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Medicare Part B Premiumsand CostPart B PremiumYou pay a premium each month for Part B. Your Part B premium will be automatically deductedfrom your benefit payment if you get benefits from one of these: Social SecurityRailroad Retirement BoardOffice of Personnel ManagementIf you don’t get these benefit payments, you’ll get a bill.Most people will pay the standard premium amount. If your modified adjusted gross income isabove a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA).Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 yearsago. This is the most recent tax return information provided to Social Security by the IRS.The standard Part B premium amount in 2022 is 170.10. Most people pay the standard Part Bpremium amount. If your modified adjusted gross income as reported on your IRS tax return from 2years ago is above a certain amount, you'll pay the standard premium amount and an IncomeRelated Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.The 2022 Part B total premiums for high-income beneficiaries are shown in the following table:File individual tax returnFile joint tax returnFile married and filedseparate tax returnsYou pay each month(in 2022IndividualMarried andFiledSeparate 91,000 or less 182,000 or less 91,000 or less 170.10 170.10greater 91,000 up to 114,000greater 182,000 up to 228,000greater 91,000 up to 409,000 238.10 544.30greater 114,000 up to 142,000greater 228,000 up to 284,000greater 284,000 up to 340,000greater 340,000 and lessthan 750,000 750,000 and greatergreater 91,000 up to 409,000greater 91,000 up to 409,000greater 91,000 up to 409,000 409,000 and greater 340.20 544.30 442.30 544.30 544.30 544.30 578.30 578.30greater 142,000 up to 170,000greater 170,000 and lessthan 500,000 500,000 or greater

2022 Services Covered by MedicarePART A HOSPITAL INSURANCE COVERED SERVICESSERVICESBENEFITSMEDICARE PAYSYOU PAYHospitalizationSemiprivate room, generalnursing, misc. servicesFirst 60 days61st to 90th day91st and BeyondAll but 1,556All but 389 per dayAll but 778 per day 1,556 deductible 389 per day 778 per daySkilled Nursing Facility Care(SNF) after a 3 night hospitalstayFirst 20 days21st to 100th dayBeyond 100 days100% of approvedAll but 194.50 per dayNothingNothing if approved 194.50 per dayAll costsHome Health CareMedically necessary skilledcare, therapyPart-time care as longas you meet guidelines100% of approvedNothing if approvedHospice CareFor the terminally illAs long as doctorcertifies needAll but limited costs fordrugs & respite careLimited costs for drugs& respite careBloodBloodAll but first 3 pintsFirst 3 pintsPART B MEDICAL INSURANCE COVERED SERVICESSERVICESMedical ExpenseMEDICARE PAYSYOU PAY80% of approved amount(after 233 deductible)20% of approved amount(after 233 deductible)Clinical Laboratorydiagnostic tests100% of approvedNothing if approvedHome Health CareMedically necessary skilled care, home health aideservices, medical supplies etc. after a 3-dayinpatient hospital stay, Requires a prescription.100% of approvedNothing if approvedOutpatient Hospital TreatmentUnlimited if medically necessary80% of approved20% of approved amount(after 233 deductible)Durable Medical EquipmentPrescribed by a doctor for use in home80% of approved amount(after 233 deductible)20% of approved amount(after 233 deductible)Blood80% of approved amount(after 233 deductible andafter the first 3 pints)20% of approved amount(after 233 deductibleand after payment of thefirst 3 pints)Physician services and medical supplies in and outof the hospital.

Part B Preventive & Screening Services Abdominal aortic aneurysmscreening Alcohol misuse screenings& counseling Bone mass measurements Cardiovascular diseasescreenings Cardiovascular disease(behavioral therapy,one-time visit) Cervical & vaginal cancerscreening Lung cancer screening Hepatitis C screening test Depression screenings Diabetes screenings Tobacco use cessationcounseling Yearly "Wellness" visit HIV screening Diabetes self-managementtraining Lung cancer screeningShots: Glaucoma tests Mammograms (screening) Flu shots Lung cancer screening Nutrition therapy services Hepatitis B shots Hepatitis C screening test Obesity screenings andcounseling Pneumonia shots HIV screening Lung cancer screening One-time “Welcome toMedicare” preventive visit Mammograms (screening) Prostate cancer screenings Nutrition therapy services Sexually transmittedinfections screening &counseling Obesity screenings andcounseling One-time “Welcome toMedicare” preventive visitFor more detailedinformation about Part Bpreventive & screeningservices please visitMedicare.gov website orcontact Medicare at1-800-633-4227

