Medicare recipients to see premium cut – but not until 2023

Medicare recipients to see premium cut – but not until 2023

FILE - Health and Human Services Secretary Xavier Becerra arrives for a hearing on Capitol Hill in Washington, April 5, 2022. Medicare recipients will get a premium reduction — but not until next year. That reflects what Becerra says was an overestimate in costs of covering a costly and controversial new Alzheimer's drug. (AP Photo/Andrew Harnik, File)

FILE – Health and Human Services Secretary Xavier Becerra arrives for a hearing on Capitol Hill in Washington, April 5, 2022. Medicare recipients will get a premium reduction — but not until next year. That reflects what Becerra says was an overestimate in costs of covering a costly and controversial new Alzheimer’s drug. (AP Photo/Andrew Harnik, File)

WASHINGTON (AP) — Medicare recipients will get a premium reduction — but not until next year — reflecting what Health and Human Services Secretary Xavier Becerra said Friday was an overestimate in costs of covering an expensive and controversial new Alzheimer’s drug.

Becerra’s statement said the 2022 premium should be adjusted downward but legal and operational hurdles prevented officials from doing that in the middle of the year. He did not say how much the premium would be adjusted.

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Medicare Part B premiums jumped by $22 a month, to $170.10, for 2022, in part because of the cost of the drug Aduhelm, which was approved despite weak evidence that it could slow the progression of Alzheimer’s.

The Centers for Medicare and Medicaid Services has limited coverage of Aduhelm to use in clinical trials approved by the Food and Drug Administration or the National Institutes of Health. It began reassessing the premium increase under pressure by Congress and consumers.

The drug’s manufacturer, Cambridge, Massachusetts-based Biogen, has cut the cost of the drug in half, to about $28,000 a year.

CMS cited the sharp reduction in the price of the drug and the limitations on coverage in concluding that cost savings could be passed on to Medicare beneficiaries. In a report to Becerra, the agency said the premium recommendation for 2022 would have been $160.40 a month had the price cut and the coverage determination both been in place when officials calculated the figure.

The premium for 2023 for Medicare’s more than 56 million recipients will be announced in the fall.

“We had hoped to achieve this sooner, but CMS explains that the options to accomplish this would not be feasible,” Becerra said. “CMS and HHS are committed to lowering health care costs — so we look forward to seeing this Medicare premium adjustment across the finish line to ensure seniors get their cost-savings in 2023.”

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Health insurance premium rise spurs non-life growth, shows data

Health insurance premium rise spurs non-life growth, shows data

Health insurance premiums, which registered a 25.6 per cent growth — almost double that of last year — have been the main driver of the double-digit growth in non-life insurance in FY22. This comes after a horrid FY21, where the industry registered a low single-digit growth. In FY22, health insurance premiums rose to Rs 73,582.13 crore, becoming the main line of business for non-life insurance sector, with a 33.33 per cent market share. This is a jump of 380 basis points (bps) over last year, data from the General Insurance Council showed. Health premiums grew at 13.5 per cent and 13 per cent in FY21 and FY20, respectively. Non-life insurers have reported an 11 per cent growth in premiums in FY22 to Rs 2.2 trillion. This compares with Rs 1.98 trillion worth of premiums collected in FY21, up 5.2 per cent over FY20. The industry had posted a growth of 11.7 per cent in FY20 over year-ago period. Within the health segment, retail health premiums reported a 16.5 per cent growth in FY22 over last year. This is mainly driven by standalone health insurance companies with 28 per cent growth. General insurers reported a meagre 7 per cent growth in retail health premiums during the same time. Health insurance premium rise spurs non-life growth, shows dataGroup health premiums, on the other hand, reported a higher growth than retail health premiums at 31 per cent. This is because of a spike in demand with pick up in hiring across sectors and price correction. Group health growth is a function of the economy. On the other hand, retail health growth is organic and depends on the awareness and needs of individuals. “There is a huge demand for quotes on group health policies from corporates. Even smaller corporates have realised that they need to provide protection to their employees. And, the pandemic has certainly boosted the demand for such policies,” Bhaskar Nerurkar, head — health administration team — Bajaj Allianz General Insurance, had said. The key trend in FY22 has been high growth in health and low growth in motor. Among private players, ICICI Lombard continues to be the market leader in motor and Star in retail health, ICICI Securities said in a report. While insurers have witnessed a jump in health premiums over the last two years, their claims burden has also gone up. Insurers have paid around Rs 25,000 crore of Covid-related health claims in the two years of the pandemic, according to the General Insurance Council. Incurred claims ratio of private sector general insurers and standalone health insurers in the health segment also went up by over 5 per cent and 10 per cent, respectively, in FY21. In FY22, motor insurance premiums showed a meagre growth of 4 per cent, rising to Rs 70,432.59 crore. In FY21, motor insurance premiums had reported de-growth of 2 per cent. In FY20, the segment reported a 7 per cent growth over the past year. Motor premiums market share in non-life insurers’ business dropped to 31.9 per cent, a decrease of 210 bps over last year. Growth in the motor segment was on a declining trajectory even before the onset of the pandemic, as vehicle sales got severely impacted owing to a slowdown in the economy. The pandemic further accentuated this problem and now the chip shortage issue has added to the misery. The third-party premium hike proposed by the insurance regulator may come as a relief to the sector this year.

