aduhelm, the government adjusted the Medicare Part B premium up $11 a month! Its list price was $56,000 a year, and the government assumed hundreds of thousands of people would take it.” (Thankfully, Medicare did not end up covering Aduhelm because of health risks associated with taking it and only minor benefits at best.) “This year, the standard Part B monthly premium is down $5.20 because the government adjusted it to account for the fact that Medicare is not covering Aduhelm.”

    Sanders wants manufacturers to voluntarily reduce Leqembi’s price. If not, he wants the US Department of Health and Human Services to use its authority to break the drug’s patent in order to drive competition in the market. Sanders also suggests that the Centers for Medicare and Medicaid Services (CMS) has the authority to pay less for Leqembi. It is possible, though not likely, that a similar Eli Lilly drug, donanemab, that has not yet gone to market will help drive down Leqembi’s price.

    How many people with Medicare would get Leqembi? We don’t yet know how many people with Medicare will take Leqembi. Medicare is covering it for “patients with mild cognitive impairment or mild dementia with confirmed amyloid plaques,” which could be a large cohort of the 6.7 million people with Alzheimer’s disease. The Kaiser Family Foundation estimates that if one in 20 people with Medicare take it, it would cost the Medicare Part B Trust Fund $8.9 billion annually.

    About half of people with Medicare have an annual income under $30,000. They would be hard-pressed to afford coinsurance of more than $5,000. Even if they have Medicare supplemental coverage to pick up the coinsurance, the cost of their supplemental coverage is likely to rise significantly, given the cost of Leqembi and the number of people with Medicare who might take it.

    What is the fair price for Leqembi? The Institute for Clinical and Economic Review suggests that the fair price for Leqembi could be as low as $8,900 a year. Even at that price, it would mean nearly $1,800 a year in out-of-pocket costs for people taking it.

    Here’s more from Just Care:

  • 2023: Medicare premiums and other costs

    2023: Medicare premiums and other costs

    The Medicare Open Enrollment period begins on October 15 and ends on December 7, so you will have several weeks to review your Medicare options for 2023. Particularly if you have Medicare Part D drug coverage or are enrolled in a Medicare Advantage private plan–a health plan offered by a corporate health insurance company–reviewing your options could save you a lot of money. Your Medicare Part B premium will be slightly lower in 2023, regardless of whether you are enrolled in traditional Medicare or a Medicare Advantage plan.

    In 2023, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $164.90, a monthly decrease of $5.20 from $170.10, for people with annual incomes of $97,000 or less in 2021. In addition, you will get a Social Security increase of around nine percent. The exact increase will be announced shortly.

    In 2023, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about seven percent of the Medicare population–pay a Medicare Part B premium of:
    • $230.80 a month, if their income is above $97,000 and no more than $123,000.
    • $329.70 a month, if their income is above $123,000 and no more than $153,000
    • $428.60 a month, if their income is above $153,000 and no more than $183,000
    • $527.50 a month, if their income is above $183,000 and less than $500,000
    • $560.50 a month, if their income is $500,000 or more

    For couples with combined incomes of $366,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $366,000 and less than $750,000 each pay a $527.50 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $560.50 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $26, a decrease of $7 from the 2022 annual deductible of $233.

    If your income is low, you may qualify for help paying your premium and sometimes also your deductibles and coinsurance through the Medicare Savings Programs: People with incomes up to 135 percent of the federal poverty level, ($1,549 in monthly income for an individual and $2,080 for a couple in 2022; these amounts may increase in 2023) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2023 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $259 a month; if you don’t have at least 30 quarters, the premium could be $471 a month.
    • The Medicare Part A inpatient hospital deductible is $1,600, in 2023 an increase of $44 from 2022, and  coinsurance for hospitalizations after day 60 is $400 a day in a benefit period; coinsurance for lifetime reserve days is $800 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $200.00, an increase of $5.50 from $194.50 in 2022.

    If you have Medicare and are 36 months post kidney transplant, you are no longer eligible for full Medicare coverage. But, beginning in 2023, you can elect to continue Part B coverage of immunosuppressive drugs if you pay a premium. In 2023, the immunosuppressive drug premium is $97.10.

    Medicare Part D premiums

    Premiums for Part D prescription drug coverage vary by income and by Part D plan. The premium is generally deducted from your Social Security check. People with annual incomes at or under $97,000 do not pay an additional income-adjusted premium amount.

