It’s time for the estimated 4.8 million Floridians enrolled in Medicare to review their health care coverage, do some comparison shopping and decide whether to change plans.
The annual Medicare annual enrollment period starts Friday, when people covered under the federal health insurance program for those 65 and older can reevaluate their coverage.
During the enrollment period, which lasts through Dec. 7, they can decide whether to switch from Original Medicare to Medicare Advantage; from Medicare Advantage to Original Medicare; from one Medicare Advantage plan to another; from one Medicare Part D prescription drug plan to another; or enroll in a Medicare Part D plan if they did not enroll when they first were eligible for Medicare.
The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in late September. There are many options and many rules, which makes Medicare a challenge to navigate.
The Tampa Bay Times’ Medicare Guide breaks down the various parts of Medicare and offers charts for plan comparison to help beneficiaries, who have a wide array of choices this year.
The Medicare Advantage enrollment process varies slightly by plan, but in all cases you must be enrolled in Medicare Part A and Part B. If you enroll in a Medicare Advantage plan during the annual enrollment period and later change your mind, you can drop the plan and go back to Original Medicare (Parts A and B) during the Medicare Annual Disenrollment Period, which begins Jan. 1. If you don’t disenroll during this period, you must keep your plan for the rest of the year unless you qualify for a Special Enrollment.
Here are some points to consider:
• While the average premium for Medicare Advantage plans nationally will be lower in 2022 — $19 per month compared to $21.22 in 2021 — the average monthly premium for Floridians is increasing 2.1 percent, from $8.36 to $8.54.
• The CMS has not yet released the 2022 Medicare Parts A and B premiums and deductibles. As in prior years, Parts A and B premiums and deductibles for the upcoming calendar year will be announced this fall.
• Additionally, the average 2022 premiums for Part D coverage will increase 4.9 percent to approximately $33 per month compared to $31.47 in 2021.
Nevertheless, as 10,000 people in the U.S. turn 65 every day, the federal government projects enrollment in Medicare Advantage to reach 29.5 million in 2022 compared to 26.9 million in 2021.
There are some bright spots for Floridians. To start with, 583 Medicare Advantage plans are available in 2022, compared to 526 plans in 2021. Every individual eligible for Medicare will have access to a Medicare Advantage plan with no monthly premium.
Through the CMS Innovation Center’s Value-Based Insurance Design Model, 163 plans will offer Medicare Advantage enrollees eliminated Part D cost-sharing, rewards and incentives programs related to healthy behaviors. There are also customized benefits that address social determinants of health, such as food insecurity and social isolation for some enrollees who are underserved and may also be chronically ill.
Additionally, 244 Medicare Advantage plans with prescription drug coverage will offer lower out-of-pocket insulin costs through the Part D Senior Savings Model, and seven Medicare Advantage plans will offer a Medicare hospice benefit.
BayCare Health System is launching three plans for 2022 geared toward providing both benefits and savings that will be available in Hillsborough, Pinellas and Pasco counties.
All three — BayCare Plus Complete, BayCare Plus Premier, and BayCare Plus Rewards — promise a large network of Tampa Bay doctors and hospitals, coverage when traveling worldwide, and money-saving extra benefits including dental, vision and fitness club memberships. BayCarePlus Premier boasts a “no referrals” policy. BayCarePlus Rewards offers a Part B premium reduction of $113 per month. BayCare Plus Complete and BayCare Plus Premier offer special benefits for diabetics.
Humana is offering Tampa Bay area residents five plans for 2022 with lowered copays for several services, such as inpatient and outpatient care, emergency room visits and some therapies, and lower medical out-of-pocket maximums.
Some plans will offer a new Flex Card, a $250 debit card that enrollees can use to cover out-of-pocket costs for dental, hearing and vision services or devices.
“After considering the needs of our members and how we could offer them more for 2022, we designed our Medicare plans to address people’s whole-life needs with a particular focus on their most important health care needs,” said Humana retail segment president Alan Wheatley.
Cigna is offering four plans to residents in Hillsborough, Pinellas, Pasco and Hernando counties. New program offerings for 2022 include the addition of a Senior Savings Model to several plans and addition of a Social Connection Program that connects members with a partner who will assist them with daily living activities such as transportation, meal preparation and chores.
