President Lyndon B. Johnson signed Medicare Part B alongside Part A in 1965 to establish a new precedent in insurance coverage. When Johnson created the act, it provided insurance for seniors and other groups who had no insurance from an employer. Today, the coverage comes with a standard premium of $170.10, but it can be as high as $578.30. This figure represents a considerable spike from the prior year’s rate of $148.50.
Medicare Part B
Many Medicare enrollees have questioned the reason for this increase and wondered whether a there might be a need for a mid-year reduction. Consider the following facts if you’re wondering what to know about Medicare Part B premiums.
Aduhelm Caused Increase
The drug Adulhelm contributed to the increase in the Medicare premium. Aduhelm is a newly-introduced treatment aimed at alleviating symptoms of Alzheimer’s. The drug is manufactured generically as aducanumab, an antibody-based therapy designed to reduce specific amyloid-beta plaque accumulation. Experts believe Alzheimer’s comes from a buildup of these amino acids, but clinical trials soon cast doubt on Aduhelm’s efficacy.
Miscaultating The Cost of Aduhelm
The rate of Aduhelm was questionable, and there was a realization that manufacturers Biogen and Eisai had miscalculated the cost.
These companies initially quoted a per-patient price of $56,000 to the Centers for Medicare and Medicaid Services (CMS). This figure then served as the justification for the sharp increase in Part B premiums. Unfortunately, though, it turned out that they exaggerated the cost estimate. Biogen eventually adjusted the cost estimate to just $28,000 per patient.
Only Some Beneficiaries Are Eligible
Despite these concerns, Aduhelm is still in Medicare, and Part B premiums remain at their inflated rate. Many stakeholders and insured disapproved of this decision, but the drug is still available to Part B enrollees. Only certain enrollees are eligible, though, restricting its availability even further. According to CMS, Aduhelm will only receive coverage if it is part of a clinical trial. The CMS, the Food and Drug Administration (FDA), or the National Institutes of Health (NIH) must approve and oversee the trial.
The Future of Part B Premiums Is Unclear
With all of the controversy surrounding Aduhelm and the increased Part B premiums that it caused, some believe there could be a reversal. Ideally, the creators could adjust to account for the miscalculations and restrictions. Many Medicare beneficiaries have advocated for this, but there have been no changes. It’s unclear whether premiums will decrease next year or whether CMS may initiate a mid-year adjustment to the current rate. The latter would be an unprecedented move, but many people agree that it may be necessary.
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