What You Need to Know About Medicare Changes for 2021!

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Medicare open enrollment is underway. Now is a great opportunity to make changes to your coverage or get a new plan. Here’s what you need to know about changes that will affect your Medicare in 2021.

Medicare Part B Changes

  • The income brackets for Medicare Part B and D will start at $88,000 for a single person, (from $87,000 in 2020) and the high-income surcharges for Part D and Part B will increase in 2021.
  • The standard Part B premium increased to $144.30 from $135.50 in 2020. The Centers for Medicare and Medicaid Services (CMS) has not yet announced the standard Part B premium for 2021.
  • Part B will cover treatment for opioid use disorder (OUD), including drug testing, medications, and individual and group therapy, including telehealth counseling. 

Medicare Part D Changes

  • Standard Medicare Part D prescription drug plan coverage parameters are new in 2021. 
    • Initial Deductible will increase by $10 to $445 in 2021. 
    • Initial Coverage Limit will increase to $4,130 in 2021 from $4,020 in 2020
    • Out-of-Pocket Threshold will increase to $6,550 from $6,350 in 2020. 
    • Coverage Gap (Donut Hole) will begin once you reach your Medicare Part D plan’s initial coverage limit of $4,130 in 2021 from $4,020 in 2020 and will end when you spend a total of $6,550 out-of-pocket in 2021.
  • The threshold for entering the catastrophic coverage phase (where you don’t have to pay as much out-of-pocket) is increasing to $6,550.
  • As part of the new Part D Senior Savings Model, about 30 percent of all 2021 stand-alone Medicare Part D plans and Medicare Advantage plans with drug coverage will offer coverage of different types of insulin at a maximum co-pay of $35 per month.
  • This is the second year Part D enrollees will receive a 75 percent discount on the total cost of their brand-name and generic drugs purchased while in the Donut Hole. This includes a 70 percent discount paid by the brand-name drug manufacturer and a 5 percent discount paid by your Medicare Part D plan.
  • The income brackets for Medicare Part B and D are projected to start at $88,000 for a single person, (from $87,000 in 2020) and the high-income surcharges for Part D and Part B will increase in 2021.

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Medigap Changes

  • Plans C and F, both of which cover the Medicare Part B deductible, are no longer available to those who are Medicare-eligible after 2020.
  • There is a new high-deductible Plan G available beginning in 2020. 

Medicare Advantage Changes

  • The average Medicare Advantage (Medicare Part C) premium for 2021 is expected to be lower — $21/month in 2021, down from $23/month in 2020.
  • People with ESRD (kidney failure) will be able to enroll in Medicare Advantage plans.
  • The maximum out-of-pocket limit for Medicare Advantage plans is increasing to $7,550 for 2021, up from $6,350 in 2020 and $5,100 in 2019.
  • An increase in access to telehealth for seniors in Medicare Advantage (MA) plans.
  • Expansion of the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases.
  • Support for more Medicare Advantage options for beneficiaries in rural communities.
  • The flexibility to include telehealth providers in practice areas including: primary care, cardiology, dermatology, psychiatry, gynecology, and endocrinology.
  • Some Medicare Advantage plans will offer supplemental home health benefits, including adult daycare, transportation, meal delivery, and more. 
  • Other popular benefits that some Medicare Advantage plans will offer include dental, hearing, vision, fitness, acupuncture, and over-the-counter drug coverage. 
  • Medicare Advantage plans will cover opioid use disorder (OUD) treatment the same as Part B, as well as supplemental benefits such as chiropractic or massage therapy treatments for pain management as ordered by a doctor. 

Temporary Medicare Changes in Response to the Coronavirus Pandemic

  • A Medicare beneficiary quarantined in the hospital will not have to pay an additional deductible for the cost of the quarantine. 
  • Medicare covers coronavirus testing under Medicare Part B when ordered by a physician. 
  • Medicare Part B will fully cover a COVID-19 vaccine when it becomes available.
  • Medicare has expanded all telehealth services in the coronavirus pandemic. 
  • Part D plans must provide up to a 90-day supply of covered drugs if requested.
  • Drugs purchased at out-of-network pharmacies will be covered if the beneficiary cannot make it to a network pharmacy. 
  • Medicare Advantage plans must cover services at out-of-network health care facilities for all beneficiaries with and without COVID-19. 
  • A beneficiary’s stay in a skilled nursing facility will be covered even if the patient does not spend three days in the hospital beforehand. 

Be prepared for any changes that are coming for Medicare! Compare top plans today to get the coverage you need. 


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