Reply
Honored Social Butterfly

Let's Start A Pool - Best GUESS Wins

The person that can guess the closest - WINS - wins what?  I don't know.

What is your guess of what the standard (most people) Medicare Part B premium will be for 2022?

 

I believe it is $ 148.50 for 2021 -

My 2022 guess is gonna be  .. . . . . . . . $ 164.00 

 

This does NOT include any premium penalties.

This does NOT include any IRMMA additions.

Come on . . . give it a guess.  🙂

It's Always Something . . . . Roseanna Roseannadanna
0
Kudos
3037
Views
0
Replies
0 Kudos
3,489 Views
21
Report
Social Butterfly

.

CMS says about half of the increase is due to making sure the program has enough money to pay for an expensive new Alzheimer’s drug if Medicare decides to cover it.

0 Kudos
2,261 Views
4
Report
Social Butterfly

.

Medicare recipients have to pay for an expensive drug that had FDA experts resign in protest over its rushed approval and questionable efficacy.

0 Kudos
2,253 Views
3
Report
Social Butterfly

.

I’m being too negative on the new Alzheimer’s drug “Aduhelm” or any other of the comparable drugs. Some studies did show a slowing in progression of this awful disease. And knowing this disease causes havoc on an individual and their families I’d be ok with paying an additional $150-$170 a year for my Medicare. It offers hope.

0 Kudos
2,168 Views
2
Report
Conversationalist

@ReTiReD51 Your effort to provide some funding is a step in the right direction and others should follow as well. However, the numbers are large for this approach and will require significantly more money. Using the proverbial "back of the envelope" calculation for a worst case scenario, multiply $56,000 times the estimated number of Alzheimer's cases of 6,000,000. This totals $336,000,000,000 which needs to be covered by approximately 56,000,0000 Part B participants. Please note that there is about a 6,000,000 difference between all Medicare participants (62,000,000) because some folks do not enroll with Part B due to various reasons (i.e., covered by employers, reject enrollment, etc.). If Congress continues the 75%/25% split on average cost, Part B needs to charge $84,000,000,000. If you divide this amount among  the 56 million participants, it will average to $1,500 per year or about $125.00 per month. However, not all 6 million cases will be initially deemed eligible for the treatment. Another factor is what savings, if any, will accrue from reducing or eliminating the current treatment protocols. For example, will some folks stabilize and not require long term nursing home care? This cost varies throughout the country, but a current average may be in the range of $75,000 to $90,000. In many cases, this cost (which is still a cost that someone has to pay) is allocated to Medicaid for the folks without LTC insurance or the financial wherewithal to pay for such costs. Because those costs are covered, in effect, elsewhere, Part B has not been allocated a significant amount. I think Congress needs to determine if General Revenue should pay for a greater share or keep the 75%/25% split which will ultimately increase Part B premiums. 

0 Kudos
1,951 Views
0
Report
Honored Social Butterfly

I posted this back in June 2021 when this new Alzheimer’s drug “Aduhelm was going thru the approval process.  

 

New Alzheimer’s drug “Aduhelm 

1.  lots of controversy over the trial data

2.  lots of controversy during the approval process 

3.  the cost of the drug wasn't even considered during approval - so there is not only controversy over the clinical value of this drug but also in relationship to any "value" that it brings (further comments below) 

4.  Since it is an infusion - coverage, if it gets to that point, would be under Part B - so yes, premium rise for everybody depending upon how many people are prescribed it.  It is not for everybody - there is a time period of when diagnosed to when the med is applicable.   Last I read, many docs are steering away from it; not just because of the cost factor but because the drug trials did not produce enough results for promise.

5.  But the cost of the drug is only one component - I believe the drug cost was set at $ 56,000.00.  The other cost would be all the monitoring with evaluation test that the patient would have to do to monitor its progress.  Again, coverage would be under Part B and an added cost of another $11,000.00 - $12,000.00.

6.  Medicare (CMS) doesn't normally have to decide on adding a covered treatment - if it gets FDA approval, it's covered.  But this approval process was so controversial (medically speaking) that they have questioned the actual  value.

 

IMO - it really sounds like approval was only given so that some resemblance of the trial under the guise of treatment could continue.  The cost of testing this drug during trial period with all the various test needed to monitor the outcome- it was getting very expensive for Biogen.  