“Many older adults have had virtual care visits during the pandemic, and they have indicated to us their desire to continue them even after the pandemic ends,” said Christine Leo, who oversees product development for Cigna’s Medicare Advantage products.
Aetna, which this year is expanding coverage to reach more than 5.8 million veterans over 65, is also beefing up its rewards program to help enrollees improve their health and well-being. Members can earn $150 or more by completing activities such as preventive screenings and annual physicals.
Five local plans include a healthful food card allowance for members to spend each quarter at approved stores, transportation to and from medical appointments, and telehealth services, which feature office visits with health care providers using interactive two-way, real-time audio and video technology.
How Medicare works
Part A and Part B generally are the most popular programs and tend to offer the most services for those who qualify.
Part A covers inpatient hospital care, nursing home care, hospice care and home health care. These services usually are free, which means there’s no premium to pay.
Part B covers two types of services: those that are medically necessary, such as outpatient hospital care, doctor bills, physical therapy and more; and preventive services and detection of illnesses at an early stage, when treatment is likely to work best.
Part B is optional and costs most people a monthly premium, which is projected to be $144.60 for most enrollees in 2022. The premium is higher for some, depending on income; for 2022, an income-related surcharge will be added to premiums of Medicare Part B if the beneficiary earns more than $90,000, or $180,000 for married couples. The premium is a bit lower for those who choose to have the premium deducted from their Social Security check.
Unless you are still on an employer’s health plan, it makes sense to sign up for Part B when you first become eligible for Medicare regardless of your current health. You will face a penalty if you decide you need this coverage later — up to 10 percent for each year you could have had Part B but didn’t sign up for it, a penalty that will continue in effect for as long as you have Part B.
Part C refers to Medicare Advantage plans. These plans, subsidized by taxpayers, are managed by private insurance companies through either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Individuals choose medical providers from a predetermined list. The plans offer bundles that include Part A, Part B, and usually a prescription drug program (Part D).
Enrollment in Medicare Advantage nationwide rose from 10 million in 2008 to 25 million in 2020 and now accounts for an increasing share of all Medicare beneficiaries. Despite the rapid growth, the total number of Medicare beneficiaries has risen even faster — from roughly 45 million to some 68 million — meaning Medicare Advantage has plenty of room to grow.
More than 44 percent of Florida Medicare beneficiaries are enrolled in Advantage plans. Miami-Dade County leads all counties in the nation for penetration rate — the percentage of those enrolled who are eligible — at 67 percent, according to CMS.
For 2022, monthly premiums will range from free to as high as $147.90. All Florida residents who qualify for Medicare have access to a Medicare Advantage Plan with no monthly premium but should weigh the pros and cons of a low or non-existent monthly charge based on their health needs.
Medicare Advantage plans will continue to offer a wide range of supplemental benefits in 2022, including eyewear, hearing aids, both preventive and comprehensive dental benefits, access to meals, over-the-counter items, fitness benefits and worldwide emergency/urgent coverage. CMS reports that the number of plans offering special supplemental benefits for chronically ill individuals will increase from 19 percent to 25 percent.
It’s important to note that Part A and Part B services under Original Medicare come with deductibles and copays. These costs can be covered by buying private Medicare supplement policies known as Medigap. Premiums tend to be high, but the extra coverage can be worth it in the event of catastrophic illness.
Original Medicare or Medicare Advantage?
Coverage: Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities but does not cover services such as eye exams, most dental care and routine exams. You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it.
Medicare Advantage plans must cover all the medically necessary services that Original Medicare does. Most plans offer extra benefits that Original Medicare doesn’t cover, such as some routine exams and vision, hearing and dental services. Medicare drug coverage (Part D) is included in most plans. In some cases, you must get a service or supply approved ahead of time for the plan to cover it.
You may be able to get Medicare drug coverage that offers broad access to many types of insulin for no more than $35 for a month’s supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.
Doctor and hospital choice: Original Medicare allows you to see any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases, you won’t need a referral to see a specialist.
