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Medicare Changes 2022

Medicare Changes for 2021: What You Should Know

Acupuncture, expanded MA availability, and more are in store for Medicare beneficiaries in 2021

Key Takeaways

Insulin copaymentA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. for a 30-day supply have been capped at $35 for qualified Medicare beneficiaries.

End-Stage Renal Disease (ESRD) patients can enroll in Medicare Advantage starting in 2021

Telehealth and telemedicine coverage will extend to 2021, along with Covid-19 lab and antibody tests.

For the first time, acupuncture may be a benefit for chronic low back pain.

What is Medicare?

Medicare is public health insurance for Americans that:

  • are 65 years of age or older.
  • are under 65 years of age but have qualifying disabilities.

Medicare was established in 1965 by President Lyndon Johnson. The intent was to establish a national program to ensure persons 65 and older had access to the healthcare coverage they needed. Initially, the coverage was limited to Part A and Part B (Original Medicare).

Today the Medicare insurance program is run by The Centers for Medicare and Medicaid Services (CMS). The program is funded partially by the federal budget, income taxes paid to Social Security and Medicare, and premiums paid by Medicare beneficiaries.

Original Medicare (Part A & Part B) insurance can be used at any doctor or hospital in the U.S. that accepts it. While Part A and Part B provide coverage for the majority of your expenses, there are federally regulated supplemental policies that you can purchase to help fill the gaps that aren’t covered in-full by Original Medicare.

The most popular form of Medicare is Original Medicare, which is Parts A & B only.

What’s Covered by Medicare?

Medicare Part A and Medicare Part B cover most standard medical services. Think of Part A as “hospital insurance or in-patient,” and Part B as “medical insurance or out-patient.”

Part A (Hospital Insurance)Part B (Medical Insurance)
InpatientDoctors & other care providers
Skilled nursing facility careOutpatient Care
Hospice CareHome health care
Home health careMedical equipment (like walkers, wheelchairs, or beds)
Preventive & screening services
Basic Part A & B coverage.

Between Parts A and B, Original Medicare covers a wide range of services. For a deeper look into what you can expect from your Medicare policy, check out Your Medicare Coverage at

Medicare also has Part C, known as Medicare Advantage and, Part D which is the drug coverage. These were both established after Original Medicare and will be discussed in detail later.

How Much Do Medicare Part A and B Cost?

For most people, their budget is front and center when considering which health insurance to choose. Here’s a starting point when working out your budget:

Medicare Part A costs for 2022

  • Deductible: $1,556
  • Premium: $0 (for most people)

Keep in mind:

  • You’ll want to know if you’re responsible for paying a premium. Most individuals don’t have a Part A premium, but it can vary from person to person based on employment and tax history.
  • You’ll be responsible for your Part A deductible.

Medicare Part B costs for 2022

  • Deductible: $233
  • Premium: $170.10

Keep in mind:

  • Medicare Part B has a standard yearly deductible cost.
  • Medicare Part B has a standard monthly premium cost.

The standard premium for Medicare Part B is income-based. For both Part A and Part B, after you meet your deductible, your cost for care will be approximately 20%, and Medicare will pay about 80% for the remainder of your benefit calendar year.

There are plenty of other factors to consider, including copayments, co-insurance, and when to enroll. Start to estimate your costs with the Medicare Expert Calculate the Costs worksheet.

How Do I Get Original Medicare?

Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.

The majority of Americans that choose Medicare health insurance plans are 65 years of age or older. If that’s you, you’ll want to remember the seven-month rule, which says that you have seven months to enroll in Medicare during the year you turn 65.

For example, if you turn 65 in August:

  • Three months before your birth month: May, June, July
  • Your birth month: August
  • Three months after your birth month: September, October, November

You can use the Medicare Expert Enrollment Calculator to see your eligibility date.

Eligibility for Part A

You are eligible for Medicare Part A at age 65 if you or your spouse has legally worked for at least 10 years in the U.S.

During those years, you paid taxes toward your Part A hospital benefits. This is why most Americans pay no Part A premiums when they become eligible for Medicare.  Part A mainly covers your hospital stays.

If you have not worked the required 10 years to qualify for Medicare Part A at no cost, you can purchase Part A. Contact Social Security to find out the cost.

If you must purchase Part A, the coverage will cost over $400/monthly. In some cases, however, there are partial premiums for people who have worked over 30 but less than 40 quarters.

You may be automatically enrolled in Part A (and Part B) at the time you turn 65 if you have already enrolled in Social Security income benefits. Your Medicare card will usually arrive in your mailbox about 4 – 6 weeks before you turn 65.

Eligibility for Part B

You are eligible for Medicare Part B at age 65 as well. However, you must pay a monthly premium for Part B. This provides for your outpatient benefits such as doctor visits, lab work, surgery fees, and more.

Some people turning 65 still have health insurance through an employer. They can delay their enrollment into Part B in favor of their group health insurance without fearing a late penalty.

If you delay enrollment into Part B, consult with an insurance agent who specializes in Medicare. He or she can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.

How Do I Enroll in Medicare?

Medicare enrollment is handled by the Social Security Administration. You can enroll in Medicare over the phone, in person, or online. If you have questions about Medicare policies, a partner like Medicare Expert can help you get started. It’s important to note that your initial enrollment window spans seven months, starting three months before the month of your 65 birthday and the three months that follow your birthday month. For example, if you turn 65 on May 1, 2021, you are eligible to enroll:

  • February to April 2021
  • May 2021
  • And, June to August 2021

To enroll, you will need some basic information:

  • Name, address, phone number
  • Social Security number
  • Identification documents, such as a birth certificate, driver’s license, or proof of U.S. citizenship.

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