Then you have a very strong advocacy group also pushing it.

 

This is our drug approval process - it is definitely different than what other countries do - good efficacy without including price in the mix isn't an effective manner of knowing value.  

 

I often ask this contemplating question - considering a last ditch cancer drug.

If a cancer drug is touted as a treatment for a specific type of cancer -

  • is it a good value no matter what it cost?
  • Is it a good value if it deteriorates your quality of life? 
  • Is it a good value if somebody else is paying the lions share of the cost?

Now what IF that same cancer drug in its last ditch effort ONLY assures (if that)  you of four more months of life, of which, there is little quality of life taken into consideration.

 

We have lots of people with Alzheimer's - it is an awful disease.  It takes your life little by little.  It is very costly in care in the later stages.  I would shout the praises of any drug that could put a dent in it or its progression.  But I am not so sure that this is the one.

 

Maybe this is the drug that will bring about some additional thinking of our Legislator - What is value?

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
2,129 Views
0
Report
Conversationalist

@GailL1 You probably have heard that the 2022 Part B premium is $170.10. It looks like your guess ($164.00) is the closest. I have not heard or read if any of the 2021 extra subsidy (approx. $12.00) was rolled in ($16.00 - $4.00). You may recall, only $4.00 was added to the 2020 premium. My high number of $179.42 rolled in all of the 2021 subsidy and a 12% increase due to medical cost increases. In other words, no subsidies. However, I guessed that Congress would help the Medicare folks again and limit any increase to the same formula that was used for 2021. In other words, just 25% of any increase, not 100%. So, my official (low) guess of approximately $153.00 which included subsidies was too low. It is hard to believe that Congress has not provided any help for the seniors especially with inflation increasing.   

0 Kudos
2,284 Views
7
Report
Honored Social Butterfly

Here is the press release - somewhat concerning.  Also the new deductible amounts for 2022 is announced.

CMS Press Release 11/12/2021 -CMS Announces 2022 Medicare Part B Premiums

 

Now what did I win?

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
2,271 Views
6
Report
Social Butterfly

.
@GailL1  Since you were the organizer and sponsor of this pool you or a member of your family are ineligible from winning according to federal, state, local and municipal laws and regulations for contests. That’s too bad you should have read the rules before you guessed.

 

I expected a hefty increase in Medicare premiums and deductible because of COVID 19 medical care but not because of “requiring additional contingency reserves” for “potential Medicare drug coverage”.

 

I hope you and @Tonster521  can now see the importance of allowing Medicare to be able to negotiate drug prices with the pharmaceutical industry.

0 Kudos
2,046 Views
4
Report
Conversationalist

@ReTiReD51 I know very well the importance of Medicare reducing medical expenses including drugs. Many employers provide retiree insurance benefits that provide benefits based on Medicare's fee schedule. A lower fee schedule saves the retiree plan and lowers the cost to the sponsoring employer. This may help the sponsoring employer continue this generous benefit for retirees as opposed to terminating such coverage. This concept is also utilized by the insurance companies that provide Medicare Advantage Plans. In concept, using a Managed Care approach along with Pharmacy Benefit Managers (PBM), seems to have been successful over the years. PBMs appear to provide some prescription drugs at costs below average retail pharmacy dispensing fees ($1.50 to $3.00). The drugs may need to be mail order and on Tier 1 and/or 2 which vary with the PBMs. Like many folks, I use a 10 mg blood pressure pill. I receive a 90 day supply with no copay via mail order. The EOB informs me that the Plan paid $2.10. Also, it paid the cost of mail delivery. I have to guess that it cost a buck or more to mail the package. So, that would put it close to a $3.00 dispensing fee at a retail pharmacy. However, the local retail pharmacy charges $9.43 for the same prescription. They told me it is savings since the copay at retail is $10.00. Obviously, the retail pharmacy has other costs to cover (i.e., triple net lease, heat, cooling, computer systems, pharmacists and technicians, other products, inventory, insurance costs, etc.). So,the retail pharmacy needs to markup all products and services to remain viable. Obviously, there are negotiations taking place with the PBMs at retail and mail order. Moreover, due to the scale of purchases, some PBMs have additional power over obtaining lower prices which may or may not get passed to the purchaser. So, negotiations may go both ways. It may lower costs on some drugs and increase the costs of other drugs. This is in no way a comparison to the efforts and risks that go into developing a new drug (solution) to treat a devastating illness.I found a link that provides some insight into drug development https://en.wikipedia.org/wiki/Cost_of_drug_development. Take a look at the paragraph entitled, Failed Drugs, and try to envision the effort ($millions if not $billions) and risk involved to obtain on average a 10% success rate over possibly a 12 year period. Just for comparison, you have a 16.67% chance of rolling a seven (7) in a dice game. So, I would place more emphasis on unraveling the three (3) drug distributors oligopoly and some of the PBMs now entering the distribution channels and their profit margins which exceed many of the pharmaceutical companies profit margins (remember how many drugs fail). With regard to the Alzheimer's drug(s), @Gail1 has pointed out that these drugs will be infusion therapy covered by Part B instead of Part D. I am providing a link https://www.medicare.gov/coverage/prescription-drugs-outpatient that addresses Medicare Part B drugs. I am familiar with Part B coverage for insulin and infusion pumps as well as enteral nutrition via G-Tube. I do not recall a case when Medicare Part B paid full price. It is always reduced; and, more importantly, the providers accepted Medicare's fee schedule. I do not know if that would be the case with the Alzheimer's drugs. So, from a financial perspective, there may be substantial value if the drugs stabilize the patient and avoid a long nursing home stay which in many cases end up in Medicaid funded by general tax revenue. 