Medicare Advantage plans in many cases require you to use doctors and other providers who are in the plan’s network, at least for non-emergency care. Some plans offer non-emergency coverage out of network but at higher cost. You may need to get a referral to see a specialist.
Cost: For Part B-covered services, Original Medicare usually requires you to pay 20 percent of the Medicare-approved amount after you meet your deductible; this is called your co-insurance. You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). There is no yearly limit to what you pay out of pocket unless you have supplemental coverage such as Medicare Supplement Insurance (Medigap).
With Medicare Advantage, out-of-pocket costs vary; plans have different costs for certain services. You pay the monthly Part B premium and may also have to pay the plan’s premium. Plans may have zero premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). Plans have a yearly limit on what you pay out of pocket for services that Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year.
You should have prescription drug coverage as soon as you are eligible for Medicare — if not through an employer or some other source, such as a union or the Department of Veterans Affairs, you may want to consider purchasing either a Part D drug plan if you are on Original Medicare or a Medicare Advantage plan that covers drugs.
If you don’t have coverage as soon as you are eligible and need it later, Medicare can charge you a late penalty, so it’s worth thinking about even if you don’t use any prescription drugs.
A coverage gap, known as the “donut hole,” begins once you reach your Medicare Part D plan’s initial coverage limit. In 2022, that amount is $4,430. It ends when you spend a certain amount out of pocket, which in 2022 is $7,050.
In 2022, part D enrollees will receive a 75 percent “donut hole discount” on the total cost of their brand-name drugs purchased while in the donut hole. Seventy percent of the discount will be paid by the brand-name drug manufacturer and 5 percent will be paid by the Medicare Part D plan.
Not all enrollees will reach the donut hole, but those who do will pay a maximum 25 percent co-pay on generic drugs purchased while in the coverage gap – in other words, receiving a 75 percent discount.
The Centers for Medicare & Medicaid Services has updated the Medical Plan Finder with 2022 Medicare health and prescription plan information. Additionally, a toll-free line — 1-800-MEDICARE (1-800-633-4227) — is available 24 hours a day, seven days a week, to provide help in English and Spanish.
Medicare’s Extra Help program assists low-income Medicare recipients pay their monthly premiums, annual deductibles and copayments related to Medicare Part D. CMS estimates this benefit is worth about $5,000 per year. To find out if you qualify and to apply, call the Social Security Administration toll-free at 1-800-772-1213, apply online at socialsecurity.gov or check this page.
The federal government offers Medicare Savings Programs to help low-income seniors and adults with disabilities with Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance and copayments. To see if you qualify and learn how to apply, call the Social Security Administration toll-free at 1-800-772-1213 or visit this medicare.gov page to learn about savings programs.
The Florida SHINE program — Serving Health Insurance Needs of Elders — is a free program offered by the Florida Department of Elder Affairs and the local Area Agency on Aging. Volunteers are available who can help you navigate Medicare’s website and assist in finding the plan that best suits you. Visit floridashine.org or call them toll-free at 1-800-963-5337.
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Tampa Bay Times 2022 Medicare Guide
Everything Florida seniors need to know to get ready for Medicare enrollment is available at tampabay.com/medicare.
• HOW MEDICARE WORKS: Here’s what seniors need to know about open enrollment, how Medicare works and how to find the best coverage for 2022.
• COMPARE MEDICARE PLANS: The Times has assembled a chart to help Tampa Bay residents shop for the best 2022 coverage in Pinellas, Hillsborough, Pasco and Hernando counties.
• COMPARE PRESCRIPTION PLANS: This chart shows the plans available in Florida under Medicare’s Part D program for prescription drugs.
• HOW TO STAY SAFE FROM COVID-19: While Florida’s seniors are the most widely vaccinated age group in the state, they still are the most threatened by COVID-19. Here’s the latest advice on staying safe, why seniors must get vaccinated and why they also should get their annual flu shot.
• FINDING HELP: Serving Health Insurance Needs of Elders, or SHINE, is a state program that connects with seniors online or by phone to help them navigate the Medicare benefits. Call 1-800-963-5337 or visit floridashine.org.