What is Medicare Part CMedicare Part C is known as Medicare Advantage.These are private plans run through Medicare that, bylaw, must at least be "equivalent" to regular Part A andPart B coverage. But, there's lots of variation amongPart C plans.How does Medicare Advantage Planswork?Medicare Advantage Plans, sometimes called "Part C" or"MA Plans," are an “all in one” alternative to Original Medicare. They are offered byprivate companies approved by Medicare. If you join a Medicare Advantage Plan,you still have Medicare. These "bundled" plans include Medicare Part A (HospitalInsurance) and Medicare Part B (Medical Insurance), and usually Medicareprescription drug (Part D).Medicare pays a fixed amount for your care every month to the companies offeringMedicare Advantage Plans. These companies must follow rules set by Medicare.However, each Medicare Advantage Plan can charge different out-of-pocket costsand have different rules for how you receive services.What are the different types of Medicare Advantage Plans? Health Maintenance Organization (HMO) plan HMO Point-of-Service (HMOPOS) plan: This HMO plan may allow you to get some servicesout-of-network for a higher copayment or coinsurance. Medical Savings Account (MSA) plans. Preferred Provider Organization (PPO) plan. Private Fee-for-Service (PFFS) plan. Special Needs Plan (SNP).Covered services in Medicare Advantage PlansMedicare Advantage Plans cover all Medicare services. Some Medicare AdvantagePlans also offer extra coverage, like vision, hearing and dental coverage.Medicare Advantage Plans cover Medicare Part A and Part B benefits. Plans mustcover all emergency and urgent care, and almost all medically necessary servicesOriginal Medicare covers. However, if you’re in a Medicare Advantage Plan, OriginalMedicare will still cover the cost for hospice care, some new Medicare benefits, andsome costs for clinical research studies.

Part C - Medicare AdvantageYour out-of-pocket costs in a Medicare Advantage Plan(Part C) depend on:1Many Medicare Advantage Plans have a 0 monthly premium. If you enroll in a plan that2Whether the plan pays any of your monthly Medicare premiums -Some Medicare Advantagedoes charge a premium, you pay that amount in addition to the Part B premium.Plans will help pay all or part of your Part B premium. This benefit is sometimes called a“Medicare Part B premium reduction.”3If the plan has a yearly deductible or any additional deductibles for certain services.4How much you pay for each visit or service (copayments or coinsurance).5Medicare Advantage Plans can’t charge more than Original Medicare for certain services, like6The type of health care services you need and how often you get them.7Whether you get services from a network provider or a provider that doesn’t contract with thechemotherapy, dialysis, and skilled nursing facility care.plan. If you go to a doctor, other health care provider, facility, or supplier that doesn’t belongto the plan’s network for non-emergency or non-urgent care services, your plan may notcover your services, or your costs could be higher. In most cases, this applies to MedicareAdvantage Plans, Health Maintenance Organizations and Preferred Provider Organizations.8Whether you go to a doctor or supplier who accepts assignment (if you’re in a PreferredProvider Organization or Private Fee-for-Service plan, or Medical Savings Account plan andyou go out of network).9The plan’s yearly limit on your out of pocket costs for all Part A and Part B medical services.10Whether you have Medicaid or get help from your state through a Medicare SavingsOnce you reach this limit, you’ll pay nothing for Part A and Part B covered services.Program.

Medicare (Part D) Drug CoverageMedicare drug coverage helps pay for prescription drugs you need. Even if you don’t takeprescription drugs now, you should consider getting Medicare drug coverage. Medicare drugcoverage is optional and is offered to everyone with Medicare. If you decide not to enrollwhen you’re first eligible, and you don’t have other creditable prescription drug coverage(like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a lateenrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long asyou have Medicare drug coverage. To enroll in Medicare drug coverage, you must join aMedicare-approved plan that offers drug coverage. Each plan can vary in cost and specificdrugs covered. Visit Medicare.gov/plan-compare to find and compare plans in your area orcontact your AR SHIIP office 1-800-224-6330.There are 2 ways to enroll Medicare drug coverage:1Medicare drug plans. These plans add drug coverage to OriginalMedicare, some Medicare Cost Plans, some Private Fee-for-Serviceplans, and Medical Savings Account plans. You must have Part Aand/or Part B to join a separate Medicare drug plan.2Medicare Advantage Plans or other Medicare health plans with drugcoverage. You get all of your Part A, Part B, and drug coverage,through these plans. Remember, you must have Part A and Part B tojoin a Medicare Advantage Plan, and not all of these plans offer drugcoverage.