    If your annual income is above $97,000, you will be charged between $12.20 and $76.40 a month extra. The extra amount is based on how much higher than $97,000 your income is, with a cap at $750,000.

    Insulin

    Beginning July 1, 2023, you will pay no more than $35 a month out of pocket for insulin. If you take insulin through a pump you get through Medicare, you will have no deductible.

    Here’s more from Just Care:

  • Biden administration says Part B premiums will drop in 2023

    Biden administration says Part B premiums will drop in 2023

    People with Medicare are paying about $11 a month in extra Part B premiums this year but, next year, everyone with Medicare should see lower Part B premiums according to HealthCareFinanceNews. After factoring the cost of covering Aduhelm, a new exceedingly costly Alzheimer’s drug, into this year’s Part B premium, the Biden administration determined that Medicare would not cover the drug, except in limited circumstances. Still it is not giving people a refund or adjusting the Part B premium until next year.

    Medicare’s projected spending on Aduhelm is responsible for $11 in Part B premiums this year based on the manufacturer’s $56,000 a year launch price and an assumption that Medicare would cover it. Since the Part B premium was calculated, however, Biogen, the manufacturer cut the launch price in half, and Medicare said it would only cover the drug for people in clinical trials.

    The Biden Administration claims it cannot lower the Part B premium this year because of administrative and legal obstacles. Secretary of Health and Human Services, Xavier Becerra said that “After receiving CMS’s report reevaluating the 2022 Medicare Part B premiums, we have determined that we can put cost-savings directly back into the pockets of people enrolled in Medicare in 2023.” “We had hoped to achieve this sooner, but CMS explains that the options to accomplish this would not be feasible.”

    Fierce Healthcare reports that a CMS report goes further: CMS  “does not have sufficient authority to send premium refunds directly to beneficiaries unless there is excess payment relative to the established premium.” If CMS had not considered the cost of Aduhelm in its Part B premium calculation this year, the premium would have been $160.40.

    Because the Centers for Medicare and Medicaid Services factored the cost of Aduhelm into the Part B premium, the 2022 Part B premium is $21.60 higher than it was last year, a 14.5 percent increase.

    Aduhelm has been found to have serious and sometimes even deadly side effects and no clear benefits. The manufacturers of Aduhelm ended two clinical trials because the drug was not helping people. At any price, the drug is likely ill-advised based on the clinical evidence to date. At $27,000, it’s insane.

    Here’s more from Just Care:

  • Social Security benefits projected to increase 8.6 percent in 2023

    Social Security benefits projected to increase 8.6 percent in 2023

    Inflation is taking a huge toll on Americans. If there’s any silver lining, it’s that people receiving Social Security benefits should see their largest benefit increase in more than 40 years. CBSNews.org reports that Social Security benefits are projected to rise 8.6 percent in 2023; that said, Social Security benefits should increase far more.

    How does the Social Security increase translate to dollars? It will mean about $142.60 more each month for the typical person on Social Security. The total average monthly check should rise to $1,800.

    Since last April the Consumer Price Index is up about 8.3 percent. It’s up about 8.9 percent for urban wage earners and clerical workers, the CPI-W. Social Security bases its cost of living adjustment for older Americans on a somewhat different calculation.

    Today, 69 million Americans receive Social Security benefits. This year they saw a 5.9 percent cost of living adjustment. That increase is lower than the overall cost of living increases typical older adults are facing. Older adults spend a lot more than younger people on health care.

    Some of the Social Security benefit increase will go to the cost of the Medicare Part B premium, which is likely to increase next year. Last year, it rose 14.5 percent or a total of $21.60.

    Then again, $11 of the increased Medicare Part B premium this year is attributable to the projected cost of Aduhelm. Since the Centers for Medicare and Medicaid Services ended up deciding not to cover Aduhelm except in rare instances, people are already spending $11 more in Medicare premiums than they should be.

    Because Social Security checks do not keep up with the inflation older adults see, the value of their benefits is estimated to have eroded 40 percent. As a consequence, an increasing number of older adults and people with disabilities rely on food banks and food stamps. A better COLA index would be the CPI-E, which factors in rising health care costs more heavily.

