Alzheimer Drug Coverage Decision in April Could Trigger Part B Premium Cut2022 Medicare Premiums Post Big Increases
The government’s top health official once again signaled that 2022 Medicare Part B premiums could be cut once Medicare formally determines how it will cover Aduhelm. The agency announced in January that it had tentatively decided to sharply limit coverage of the expensive dementia drug. Its formal decision is due April 11.
“Once we have that determination, we’ll be able to fully assess what impact Aduhelm may have had on premiums for seniors in Medicare,” Becerra was quoted in a recent STAT story. “We’re gonna make sure that seniors don’t pay more than they have to.”
In November, when Medicare announced a large increase in 2022 Part B premiums, it attributed much of the rise to the possibility of large claims by users of Aduhelm, which is made by Biogen. Because this drug must be administered by licensed caregivers, it would be covered under Part B of Medicare as an outpatient service, not by Part D prescription drug plans.
The 2022 monthly Part B premium was increased then to by $21.60, or nearly 15 percent, to $170.10 from $148.50 in 2021. This increase is more than double the projected $10 boost included in the annual report from Medicare program trustees that was released last August. the possibility of large claims by users of Aduhelm, which is made by Biogen. Because this drug must be administered by licensed caregivers, it would be covered under Part B of Medicare as an outpatient service, not by Part D prescription drug plans.
The Centers for Medicare & Medicaid services (CMS) had explained its reasoning then as follows:
“Depending on utilization, the potential costs for this course of treatment range from negligible to very significant. To ensure that Part B is able to pay claims in full and on time, the Part B financing must be sufficient to provide for a realistic high-cost scenario of Aduhelm coverage. The contingency margin has been increased to accommodate this risk.”
The rational for basing a large part of its 2022 premium increases on the possibility of big Aduhelm spending has largely disappeared since then.
On Dec. 20, Biogen, said it would halve the drug’s annual price from $56,000 to $28,200. Many Medicare organizations urged CMS then to reduce Part B premiums.
On January 10, Xavier Becerra, head of the U.S. Department of Health & Human Services, also asked CMS to reassess the amount of the Part B premium increase.
CMS has not yet indicated whether or when it might change Part B premiums but the agency’s limited approval of Adulhelm seems likely to trigger such action.
Under the 2022 premiums announced in November, higher health care expenses will also be reflected in higher patient charges for Part A and in the high-income surcharges paid on Part B and Part D premiums.
| Part A Deductible and Coinsurance Amounts | ||
| 2021 | 2022 | |
| Inpatient hospital deductible | $1,484 | $1,556 |
| Daily coinsurance for 61st-90th Day | $371 | $389 |
| Daily coinsurance for lifetime reserve days | $742 | $778 |
| Skilled Nursing Facility coinsurance | $185.50 | $194.50 |
Some people with insufficient Social Security work earnings must pay Part A premiums. “Individuals who had at least 30 quarters 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.” CMS said. “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 B Income-Related Monthly Adjustment Amounts
| Beneficiaries who file individual tax returns with modified adjusted gross income: | Beneficiaries who file joint tax returns with modified adjusted gross income: | Income-related monthly adjustment amount | Total monthly premium amount |
| Less than or equal to $91,000 | Less than or equal to $182,000 | $0.00 | $170.10 |
| Greater than $91,000 and less than or equal to $114,000 | Greater than $182,000 and less than or equal to $228,000 | 68.00 | 238.10 |
| Greater than $114,000 and less than or equal to $142,000 | Greater than $228,000 and less than or equal to $284,000 | 170.10 | 340.20 |
| Greater than $142,000 and less than or equal to $170,000 | Greater than $284,000 and less than or equal to $340,000 | 272.20 | 442.30 |
| Greater than $170,000 and less than $500,000 | Greater than $340,000 and less than $750,000 | 374.20 | 544.30 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | 408.20 | 578.30 |
Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:
| Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income: | Income-related monthly adjustment amount | Total monthly premium amount |
| Less than or equal to $91,000 | $0.00 | $170.10 |
| Greater than $91,000 and less than $409,000 | 374.20 | 544.30 |
| Greater than or equal to $409,000 | 408.20 | 578.30 |
Medicare Part D Income-Related Monthly Adjustment Amounts
| Beneficiaries who file individual tax returns with modified adjusted gross income: | Beneficiaries who file joint tax returns with modified adjusted gross income: | Income-related monthly adjustment amount |
| Less than or equal to $91,000 | Less than or equal to $182,000 | $0.00 |
| Greater than $91,000 and less than or equal to $114,000 | Greater than $182,000 and less than or equal to $228,000 | 12.40 |
| Greater than $114,000 and less than or equal to $142,000 | Greater than $228,000 and less than or equal to $284,000 | 32.10 |
| Greater than $142,000 and less than or equal to $170,000 | Greater than $284,000 and less than or equal to $340,000 | 51.70 |
| Greater than $170,000 and less than $500,000 | Greater than $340,000 and less than $750,000 | 71.30 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | 77.90 |
Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:
| Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses, with modified adjusted gross income: | Income-related monthly adjustment amount |
| Less than or equal to $91,000 | $0.00 |
| Greater than $91,000 and less than $409,000 | 71.30 |
| Greater than or equal to $409,000 | 77.90 |
