As Medicare Open Enrollment Nears, Here Are the Changes
Medicare’s Annual Enrollment Period begins Oct. 15. and runs through Dec. 7.
This is the time to reassess your Medicare plans.
As you get started, you should ask yourself:
- Am I satisfied with my current plan?
- Am I comfortable maintaining it for another year?
- Are the medications I need in my plan’s formulary next year?
- How much can I expect to pay for my medications next year?
If you are a current Medicare recipient, you should have receive your Annual Notice of Change from your Advantage plan or pharmaceutical plan company in September. This notice will highlight all of your plan’s changes for 2021.
You should set aside some time to look it over. If you have questions or something has changed, you can call us and we’ll help you understand the changes.
The open enrollment period allows you to make a number of changes if you’re already enrolled. The major changes you can make include:
- Switching from Original Medicare to a Medicare Advantage plan, or vice versa.
- Changing your Medicare Advantage plan.
- Joining a Medicare prescription drug plan or picking a new drug plan.
- Dropping your drug coverage.
Take your time during the current open enrollment period to look over the options available to you, and think about your health care needs and whether your current plan is robust enough for you.
What’s New
Insulin coverage
The big news is the introduction of enhanced Advantage and drug plans, capping insulin costs at $35 through the coverage gap, or “donut hole.” Studies have estimated these plans will save insulin users an average of more than $700 a year.
If you are on insulin, check your plan carefully as not all plans will offer this reduction. It is only available from the insurers that are participating in a five-year trial period for the program. Lower-cost drug plans will likely not offer these savings.
Drug plan deductibles
The drug plan deductible limit will be $445. To reach the coverage gap/donut hole, you’ll need to spend more: $4,130 (up $110 from this year). Drug costs in the gap will remain at 25% of the retail cost. The out-of-pocket threshold to get out of the gap will be $6,550 in 2021.
Part B premiums
The Part B premium is expected to rise 2.7% to $148.50 per month. For higher income earners, the income limits will increase $2,000 for each category. That said, it’s likely there will not be a Social Security Cost of Living Adjustment for 2021, which means they cannot raise Part B premiums.
COVID-19
Since the novel coronavirus continues to spread and no vaccine has yet become available, obviously coverage for COVID-19-related services is on the minds of many seniors, particularly if they have to pay out of pocket for them.
Testing for COVID-19 ordered after Feb. 4, 2020 is covered under traditional Part B when ordered by a physician or other health care provider. Beneficiaries are not required to pay the Part B deductible or any related co-insurance.
Medicare Advantage plans may not charge for COVID-19 tests and testing-related services. Additionally, Part B is required to fully cover a COVID-19 vaccine if one becomes available.
Also, telemedicine services are now available to beneficiaries in any geographic area and will be reimbursed by Medicare. CMS has also waived the requirement that a provider of telemedicine must have treated the beneficiary in the past three years.
As for treatment, if a Medicare patient is required to be quarantined in the hospital even if they no longer require acute care, they will not be required to pay an additional deductible for the cost of the quarantine.
Medicare Advantage plans may waive or reduce cost-sharing for COVID-19-related treatments, but this is not required. These plans may also waive prior authorization requirements for COVID-19 services.
