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A possible reduction for Medicare Part B premiums is still in play


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Medicare beneficiaries are still waiting to see if Part B premiums might be lower.

More than three months after Health and Human Services Secretary Xavier Becerra ordered a reassessment of this year’s $170.10 standard monthly premium — a bigger-than-expected jump from $148.50 in 2021 — it remains uncertain when a determination will come and whether it would affect what beneficiaries pay this year.

Tricia Neuman (executive director, Medicare policy program Kaiser Family Foundation) stated that a mid-course drop in premiums is unprecedented.

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A spokesperson for the Centers for Medicare & Medicaid Services said the agency continues to reexamine the premium and will announce further information when it’s available.

About half of the larger-than-expected 2022 premium increase, set last fall, was attributed to the potential cost of covering Aduhelm — a drug that battles Alzheimer’s disease — despite actuaries not yet knowing the particulars of how it would be covered because Medicare officials were still determining that.

CMS must set the Part B premium for each year at 25% of estimated program costs. This is required by law. The agency also had to consider the possibility that Aduhelm could be covered in a broad manner when calculating its 2022 budget.

The logic behind a rise that high has been lost.

Paul Ginsburg

Brookings Institution senior Fellow nonresident

But things have changed.

CMS officials stated that Aduhelm would only be covered by the program for those beneficiaries who received it in a clinical trial. Additionally, the per-patient price tag that actuaries had used in their calculation last year was cut in half, effective Jan. 1, by manufacturer Biogen — to $28,000 annually from $56,000.

Paul Ginsburg is a Brookings Institution senior fellow and expert in health policy. He stated that “certainly the reason for an increase so high” was gone.  “The real question is what administratively possible.”

A premium drop could mean that it can be used for 2023, instead of 2022. For a variety of reasons, there have been years-to-year decreases in Part B premiums in the past. These include legislative changes that affect how premiums are calculated.

Ginsburg said, “If I was to administer this, I’d be anxious about setting the precedent for changing in the middle of each year.”

There is also the possibility that Aduhelm’s lower than expected spending could be partially offset by higher Part B costs, including outpatient care or medical equipment. While Medicare Part D provides prescription drug coverage, some medicines are administered in a doctor’s office — as with Aduhelm, which is delivered intravenously — and therefore covered under Part B.

Neuman stated that even if Aduhelm is used by fewer people than initially projected, and at a lower cost than expected, actuaries might be inclined to consider other factors that may moderate the amount.

About 6 million Americans are affected by Alzheimer’s. This degenerative neurological condition slowly damages memory and thinking abilities and is not curable. The disease can also cause irreparable damage to the lives and relationships of loved ones.

The majority of the patients in these cases are 65-plus and enrolled in Medicare. Medicare covers over 63,000,000 people. The Kaiser Family Foundation estimates that about 2 million beneficiaries used Part D’s available Alzheimer’s therapies in 2017, according to Kaiser Family Foundation.