0 Kudos
1,933 Views
2
Report
Social Butterfly

.

@Tonster521  

Thanks for your opinions on Managed care and Pharmacy Benefit Managers.

 

In my state Pharmacy Benefit Managers came under scrutiny because they were found to have overbilled taxpayers by tens of millions of dollars. They were found guilty of layering pharmacy middlemen atop one another and then double billing. They agreed to a $88 million settlement and have set aside over a billion dollars in anticipation of lawsuits coming from other states.

 

Why is it necessary to have a pharmacy benefit manager act as the middleman in the drug supply chain? It’s not. Allow Medicare to act as its own middleman and negotiate with the pharmaceutical industry.

 

We need to remove the profit motive from our healthcare system. No middleman should stand between you and your healthcare provider.

0 Kudos
1,905 Views
1
Report
Conversationalist

@ReTiReD51 Interesting info regarding the Ohio Medicaid Case. I clicked on the Pharmacy Benefit Managers link that you provided and continued reading related articles. I am including an article that provides more detail as to how these companies allegedly double billed Ohio Medicaid and conducted other questionable activities https://ohiocapitaljournal.com/2021/04/12/conflicting-corporate-claims-at-the-heart-of-ohios-blockbu.... Although not a criminal attorney, I am amazed that no one in the named organizations are wearing silver bracelets. At any rate, I also question the skills of the Ohio Medicaid Administrative/Managerial Staff including their Auditors. Are they not reviewing the contracts and any sub-contractors? More importantly, are they not auditing where the money is flowing? The article indicates that in 2017, Ohio Medicaid totaled $24 Billion of which $53 Million was paid to Centene, CVS, and various sub-contractors directly and indirectly. I would also look at who in Ohio approved these contracts and who in the Medicaid system approved the payments. Perhaps there is more info that will not see the light of the day; and, that may be the reason a settlement was reached wherein no one has admitted any wrongdoing. The PBM  business model has pluses and minuses just like all business models. I will once again repeat what I posted yesterday that efforts should be initiated to unravel the opaque clouds of mystery pricing and rebates with the current PBM oligopoly especially with State and Federal programs that perhaps do not require the level of disclosure that the private sector must disclose via Annual Reports called Form 5500 to the DOL and IRS. FYI, Plan Administrators in the private sector who are found in violation of ERISA are subject to fines and imprisonment. I am not pointing fingers, but this is a good example of lack of internal controls with the Ohio Medicaid Program. Having spent most of my career working in the benefit trenches in administrative, managerial and fiduciary capacities, this is one of the reasons I believe single payer systems are prone to over payments and lack of controls especially when Managers and Staff believe they have guaranteed lifetime jobs with gold plated pensions and health insurance. This includes the proposed "Medicare for All" approach. I believe competition and the profit incentive will out perform any tax subsidized government program. The Ohio case may be the "tip of the iceberg" as other State Medicaid Programs review their own situations. I hope the Ohio taxpayers prevail in this case. 

