Reduction to Medicare Part B Looming

The Centers for Medicare & Medicare Services is still evaluating its Part B premium due to changes that have happened after the amount was established last year. Approximately, 50% of the increase in the premiums is the result of the potential cost associated with paying for the Alzheimer’s medication, Aduhelm. If the Center ultimately decides to reduce its Part B premium, the reduction would likely apply in 2023 rather than 2022. 

The Value of Aduhelm 

Aduhelm plays a role in helping the approximately 6 million Americans who have been diagnosed with Alzheimer’s Disease, which is a degenerative neurological disease that slowly destroys a person’s memory and thinking skills. The medication can also negatively impact the lives of families and other loved ones connected to the person with the disease. Most people who are age 65 or older are also generally enrolled in Medicare, which pays for more than 63 million individuals. 

Waiting for a Decision about Part B

For Medicare beneficiaries who are curious about whether Part B will be reduced, however, waiting is still required. After all, over three months have elapsed since Health and Human Services required a reassessment of this year’s $170.10 standard monthly premium, which is bigger than the anticipated increase from $148.50 in 2021. It remains uncertain when a decision about Part B will come and whether it will end up impacting the amount that beneficiaries pay in 2022. A reduction in premiums that occurs halfway through the year, however, would be unprecedented.

Law the Center Must Follow

Following the law, the Center is required to establish Premium B annually at 25% of the estimated costs that will be generated by the program. During its 2022 calculation, the agency had to take into consideration the chance of widely covering Aduhelm.

Weeks ago, the Center stated that its program will only include Aduhelm for beneficiaries, who receive the medication as part of a clinical trial. In addition, the price that actuaries utilize in their collection was cut in half. The reason behind why the increase was so sharp is gone. As a result, the most pressing question is now what is feasible for the Center’s administration. 

How Reductions Would Work

If a reduction of premiums occurs, the chance exists that this reduction will be applied to 2023 premiums instead of 2022. Decreases in yearly premium amounts for Part B have occurred for various reasons. The amount has even been previously lowered due to revisions in how premiums are calculated. 

The chance also exists that lower-than-expected spending on Aduhelm could be reduced by increased costs in other sections of Part B coverage. Some of these other areas where costs increased include medical equipment and outpatient care.

Medicare Part D provides prescription drug coverage. Meanwhile, some medications are administered in physicians’ offices and consequently are covered under Part B. 

Even if fewer people are using Aduhelm than the Center anticipated and consequently at a lower price than expected, the Center might decide that other changes have occurred that nullify the expected decrease in Part B premiums. 

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