    Here’s more from Just Care:

  • New Alzheimer’s drug drives up Part B premiums

    New Alzheimer’s drug drives up Part B premiums

    As with all health care costs, Medicare out-of-pocket costs are rising rapidly. In 2022, Medicare Part B premiums, which everyone with Medicare must pay–except for people with Medicaid–will be 14.5 percent higher. The reason in large part is Aduhelm, the new Alzheimer’s drug, which Medicare is likely to begin covering under Part B and which costs a hefty $56,000 a year.

    About half of the Medicare Part B increase–$15 a month or $180 a year–can be attributed to an expected Centers for Medicare and Medicaid Services’ final determination that Medicare should cover 80 percent of the cost of Aduhelm. It is unacceptably tragic that Medicare would cover this extraordinarily costly drug, which has yet to show any benefits in clinical trials, yet does not cover long-term nursing home care and home care, or vision, hearing and dental care, which we know would benefit everyone.

    Part B premiums for almost everyone with Medicare will be $170.10 a month in 2022, up $21.60 from this year. For people with annual incomes over $91,000, these premiums will be even larger. While Social Security benefits are increasing an average of $90 a month, this Medicare Part B premium increase will eat into more than 20 percent of that benefit increase.

    Right now, few insurers are willing to pay for Aduhelm. And, for good reason. There is no evidence that it slows the progression of dementia and provides benefits worth anything close to its $56,000 a year price tag. But, it has been approved by the Food and Drug Administration. And, the Centers for Medicare and Medicaid Services historically has covered all drugs that are FDA approved, though it is not obligated to do so.

    The non-profit Institute for Clinical and Economic Review has ascribed a value of around $5,000 a year to Aduhelm, based on the little known about its benefits. That’s about ten percent of what Biogen, its manufacturer, is charging for it.

    Nothing in the Build Back Better legislation currently being finalized in Congress would bring down the price of Aduhelm. At best, the bill would bring down the cost of 60 drugs that Medicare covers, beginning with the 10 that are the most expensive for the program, so long as they have been on the market for nine years or more and 12 years or more for biologics.

    If approved, Aduhelm will be covered under Medicare Part B, because it must be administered by a physician and cannot be bought at the pharmacy. In addition to bearing the expense of higher Part B premiums, people in traditional Medicare will likely see significantly higher premiums for supplemental insurance. And, people in Medicare Advantage plans will likely see far higher out-of-pocket costs.

    Here’s more from Just Care:

  • What are Medicare premium and other costs in 2022?

    What are Medicare premium and other costs in 2022?

    The Medicare Open Enrollment period ends on December 7, so you still have time to review your Medicare options for 2022. Particularly if you have Medicare Part D drug coverage or are enrolled in a Medicare Advantage private plan–a health plan offered by a corporate health insurance company–it could save you a lot of money. Your Medicare Part B premium is rising regardless of whether you are enrolled in traditional Medicare or a Medicare Advantage plan.

    In 2022, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $170.10, a monthly increase of $21.60 from $148.50, for people with annual incomes of $88,000 or less in 2021. Your Social Security increase should cover that cost and, for most people, provide an additional $70 a month in benefits.

    Social Security benefits in 2022 will be up an average of nearly six percent from this year, around $90 a month. Some of that increase will go towards the higher Medicare monthly premium.

    In 2022, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about six percent of the Medicare population–pay a Medicare Part B premium of:
    • $238.10 a month, if their income is above $91,000 and no more than $114,000.
    • $340.20 a month, if their income is above $114,000 and no more than $142,000
    • $442.30 a month, if their income is above $142,000 and no more than $170,000
    • $544.30 a month, if their income is above $170,000 and less than $500,000
    • $578.30 a month, if their income is $500,000 or more

    For couples with combined incomes of $330,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $340,000 and less than $750,000 each pay a $544.30 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $578.30 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $233, an increase of $30 from the annual deductible of $203 in 2021.

    People with incomes up to 135 percent of the federal poverty level, ($1,456 in monthly income for an individual and $1,960 for a couple in 2020; these amounts may increase in 2021) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2021 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $259 a month; if you don’t have at least 30 quarters, the premium could be $471 a month.
    • The Medicare Part A inpatient hospital deductible is $1,556, in 2022 an increase of $72 from 2021, and  coinsurance for hospitalizations after day 60 is $389 a day in a benefit period; coinsurance for lifetime reserve days is $778 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $194.50, an increase of $9.00 from $185.50 in 2020.