0 Kudos
1,814 Views
0
Report
Honored Social Butterfly

Well, too bad for me to be ineligible to win the pool and get the prize (whatever it may have been) - but I did win 100 bucks at Keno this morning - YAY for me 😀

 

Yes, part, probably a big part of this Part B increase is due to Covid, this years and last year when they did give us a break.  Like @Tonster521 said they are dishing this amount out over time $ 3.00 now, $ 3.00 next - and so on, in addition to utilization cost - as long as the COLA keep pace and these increases in the premiums are not affected by the hold-harmless clause in the SS law, it will continue to go up -  Only one thing can stop or slow the cost of Part B and for that matter all health care cost - COST SAVING STRATEGIES.

 

But remember this Covid-effect is Part B and thus is affected ONLY by what Part B covers.  Test, vaccines, treatments & provider care outside of hospital.

 

We may see the $$$$ harm done to the Medicare Part A (Hospital Insurance) portions of Medicare cause by Covid too.  But since the Medicare Trust Fund (Part A) has a funding source that most seniors don't pay any long - we will have to rely on those who are still working to pay this bill.

 

But we may also see a rise in Medigap premiums too which correlates with both Part A & Part B.

 

Part B only covers a few drugs - usually those which are infused in a clinical setting - as is this new Alzheimer's drug & many very expensive drugs like cancer chemo & associated infusions and others used to treat various other illnesses.  These are the lions share of the ones included in the current proposed legislation.  

 

I have no problem with allowing CMS to negotiate the cost of meds under a FORMULARY - just like the VA does now.  But it will not cover all drugs - the formulary would be developed to cover the BEST for the price - like the VA does now.

 

  • How much of a negotiation would be effective IF it is the only drug available for treatment ?
  • How much of a negotiation would be effective IF the drug is of the orphan type developed only to treat a condition in the very few?

If a program is designed (as currently) to offer a very wide number of drugs in each class - and in (5) classes pretty much ALL drugs - the negotiation of price isn't effective.

 

The negotiation needs to begin when the drug is approved with price included as a measure of value - not a good value - no approval.  By value, I mean is the drug better than, including price, of what is now a treatment - measure price along with medical conclusion.  If there is no current treatment and the drug does what it is suppose to do and has documented science to support the claim - the sky's the limit, at least until the patent runs out or more likely, other drugs are introduced for competition.  

 

 

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
1,999 Views
0
Report
Conversationalist

@GailL1 There is quite a bit of info in the press release and the additional links. I elected to read the third link which is from the Federal Register. https://public-inspection.federalregister.gov/2021-25050.pdf It addresses Medicare Part B Actuarial Rates..... and is only 28 pages with the historical legislation that amended the Medicare Part B premium calculation over the years. This article indicated that only $3.00 of the remaining outstanding 2021 subsidy was rolled in to the 2022 rate ($170.10). It appears that for the next three (3) years; namely, 2023,2024,and 2025, $3.00 will be rolled in each year or another $9.00. It is scary that the high number I provided ($179.42) which included all remaining subsidy from 2021 ($12.00 immediately not prorated over 3 years) was just  $0.32 greater than the 2022 Part B rate ($170.10 includes $3.00 subsidy from 2021). However, I guessed low ($153) thinking that us seniors would be eligible for some additional assistance similar to 2021. That ended up just wishful thinking. With regard to your question, it think we would have had more participants if there was some sort of reward or prize. However, that may be against the rules at AARP. At any rate, you have won "bragging rights" for the year. Do you pick lottery numbers? 

Conversationalist

@GailL1 You are optimistic. You may remember that 2021 was limited to an only 25% increase by a Bill/Resolution passed by Congress in 2020. The existing Part B formula would have developed the 2021 Part B contribution at about $160.20 (which was an increase of $15.60) . However, the above 25% provision limited the increase to about $4.00. So, the 2020 Part B contribution which was $144.60 increased to $148.50 or only $3.90 (or about $4.00). Because we do not have the data from the 2021 Trustees Report (which is going on 5 months late), any guess is a "shot in the dark". In my opinion, the Trustees Report is being delayed until the proposed provisions of the $3.5 Trillion Bill is resolved. That Bill may end up subsidizing Part B again. So, if acceptable, I will provide two numbers. The first number is without any subsidies from 2021 and 2022 or $179.42. The second number includes subsides from 2021 and 2022 ( forecast 12% increase for 2022) or $152.95 (call it $153.00). I cannot imagine Congress rolling in the increase from 2021 even though.that provision has expired. 

