The standard premium for Medicare’s outpatient care coverage will jump by 14.5% for 2022, far outpacing an earlier estimate of 6.7%, according to the government.
The standard premium for Part B, which covers outpatient care and durable equipment, will be $170.10 next year, up $21.60 from $148.50 this year, said a senior official for the Centers for Medicare & Medicaid Services on Friday. The program’s trustees had estimated this summer that the premium would rise to $158.50.
The deductible for Part B will be $233, up $30 (14.8%) from this year.
It's due to the possibility that CMS will cover Adulhelm, the new Alzheimers drug. That was hastily approved in a total departure from long standing protocols because it showed very little benefit.
quote:
The increases in the 2022 Medicare Part B premium and deductible are due to:
Rising prices and utilization across the health care system that drive higher premiums year-over-year alongside anticipated increases in the intensity of care provided.
Congressional action to significantly lower the increase in the 2021 Medicare Part B premium, which resulted in the $3.00 per beneficiary per month increase in the Medicare Part B premium (that would have ended in 2021) being continued through 2025.
Additional contingency reserves due to the uncertainty regarding the potential use of the Alzheimer’s drug, Aduhelm™, by people with Medicare. In July 2021, CMS began a National Coverage Determination analysis process to determine whether and how Medicare will cover Aduhelm™ and similar drugs used to treat Alzheimer’s disease. As that process is still underway, there is uncertainty regarding the coverage and use of such drugs by Medicare beneficiaries in 2022. While the outcome of the coverage determination is unknown, our projection in no way implies what the coverage determination will be, however, we must plan for the possibility of coverage for this high cost Alzheimer’s drug which could, if covered, result in significantly higher expenditures for the Medicare program.
-------------------------------- "A mob is a place where people go to get away from their conscience" Atticus Finch
I didn't do a detailed analysis, but something doesn't pass my sniff test. I'd love to see the National Coverage Determination analysis for this drug. How could the projected premium increase more than double since the original summer projection if coverage of the new drug is included?
I wonder if they're using the drug as an excuse to raise revenues to cover other budget issues.
And on another note...that drug and how it got approved was an cluster....
-------------------------------- When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier
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Medicare has proposed covering the controversial and costly Alzheimer's drug Aduhelm only for those enrolled in qualifying clinical trials, the Centers for Medicare and Medicaid Services announced Tuesday.
The draft decision, the latest step in the drug's contentious path to market, would have far-reaching consequences both for millions of Alzheimer's patients and for tens of millions of Medicare enrollees. A final decision should be released by April 11.
"CMS has proposed an evidence-based coverage policy after experts reviewed all relevant publicly available evidence and feedback received from stakeholders," said Chiquita Brooks-LaSure, the agency's administrator.
The move is expected to restrict the number of people who could receive the medication. CMS did not have an estimate of how many patients might have access to Aduhelm through the trials.
The agency will accept public comments for 30 days and hopes to hear from Americans with Alzheimer's, their family members, patient advocacy groups, medical experts and others. Also, CMS emphasized that the clinical trials must reflect the diversity of the Medicare population with Alzheimer's.
It is weighing the benefits versus the risks associated with Aduhelm and similar Alzheimer's medications, including headaches, dizziness, falls and brain bleeds, said Dr. Lee Fleisher, CMS' chief medical officer.
It's unprecedented to require Medicare enrollees to participate in a clinical trial for a drug already approved by the US Food and Drug Administration that's being used for its intended purpose, said Tricia Neuman, executive director of the Kaiser Family Foundation's Program on Medicare Policy.
"CMS is moving forward cautiously in covering (Aduhelm) and similar drugs for Alzheimer's disease," she said, "to be sure that the drug actually works and doesn't cause harm."