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Medicare weighs premium cut after limiting Alzheimer’s drug

Medicare weighs premium cut after limiting Alzheimer’s drug

File - The Biogen Inc., headquarters, Wednesday, March 11, 2020, in Cambridge, Mass. Medicare says it’s considering a cut in enrollee premiums, after officials stuck with an earlier decision to sharply limit coverage for a pricey new Alzheimer’s drug projected to drive up program costs. (AP Photo/Steven Senne, File)

File – The Biogen Inc., headquarters, Wednesday, March 11, 2020, in Cambridge, Mass. Medicare says it’s considering a cut in enrollee premiums, after officials stuck with an earlier decision to sharply limit coverage for a pricey new Alzheimer’s drug projected to drive up program costs. (AP Photo/Steven Senne, File)

WASHINGTON (AP) — Medicare said Thursday it’s considering a cut in enrollee premiums, after officials stuck with an earlier decision to sharply limit coverage for a pricey new Alzheimer’s drug projected to drive up program costs.

The agency “is looking at that, and is still going through the process,” spokeswoman Beth Lynk said of a potential reduction in premiums, as Medicare announced its final coverage decision for Aduhelm, a drug whose benefits have been widely questioned in the medical community.

Officials said Medicare will keep coverage restrictions imposed earlier on the $28,000-a-year medication, paying for Aduhelm only when it’s used in clinical trials approved by the Food and Drug Administration or the National Institutes of Health.

The projected cost of Aduhelm was a major driver behind a $22 increase in Medicare’s Part B premium this year, boosting it to $170.10 a month. That price hike is already being paid by more than 56 million Medicare recipients signed up for the program’s outpatient coverage benefit. Lawmakers have called for a rollback and Health and Human Services Secretary Xavier Becerra already directed Medicare to reassess.

Thursday’s coverage decision illustrates the impact that a single medication can have on the budgets of individuals and taxpayers. It comes as legislation to authorize Medicare to negotiate prescription drug prices remains stuck in the Senate, part of President Joe Biden’s stalled social and climate agenda. That’s left Democrats with nothing to show on their promises to cut prescription drug costs, unless they can overcome internal disagreements.

Medicare’s determination on Aduhelm included an important caveat. Officials said that if it or any other similar drug in its class were to receive what’s called “traditional” FDA approval, then Medicare would open up broader coverage for patients. Such approval is granted when a medication shows a clear clinical benefit.

That was not the case with Aduhelm. It received what’s known as “accelerated” approval last year because of its potential promise. But manufacturer Biogen is required to conduct a follow-up study to definitively answer whether Aduhelm truly slows the progression of Alzheimer’s. If that study is successful, FDA would grant full approval.

That would also open up Medicare coverage.