0 Kudos
3,370 Views
4
Report
Honored Social Butterfly


@Tonster521 wrote:

. . . .  Because we do not have the data from the 2021 Trustees Report (which is going on 5 months late), any guess is a "shot in the dark". In my opinion, the Trustees Report is being delayed until the proposed provisions of the $3.5 Trillion Bill is resolved. That Bill may end up subsidizing Part B again.

 

So, if acceptable, I will provide two numbers. The first number is without any subsidies from 2021 and 2022 or $179.42. The second number includes subsides from 2021 and 2022 ( forecast 12% increase for 2022) or $152.95 (call it $153.00). I cannot imagine Congress rolling in the increase from 2021 even though.that provision has expired. 


REALCLEAR Politics - Commentary 08/17/2021 - Where Are the Social Security/Medicare Trustees' Report... 

 

Don't you think that BEFORE any further work on this $ 3.5 TRILLION dollar Budget Reconciliation "human" infrastructure legislation, we do need to know where these Trust Funds stand at the present time.  I agree with this Commentary.

 

No, now @Tonster521 , you only get one guess in this contest  - sounds like you are leaning towards the higher guess.  

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
3,265 Views
3
Report
Conversationalist

@gail1 I just saw the 2021 Trustee Report is now available online. It will take sometime to read and comprehend. So, I will go with $153.00 per month for Part B. I am guessing that Congress will provide some assistance like they did for 2021. 

Honored Social Butterfly

Thank You for the HeadsUP !!!!   👍

Here is the Summary

https://www.ssa.gov/oact/TRSUM/ 

It's Always Something . . . . Roseanna Roseannadanna
Conversationalist

@GailL1 Thanks for the link to the Summary.

0 Kudos
3,174 Views
0
Report
Social Butterfly

Honored Social Butterfly


@GailL1 wrote:

 

What is your guess of what the standard (most people) Medicare Part B premium will be for 2022?

 

I believe it is $ 148.50 for 2021 -

My 2022 guess is gonna be  .. . . . . . . . $ 164.00 

 

Come on . . . give it a guess.  🙂


 

I guess $157.41.

 

If the SS benefit has a 6% cola....... I think they will raise the Part B also by 6%.

0 Kudos
3,456 Views
1
Report
Honored Social Butterfly

Thanks for the guess - but you know that it does not work that way - right?

The SS/Medicare Hold-Harmless Clause states that the Part B premiums cannot rise more that the COLA so that one's SS benefit is not lower the next year than the year before due to any Part B premium increase.  

Since we are all hopeful that the COLA increase in SS benefits is gonna be pretty substantial in dollar amount - yep, 6% would be nice - we just have to hope that the government doesn't take it all for our share of Part B premiums.

We got a deal for this year (2021)  due to covid - 

AARP.org 10/20/2020 - Congress Limits Medicare Part B Premium Increase 

 

from the link ~

The Medicare Part B premium increase for 2021 will not be as large as government actuaries predicted because of a new provision in the spending law that keeps the federal government running until Dec. 11.

 

The monthly premiums for Part B — which helps pay for doctor visits, diagnostic tests and other outpatient services — are determined based on Medicare's overall program costs and other health insurance factors. As the actuaries for the Centers for Medicare and Medicaid Services (CMS) began running the numbers earlier this year, lawmakers and advocates like AARP learned that the data indicated that the 2021 Part B premium could increase by as much as $50 a month for some beneficiaries.

 

read more at the link provided.

 

Would you and others here be upset IF we got a 6% COLA  (maybe around $ 100 per month +/- ) and the government raised Part B premiums by $ 50 a month?  We certainly have spent it within Part B.  Thoughts?

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
3,416 Views
0
Report
cancel
Showing results for 
Show  only  | Search instead for 
Did you mean: 
Users
Need to Know

"I downloaded AARP Perks to assist in staying connected and never missing out on a discount!" -LeeshaD341679

AARP Perks

More From AARP