Drug Coverage RulesPlans may have coverage rules for certain drugs Prior authorization: You and/or your prescriber must contact your plan before you can fillcertain prescriptions. Your prescriber may need to show that the drug is medically necessary forthe plan to cover it. Plans may also use prior authorization when they cover a drug for onlycertain medical conditions it is approved for, but not others. When this occurs, plans will likelyhave alternative drugs on their list of covered drugs (formulary) for the other medical conditionsthe drug is approved to treat.Quantity limits: Limits on how much medicine you can get at a time.Step therapy: You may need to try one or more similar, lower-cost drugs before the plan willcover the prescribed drug.Prescription safety checks at the pharmacy (including opioid pain medicine): Before thepharmacy fills your prescriptions, your Medicare drug plan and pharmacy perform additionalsafety checks, like checking for drug interactions and incorrect dosages. These safety checksalso include checking for possible unsafe amounts of opioids, limiting the days supply of a firstprescription for opioids, and use of opioids at the same time as benzodiazepines (commonlyused for anxiety and sleep). Opioid pain medicine (like oxycodone and hydrocodone) can helpwith certain types of pain, but have risks and side effects (like addiction, overdose, and death).These can increase when you take opioids with certain other drugs, like benzodiazepines,anti-seizure medications, gabapentin, muscle relaxers, certain antidepressants, and drugs forsleeping problems. Check with your doctor or pharmacist if you have questions about risks orside effects.Drug Management Programs: Some Medicare drug plans and health plans with drug coveragehave a program in place to help you use these opioids and benzodiazepines safely. If you getopioids from multiple doctors or pharmacies, your plan will contact the doctors who prescribedthese drugs to make sure they’re medically necessary and you’re using them appropriately.If your plan decides your use of prescription opioids and benzodiazepines may not be safe, theplan will send you a letter in advance. This letter will tell you if the plan will limit coverage ofthese drugs for you, or if you’ll be required to get the prescriptions for these drugs only from onedoctor or pharmacy you select. You and your doctor have the right to appeal these limitations ifyou disagree with the plan’s decision. The letter will also tell you how to contact the plan if youhave questions or would like to appeal.The opioid safety reviews at the pharmacy and the Drug Management Programs generallydon’t apply if you have cancer, are getting palliative or end-of-life care, are in hospice, or live ina long-term care facility.If you or your prescriber believes that your plan should waive one of thesecoverage rules, you may be able to ask for an exception.

Drug Coverage CostYour actual drug coverage costs will vary depending on: Your prescriptions and whether they’re on your plan’s list of covered drugs (a “formulary”) Each plan has its own formulary. What “tier” the drug is in (Medicare health plans with drug coverage place drugs into differentlevels). Which drug benefit phase you’re in (such as, whether you’ve met your deductible, or if you’re inthe catastrophic coverage phase. Which pharmacy you use and whether that pharmacy offers preferred or standard cost sharing,is out of network, or if your prescription is a mail order. Your out-of-pocket drug costs may be less at a preferred pharmacy that has an agreement with your plan to charge less.Whether you get Extra Help paying your drug coverage costs (see box below).You may be able to lower the cost of your drugs, by choosing generics overbrand name or paying the non-insurance cost of a drug, ask your pharmacistif there’s a less expensive option available or check with your doctor to makesure the generic option is best for you.Extra Help paying for health and drug cost If you have limited income and resources, you may qualify for help to pay for somehealth care and drug coverage costs. Extra Help is a program to help people with limited income and resources payMedicare drug costs. You may qualify for Extra Help if your yearly income andresources are below these limits in 2022 (see box below).FULL EXTRA HELPANNUAL INCOME:Individual not more than 17,628.00Couple not more than 23,757.00ASSET LIMIT:Individual not more than 9,470.00Couple not more than 14,960.00

Difference between Medigap & MedicareAdvantage PlansMedigap policies and Medicare Advantage Plans arealternative plans to Original Medicare Medigap and Medicare Advantage offer different options. What is best for a persondepends on their particular needs. Medigap is supplemental insurance for people who have Original Medicare.Medicare Advantage, also known as Medicare Part C. The key factors that a person will need to compare to decide which option bestsuits their needs include coverage, flexibility in choosing doctors, and costs.Medigap policies do not work with Medicare Advantage Plans. If you have a Medigappolicy and join a Medicare Advantage Plan (Part C), you must drop your Medigappolicy. Your Medigap policy can't be used to pay your Medicare Advantage Plancopayments, deductibles, or premiums.If you want to cancel your Medigap policy, contact your insurance company. In mostcases, if you drop your Medigap policy to join a Medicare Advantage Plan, you maynot be able to get the same policy back unless you have a "trial right."If you have a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigappolicy unless you're switching back to Original Medicare. Contact your StateInsurance Department if this happens to you.If you want to switch to Original Medicare and buy a Medigap policy, contact yourMedicare Advantage Plan to see if you're able to disenroll.Special Rights under Advantage PlansIf you join a Medicare Advantage Plan for the first time, when you are first eligible forMedicare and you are not happy with the plan, you’ll have special rights under federallaw to buy a Medigap policy and a separate Medicare Prescription Drug Plan (Part D),if you return to Original Medicare within 12 months of joining the Medicare AdvantagePlan. If you had Medigap before you joined, you may be able to get the same policy backif the company still sells it. If it isn’t available, you can buy another policy. Some states provide additional special rights to buy a Medigap policy.

As of January 1, 2020, Medigap plans sold to new people with Medicare are not allowed tocover the Part B deductible. Because of this, Plans C and F are not available to people new toMedicare starting on January 1, 2020. If you already have either of these 2 plans (or the highdeductible version of Plan F) or are covered by one of these plans before January 1, 2020,you’ll be able to keep your plan.What is Medicare Supplement In

Arkansas Insurance Department Senior Health Insurance Information Program (AR SHIIP) Division 1 ommerce Way Little Rock, AR 72202 Toll Free: 1-800-224-6330 www.insurance.arkansas.gov FIND US ON FAEOOK AND TWITTER This publication was created by the State of Arkansas nsurance epartment and AR SP ivision, supported