Dr. Lee Fleisher, chief medical officer of the Centers for Medicare & Medicaid Services, said “there will be quick access for Medicare beneficiaries” for Alzheimer’s drugs that receive the traditional FDA approval, after demonstrating a clear benefit.

Aduhelm hit the market as the first new Alzheimer’s medication in nearly two decades. Initially priced at $56,000 a year, it was expected to quickly become a blockbuster drug, generating billions for Cambridge, Mass.-based Biogen.

But although the company slashed the price in half — to $28,000 a year — Aduhelm’s rollout has been disastrous.

Pushback from politicians, physicians and insurers left the company with just $3 million in sales from Aduhelm last year. Doctors have been hesitant to prescribe it, given weak evidence that the drug slows the progression of Alzheimer’s. Insurers have blocked or restricted coverage over the drug’s high price tag and uncertain benefit.

The CMS decision means that for Medicare to pay, patients taking Aduhelm will have to be part of clinical trials to assess the drug’s safety and effectiveness in slowing the progression of early-stage dementia.

Tamara Syrek Jensen, head of CMS’s coverage and analysis unit, said “it’s status quo” as far as limitations the agency initially imposed on Aduhelm in January.

The limits stayed on despite a massive lobbying push by the Alzheimer’s Association to change Medicare’s position, including outreach to members of Congress, online advertising and social media campaigns directed at the agency.

The association, the largest group of its kind, has received contributions from drugmakers, including Biogen.

The group’s CEO said he was “very disappointed” after reviewing Medicare’s decision.

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“Denying access to FDA-approved Alzheimer’s treatments is wrong,” Harry Johns said in a statement. “At no time in history has CMS imposed such drastic barriers to access FDA-approved treatments for people facing a fatal disease.”

Aduhelm has sparked controversy since the FDA approved it against the recommendation of outside advisers.

The medicine, administered intravenously in a doctor’s office, hasn’t been shown to reverse or significantly slow Alzheimer’s. But the FDA said its ability to reduce clumps of plaque in the brain is likely to slow dementia.

Many experts say there is little evidence to support that claim. And a federal watchdog and congressional investigators are conducting separate probes into how the FDA reviewed the medication.

Alzheimer’s is a progressive neurological disease with no known cure. The vast majority of U.S. patients are old enough to qualify for Medicare, which covers more than 60 million people, including those 65 and older, and disabled people under 65.

The reason Aduhelm falls under Medicare’s outpatient benefit, and not its pharmacy drug program, is that it’s given in a doctor’s office. Beneficiary premiums are set to cover about 25% of the cost of outpatient care.

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7 fitness apps beginners may want to check out

7 fitness apps beginners may want to check out

Indeed, thanks to fitness apps, we can access countless thousands of at-home workouts right from our smart devices