    Here’s more from Just Care:

  • MedPac: High drug prices mean higher Medicare spending

    MedPac: High drug prices mean higher Medicare spending

    Not only are drug prices rising at the pharmacy for people with Medicare, but drug prices are rising for hospital inpatients as well. MedPac, the agency that oversees Medicare, says rising drug prices are responsible for a huge increase in Medicare Part B drug spending. It wants Congress to rein in these prices.

    During its October 7 meeting, MedPac members discussed Medicare Part B drug spending. For years, MedPac has said that Congress needs to rein in drug prices. But, the pharmaceutical industry has consistently managed to keep Congress from responding appropriately and regulating prices.

    MedPac members focused on prices for infusible and injectable drugs. Medicare pays for these drugs at the average sales price plus six percent. Members believe that Aduhelm, the new FDA-approved drug for people with Alzheimer’s disease, could literally wipe Medicare out. Yet, there is little clinical evidence that Aduhelm actually helps people with Alzheimer’s or helps them enough to warrant its launch price of $56,000.

    Prices are rising on injectable and infusible drugs that have therapeutic alternatives. So, some MedPac members are asking why Medicare should pay the high prices that these drugs command.

    And, some MedPac members believe that Congress must change its payment formula for Part B drugs. Medicare’s payment rate–average sales price plus six percent–creates an incentive for pharmaceutical companies to keep raising their rates.

    Part B drugs have seen nearly 10 percent annual Medicare spending growth over the last 12 years, which MedPac members attribute to higher drug prices. Drugs in the US have higher launch prices than in other countries and higher price increases each year. And, prices keep rising on drugs which have little or no evidence of being effective.

    Democrats in Congress are working on legislation in the reconciliation bill that should rein in these prices. Time will tell if they succeed.

    Here’s more from Just Care: 

  • Coronavirus: Medicare Trust Fund has reserves until 2026

    Coronavirus: Medicare Trust Fund has reserves until 2026

    Every year, Trustees of the Medicare Trust Fund project when the Trust Fund will not have the money needed to pay full Medicare Part A inpatient benefits. Notwithstanding the coronavirus pandemic, their 2021 projection remains the same as last year, 2026. And, Congress could and should act to shore up the Trust Fund.

    A brief Medicare primer. About 63 million older adults and people with disabilities receive health insurance coverage through Medicare. Medicare has two primary funding sources, payroll contributions and general taxes. Payroll contributions cover the cost of Medicare Part A inpatient services. Fewer people used these services in 2020 because of COVID-19.  So, even though fewer people were working and making payroll contributions, Part A remains as strong as last year.

    It’s worth noting that the Medicare Part A Trust Fund has never had its reserves depleted. And, over the last 55 years, the Part A Trust Fund reserves have fluctuated wildly. Back in 2010, Congress gave it a large injection of capital, when it passed the Affordable Care Act and imposed an additional Medicare tax on the wealthiest Americans.

    It’s also important to recognize that if the Part A reserves were to run out, Medicare Part A would still be able to cover 91 percent of projected benefits in 2026. And, if employment rises, payroll contributions will increase. Therefore, it’s more likely that the trust fund will build more reserves.

    Last year, the Part A Trust Fund lost between $60 billion and $134 billion because of loans extended to providers and suppliers to help with COVID-19 payment disruptions. The Trust Fund should get this money back this year and next.

    One critical way to strengthen the Trust Fund is for Congress to stop overpaying Medicare Advantage plans. By one expert account, if Congress does nothing, these plans will be overpaid as much as $355 billion in the next ten years. These overpayments are also driving up Medicare Part B premiums. Congress must trim the fat in Medicare Advantage.

    In addition to the Part A Trust Fund, Medicare has a Supplemental Medical Insurance Trust Fund that covers 75 percent of outpatient care under Medicare Part B. The Medicare Part B premium covers the remaining 25 percent.  And there is a Trust Fund that covers prescription drugs under Medicare Part D.

    The Medicare Part B and D Trust Funds have the money they need to cover outpatient and drug benefits. General revenues cover these expenses, so money never runs out.

    Here’s more from Just Care: