Special to the NABBW By Lindsay Engle, Medicare Expert, MedicareFAQ

With the Medicare Open Enrollment period quickly approaching, current and newly eligible beneficiaries will see a variety of changes that could impact their coverage for the 2021 calendar year, including budget updates and a reduction in drug costs among others.

It is critical that all beneficiaries keep a close eye on important dates and educate themselves on their options in order to make the best decision for their individual needs. However, navigating these choices can be overwhelming.

The following article will provide information on key dates, expected changes and the impact on coverage for the upcoming year.

Important 2021 Dates

While beneficiaries are not required to make changes to their coverage, there are a few important dates they should be aware of as we head towards the end of 2020.

  • Annual Enrollment Period: The annual enrollment period begins on October 15, 2020 and runs until December 7, 2020. During this period, current beneficiaries have the opportunity to make any changes to their current Medicare plan, effective January 1, 2021.
  • Five-star Medicare Advantage Policy Enrollment: The five-star Medicare advantage policy enrollment is a special enrollment period that begins on December 8, 2020 and ends November 30, 2021. During this time, beneficiaries have the option to enroll in a five-star Medicare Advantage plan, Medicare cost plan, or a Medicare prescription drug plan. Anyone who wants to use this special enrollment period needs to make their one-time change before November 30th or will have to wait until December 8th.
  • Medicare Advantage Plan’s Open Enrollment: This plan’s open enrollment runs from January 1, 2021 to March 31, 2021 and provides beneficiaries who are enrolled in a Medicare Advantage Plan with the opportunity to make a one-time change to their coverage.
  • Medicare General Enrollment Period: This enrollment period also begins on January 1, 2021 and ends on March 31, 2021. Beneficiaries who did not enroll in Part A and Part B when first eligible are able to do so during this period in what is considered a second chance.
2021 Medicare Changes

Budget:

One of many changes coming to Medicare, yet one of the most important, is President Trump’s proposed new budget that will help reduce Medicare spending by an estimated 7% over the course of 10 years (2021-2030).

In order to achieve this goal, several changes will be made, including allowing patients to see nurse practitioners as their primary caregiver. Additionally, there is a potential that providers will see a reduction in reimbursement rates, which has caused a bit of controversy for many. While a reduction in rates may save taxpayer’s money, beneficiaries could lose access to some doctors.

Part B Premium Costs:

There is not much to report here as Part B premiums have yet to be released. However, we do expect there to be a change as projections from the Centers for Medicare and Medicaid Services (CMS) have shared that beneficiaries should expect a cost of around $150 per month. We anticipate a final announcement this Fall.

Medicare Advantage:

Given the current state of the world, it should come as no surprise that Medicare Advantage policies will be increasing their telehealth services and coverages. As telehealth has become a popular alternative, CMS is providing Advantage plans the opportunity for more flexibility to include these services in specific areas, including:

  • Dermatology
  • Psychiatry
  • Cardiology
  • Primary Care
  • Gynecology
  • Endocrinology

Additionally, beneficiaries with end-stage renal disease (ESRD), who have been limited in coverage options, will now have the ability to enroll in a plan beginning in 2021. This is a result of changes made by the 21st Century Cures Act, which have been implanted to provide ESRD beneficiaries more coverage options under Medicare.

One final, significant change that beneficiaries should be aware of are increased long-term care benefits offered by some Advantage plans, including day care services, in-home personal care services and home safety modifications.

Reduced Drug Costs:

As previously mentioned, President Trump has proposed a new budget to reduce Medicare spending. As part of that, Trump has called on Congress to pass a “comprehensive drug pricing reform” which estimates to reduce the federal deficit by $135 billion within the next ten years.

We’ve already seen a significant decrease in the cost of insulin and in 2021 that will be evident as patients with diabetes will have the opportunity to join Medicare plans with insulin pricing caps and copays of no more than $35 per month.

Star Ratings Program:

Another change we’ll see is how the Star Ratings are handled. Star Ratings help beneficiaries compare health and drug plan quality, but given the current national health crisis, CMS has approved changes for the 2021- and 2022-star ratings to provide better support. CMS will use last year’s scores (2019) and this year’s ratings to provide 2021 Star Ratings. Since this will have an impact on Part C Star Ratings, we will also see changes to Part C coverage.

State-specific Changes:

New Hampshire is the only state where we’ll see a new rule with the passing of a new bill called “the birthday rule.” The bill prohibits insurance companies from charging a higher rate to people with disabilities who are Medicare-eligible. The bill will go into effect on January 1, 2021, meaning any beneficiary who is under 65 will have the same premiums as those who are already 65.

Physician Fee Schedule:

Effective January 1, 2021, there will be changes made to the physician fee schedule. Proposed cuts to psychologists, physical therapists, and social workers will stay intact, but starting in the new year, physicians will see payment cuts of 8% while social workers and psychologists will see 7%.

While there is a lot of information to digest, beneficiaries enrolled in Part A, Part B, Medicare Advantage or Part D can expect to receive a Medicare Annual Notice of Change (ANoC) letter in September, which outlines any changes to their individual plan for the upcoming year. If you haven’t received the letter yet, you should contact your plan provider. The changes outlined will help beneficiaries decide if they should keep or change their current plan. Major changes to look out for include:

  • Cost
  • Benefits
  • Changes to the service area
  • Formulary changes (Part D)

Medicare is constantly making changes to its policies to provide beneficiaries with the best quality and variety of options for their specific needs. Given the wide range of changes from year-to-year it is essential that beneficiaries remain educated about these changes and how they can impact them. By staying informed, beneficiaries can make the best decisions for their individual needs.

Lindsay Engle is the Medicare expert for MedicareFAQ. She has worked in the Medicare industry since 2017 and is featured in many publications as well as writing Medicare focused columns for other publications. Lindsay is part of the Medicare Marketing Association, the Medicare Supplement Insurance Professionals group, and the DecisionHealth – Medical Practice & Hospital Group. You can also find her over on MedicareFAQ’s Medicare Channel on YouTube as well as contributing to their Medicare Community on Facebook.

 

NABBW Contributing Author