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Spring is coming — and some of you may finally want to make good on those promises to start a fitness routine, even if this season has plenty of April showers. Thanks to fitness apps, we can access countless thousands of at-home workouts right from our smart devices. Here are seven apps to check out that can help you get motivated, energized and fit.Free Johnson & Johnson Official 7 Minute Workout® App  This popular — and free — app was designed by the Director of Exercise Physiology at the Johnson & Johnson Human Performance Institute. The exercises and workouts can be mixed and matched to create over 1,000 variations. You can opt in or out of a warmup, cool down, and choose how much time you want to work out.  During your workout, you can listen to the trainer alone or layer in your own music (which is great, because — IMO —some workout music is intolerable.) As you use the app, you can fine-tune your preferences by giving workouts a thumbs-up or thumbs- down. And it can also be synced with the Apple Health app. The workouts have a pretty clinical aesthetic, so if you like more atmosphere in your workouts, this app may not be for you. Also see: Mansion Global Picks: Ditch the gym for high-end personal exercise equipmentFee-based STRÅLA HOME If you want start gently, try this app created by Stråla Yoga founders Tara Stiles and Mike Taylor. It offers thousands of videos of varying lengths, and regular opportunities for live virtual instruction. The workouts combine elements of tai chi, yoga, qigong, and traditional Chinese medicine to help to increase your fitness level and flexibility, and reduce stress. Price: $19.99 per month or $199.99 per year. Free 7-day trial. THE FITNESS APP This app by fitness guru Jillian Michaels has won “best of” awards from both Google and Apple. Customizable fitness, nutrition, and mindfulness features can help you meet your goals with a workout routine that suits you, no matter your fitness level or time constraints. Workouts range from yoga, HIIT, kickboxing, and weights, to prenatal/postnatal, booty bands, and 5K training. Plus, you’ll have access to content from Michaels’ DVD collection. The app syncs with Apple Health, Apple Watch, MyFitnessPal, and many other devices and platforms. There is no live instruction.  Price:  $14.99 per month, $34.99 for 3 months, $119.99 per year. Free 7-day trial for new customers. CROSSFLOW – Heidi Kristoffer  In this app, super-bendy yogi Heidi Kristoffer fuses yoga with other disciplines in yoga-based routines for every fitness level, mood, duration, and stage of life. Among the 170+ videos: CrossFlowX™, a fast-moving mix of strength, core, and high-intensity cardio intervals; CrossFlowZ, which has gentle flows to help you relax and wind down; and CrossFlowP, which has prenatal and postnatal flows. There is no live instruction, but new videos are added each week. Price: $14.99 per month, $149 per year. Free 14-day trial.  If you’re tied to your smartwatch, here are two apps that link to your fitness watch to access more detailed analytics, including calories burned and steps taken. Fitbit Premium The regular Fitbit app is free. But if you’re looking for something more robust, the Premium subscription gives you access to 150+ guided video and audio workouts and programs from Fitbit instructors and from popular fitness brands like Daily Burn, barre3, and Yoga Studio by Gaiam. You can easily search workouts by difficulty, time, style, and more. Beyond the workouts, Fitbit Premium gives a deeper analysis of your data and access to guided programs for improving sleep and diet/nutrition, mindfulness activities for stress and sleep, and exclusive games and challenges.    Price: $9.99 per month, $80 a year. Free 90-day trial in many cases. Apple Fitness+  This app designed for the Apple Watch contains over 1000 videos in 11 disciplines, including Pilates, Strength, HIIT, Yoga, and Walking–in a wide range of lengths, taught by top, certified fitness instructors. The Apple Watch tracks your workouts and provides metrics that sync across your Apple devices. There are new workouts every week.  Price: $9.99 per month, $79.99 per year. If you own an Apple Watch Series 3 or later, you qualify for a 3-month trial of Apple Fitness+.

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Watch out — Decisions you make on your 2021 tax return can affect your future Medicare health insurance premiums

Watch out — Decisions you make on your 2021 tax return can affect your future Medicare health insurance premiums

Medicare health insurance premiums can add up to major bucks — especially if you’re upper-income, married, and both you and your spouse are paying. This column lists the 2022 Medicare health insurance premium amounts, explains why decisions made on your 2021 Form 1040 will determine your premiums for 2023, and more. Here goes.    Medicare Part B coverage is commonly called Medicare medical insurance or original Medicare. Part B mainly covers doctors and outpatient services, and Medicare-eligible individuals must pay monthly premiums for this benefit. 
The monthly premium for the current year depends on your modified adjusted gross income (MAGI), as reported on your Form 1040 for two years earlier. MAGI means the adjusted gross income (AGI) number shown on your Form 1040 plus any tax-exempt interest income.  Your 2023 premiums depend on your 2021 MAGI, as reported on your 2021 Form 1040, which you may not have filed yet. That means that things you do or don’t do on that return can impact your 2023 premiums. This is especially true if you’re self-employed or an owner of a pass-through business entity (LLC, partnership, or S corporation).  2022 Part B premiums   For 2022, most individuals will pay the base Part B premium of $170.10 per covered person ($2,041.20 if you pay premiums for the full year).  Higher-income individuals must pay a surcharge on top of the base premium for Part B coverage. For 2022, surcharges apply if you: (1) filed as a single for 2020 and reported MAGI for that year in excess of $91,000 or (2) filed jointly for 2020 and reported MAGI for that year in excess of $182,000. The Feds call the surcharge an Income Related Monthly Adjustment Amount (IRMAA), but we will call it what it is: a surcharge. For 2022, Part B monthly premiums, including surcharges if applicable, for each covered individual are as follows. See more info here. * The $170.10 base premium with no surcharge ($2,041.20 if you pay premiums for the full year) if your 2020 MAGI was no more than $91,000 and you filed as a single for that year or no more than $182,000 if you filed a joint return. * $238.10 ($2,857.20 for the full year) if your 2020 MAGI was between $91,001 and $114,000 and you filed as a single or between $182,001 and $228,000 if you filed a joint return.  * $340.20 ($4,082.40 for the full year) if your 2020 MAGI was between $114,001 and $142,000 and you filed as a single or between $228,001 and $284,000 if you filed a joint return.    * $442.30 ($5,307.60 for the full year) if your 2020 MAGI was between $142,001 and $170,000 and you filed as a single or between $284,001 and $340,000 if you filed a joint return.    * $544.30 ($6,531.60 for the full year) if your 2020 MAGI was between $170,001 and $500,000 and you filed as a single or between $340,001 and $750,000 if you filed a joint return.    * The maximum of $578.30 ($6,939.60 for the full year) if your 2020 MAGI was above $500,000 and you filed as a single or above $750,000 if you filed a joint return. Key point: The 2022 premiums are significantly higher than the 2021 amounts. We don’t yet know the numbers for 2023, but they will probably be considerably higher than the 2022 amounts. Ugh. Paying Part B premiums  Part B premiums, including any surcharge, are withheld from your Social Security benefit payments and are shown on the annual Form SSA-1099 sent to you by the Social Security Administration (SSA). Premiums for Medicare Advantage coverage (Medicare Part C)  You can get your Medicare Part B benefits through the government, for the monthly premium costs listed above, or you can get your benefits through a so-called Medicare Advantage plan offered by a private insurance company that contracts with Medicare to provide benefits under rules established by Medicare. Medicare Advantage plans are also sometimes called Medicare Part C.  Medicare Advantage basics  When you sign up for a Medicare Advantage plan, you still must pay the standard Part B premium, including any applicable surcharge for higher-income folks, and you still get the standard Part B coverage. The advantage is that the Medicare Advantage plan will deliver benefits beyond what the government gives you under Part B, such as prescription drug coverage, dental care, and vision care. You may be charged an additional monthly premium for the Medicare Advantage plan, but depending on where you live, some plans don’t charge anything extra. The additional premium, if any, depends on the plan you select and where you live. With a Medicare Advantage plan, you are usually limited to a defined provider network, which you may view as a disadvantage.   Paying Medicare Advantage premiums  When you have a Medicare Advantage plan, the standard Part B premiums, including any surcharge for higher-income folks, will still be withheld from your Social Security benefit payments and will still be shown on the annual Form SSA-1099 sent to you by the SSA. If you pay an extra premium for your Medicare Advantage coverage, you can pay it like any other bill or arrange to have it withheld from your Social Security benefit payments. Most people choose the first option because it avoids bureaucracy. Premiums for Medicare Part D prescription drug coverage Medicare Part D premiums are for private prescription drug coverage. Base premiums vary depending on the plan. Higher-income individuals must pay a surcharge on top of the base premium. For 2022, surcharges apply to individuals who: (1) filed as singles for 2020 and reported MAGI for that year in excess of $91,000 or (2) filed joint returns for 2020 and reported MAGI in excess of $182,000. The 2022 monthly Part D surcharges for each covered person are as follows, according to the Medicare website. * Zero if your 2020 MAGI was no more than $91,000 and you filed as a single for that year or no more than $182,000 if you filed a joint return. * $12.40 ($148.80 for the full year) if your 2020 MAGI was between $91,001 and $114,000 and you filed as a single or between $182,001 and $228,000 if you filed a joint return.  * $32.10 ($385.20 for the full year) if your 2020 MAGI was between $114,001 and $142,000 and you filed as a single or between $228,001 and $284,000 if you filed a joint return.    * $51.70 ($620.40 for the full year) if your 2020 MAGI was between $142,001 and $170,000 and you filed as a single or between $284,001 and $340,000 if you filed a joint return.    * $71.30 ($855.60 for the full year) if your 2020 MAGI was between $170,001 and $500,000 and you filed as a single or between $340,001 and $750,000 if you filed a joint return.    * The maximum of $77.90 ($934.80 for the full year) if your 2020 MAGI was above $500,000 and you filed as a single or above $750,000 if you filed a joint return. Key point: The 2022 surcharges are barely above the 2021 amounts. Good. We don’t yet know the numbers for 2023, but we can hope for more good news. Fingers crossed. Paying Part D premiums  You pay the base Part D premium, which depends on the private insurance company plan that you select, to the insurance company. Any surcharge,will be withheld from your Social Security benefit payments and reflected on the annual Form SSA-1099 sent to you by the SSA.  Impact of decisions made on your 2021 Form 1040  Decisions made on your 2021 Form 1040 can affect your 2021 MAGI and, in turn, your 2023 Medicare health insurance premiums. If you’re self-employed or an owner of a pass-through business entity, you have more ways to micromanage your MAGI. For instance: * Until the due date for your 2021 Form 1040 (10/17/22 if you get an extension), you as a self-employed individual can make a bigger or smaller deductible contribution to your self-employed retirement account for the 2021 tax year. Your choice will impact your 2021 MAGI and, in turn, your 2023 Medicare health insurance premiums.  * You as an owner of a pass-through business entity can (along with the other owners, if applicable) make other choices that will impact your 2021 MAGI, such as choosing to maximize or minimize depreciation deductions for the entity. Those choices will impact each owner’s 2021 MAGI and, in turn, each owner’s 2023 Medicare health insurance premiums. Deducting Medicare health insurance premiums You can combine premiums for Medicare health insurance coverages with other qualifying health care expenses for purposes of claiming the itemized federal income tax deduction for medical expenses. You can claim an itemized medical expense deduction to the extent your total qualifying expenses exceed 7.5% of your adjusted gross income (AGI).  If you’re self-employed or an S corporation shareholder-employee, you can potentially claim an above-the-line deduction for health insurance premiums, including Medicare health insurance premiums. If you qualify, you don’t need to itemize to collect the tax savings. The bottom line Medicare health insurance premiums can add up to major bucks, and premiums for Part B coverage will probably increase significantly in 2023.   Medicare health insurance premiums and the related tax implications have lots of moving parts, and what you do with your 2021 Form 1040 can impact your 2023 premiums. While 2023 might seem far in the future right now, it will be here before you know it. So, if you’ve not yet filed your 2021 Form 1040, keep the Medicare health insurance premium factor in mind when making decisions on that return.  Sidebar No. 1: You can get hit with delayed premium surcharges  For years, the IRS has had big-time data processing problems, and nothing has changed. For that reason, it can take a long time for Medicare health insurance premium surcharges for the year in question to catch up with the MAGI number reported on your Form 1040 for two years earlier — and eventually reported by the IRS to the SSA. When the SSA finally gets your MAGI number for two years earlier, it will refigure your Part B and Part D surcharges, if applicable. If prior withholding from your Social Security benefits did not cover the refigured surcharges, you will be charged the difference via additional withholdings.  For example, if you extended your 2019 Form 1040, you may just now be finding out how much your actual Part B and Part D surcharges were for 2021. Any shortfall between what was actually withheld from your Social Security benefits in 2021 and what should have been withheld for that year after the SSA’s refiguring will be withheld from your 2022 benefits. You’re welcome.         SIDEBAR No. 2: You can take tax-free HSA distributions to cover Medicare health insurance premiums  Good news if you have a health savings account (HSA). You can take federal-income-tax-free HSA distributions to reimburse yourself for Medicare health insurance premium costs. If you take distributions during the year, fill out IRS Form 8899, Health Savings Accounts (HSAs), and include it with your Form 1040 for that year.  

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