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Navigating Medicare Changes in 2022

What is Medicare? Medicare is a federal program older Americans and people with disabilities use for healthcare coverage. According to AARP, Medicare will help more than 61 million people pay for healthcare-related costs such as hospital stays, doctor visits and prescription drugs this year alone. Those who receive Social Security are automatically enrolled in Medicare. Whether you’re enrolling for the first time or want to make changes to your plan, you must do so between October 15-December 7 for the plan to take place on January 1. It’s no secret that Medicare is a complex program with many different parts. If you’re preparing to enroll in Medicare or are planning to make changes to your current plan, here’s what you need to know to get started. 

Understanding Medicare Options

Medicare is a comprehensive program that provides coverage for all healthcare needs. In general, Medicare offers lower out-of-pocket costs when compared to traditional commercial healthcare plans. To make the program easier to navigate, it’s broken down into four major parts. 

Medicare Part A covers inpatient hospital care, including hospice care and short-term skilled nursing care. You’re automatically enrolled in Part A when you apply for Medicare. In addition to hospitalization, Part A will cover doctor services and lab tests that were done while you are in a hospital or other healthcare facility. While you don’t have to pay a premium, Part A does require a yearly deductible and coinsurance costs. 

Medicare Part B covers doctor visits, lab tests, diagnostic screening, medical equipment, and ambulance transportation. Part B can involve more out-of-pocket expenses, so if you have insurance through your job or a spouse, you might consider deferring. However, if you don’t have other coverage and choose not to enroll in Part B, you’ll likely pay a higher monthly premium for the duration of your enrollment. In addition, Part B requires an annual deductible and payment of 20% of doctor visits and outpatient services costs. 

Medicare Part C is the Medicare Advantage program, which offers an alternative to traditional Medicare (Parts A and B). Medicare Advantage programs are Medicare plans that are offered by Medicare-approved private insurance companies. These plans include Parts A, B and usually Part D in addition to other benefits such as vision, hearing and dental programs. While deductibles and copays are usually lower when compared to traditional Medicare, the premiums are higher. Some people choose Medicare Advantage programs for more coverage and to make paperwork and communication easier and more efficient.

Medicare Part D covers prescription drugs and is purchased through a private insurer. Many options are depending on your needs and prices can vary. It’s best to check medicare.gov to see whether the plans you’re considering cover the medications you need.

What Changes Are Coming to Medicare in 2022?

As open enrollment is approaching, it’s important to be aware of the changes being made to Medicare. According to the official U.S. government Medicare handbook, here’s what you need to know before open enrollment:

 COVID-19 related items and services

Many people with Medicare coverage are at a higher risk of developing complications and serious illness due to COVID-19. To help protect these individuals, Medicare has continued and expanded coverage of COVID-19 related services to include the following:

  • Vaccines. FDA-authorized vaccines help reduce the risk of COVID-19 by helping the body to develop immunity to the virus. Medicare covers 100% of the cost associated with the vaccine.
  • Diagnostic tests. These FDA-authorized tests check to see if you have COVID-19. These tests are free during the COVID-19 public health emergency when you get them from a laboratory, pharmacy, doctor’s office or hospital.
  • Antibody tests. These FDA-authorized tests help see if you have developed an immune response to the illness and may be at less risk of reinfection.
  • Monoclonal antibody treatments. These FDA-authorized treatments help fight off the disease and keep you out of the hospital if you have tested positive for COVID-19 and have mild to moderate symptoms. You pay nothing for these treatments when you receive them from a Medicare provider or supplier. However, you must meet certain conditions to qualify. 

Cognitive assessment and care plan services

When you see your provider for an annual wellness check, they may perform a cognitive assessment that looks for signs of Alzheimer’s disease and other forms of dementia. These signs can include difficulty remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. Medicare covers a separate visit with your regular healthcare provider or specialist to do a full review of your cognitive function and establish or confirm a diagnosis. A diagnosis can help your healthcare team establish a care plan and manage symptoms. 

Blood-based biomarker test

Medicare covers preventive services such as colorectal cancer screenings to help find precancerous growths or find cancer early. This year, Medicare has added another lab test used to identify colorectal cancer. This lab test is available once every three years to those ages 50-85 and who have an average risk of developing colorectal cancer and have not experienced symptoms. 

Tips for Enrolling or Making Changes to Your Medicare Plan

  • Choose your doctors carefully. If you’re new to Medicare or are looking for a new doctor, it’s important to understand their Medicare status. Providers can have various statuses, including participating, nonparticipating, opt-out, and Medicare Advantage. Depending on their status, the cost of your fee might increase. If you’re preparing to visit a doctor for the first time, it’s common to set up an interview beforehand. This will allow you to see if they’re a good fit or if you need to keep looking.
  • Avoid surprise charges. Because Medicare is a complicated program, it can be difficult to keep track of which services are covered and which are not. You can always check the Medicare website to make sure you will be covered before having a treatment or appointment. If you receive a surprise bill, don’t pay it right away. Instead, call your provider and Medigap insurer to ask about the bill.  
  •  Take advantage of benefits. There are so many benefits provided by Medicare that people often forget to use them! Medicare covers annual wellness visits, eyeglasses, telehealth visits, nutrition counseling, and counseling for smokers who want to quit.
  •  Keep good records. Experts suggest keeping records of your medical history, including hospital stays, any conditions you have, your prescription drug list, medical equipment you use, pharmacy information, and emergency contact information. This will help you if you ever need to switch doctors or if you have an issue with your Medicare plan and need to access information quickly.

At Maplewood Senior Living, health is our number one priority. We know Medicare can be confusing, but enrolling in the program and knowing about Medicare changes in 2022 will allow you to access the best healthcare possible. For more information, or to schedule a tour, please contact us here.


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