What's New for Medicare in 2021

What’s new for Medicare in 2021?

Major Changes in 2021 for Medicare Advantage Plans

One of the big questions everyone wants to know is how is my Medicare coverage going to change in 2021.  If you are on a Medicare Supplement Plan / Medigap plan your plan will never change as it remains the same year after year.  The only thing you need to review is your Part D prescription drug coverage.  For everyone on a Medicare Advantage plan your plan does change each year to include your Part D plan that is imbedded into your Part C – Medicare Advantage plan.  


Medicare Supplement Plan Long Beach California

End-Stage Renal Disease (ESRD)

Prior to 2021 if you were on a Medicare Advantage plan and you suffered from End-Stage Renal Disease you were limited to specific plans that included coverage for ESRD.  Starting in 2021 you are now allowed to join any Medicare Advantage plan that you would like and you will still be covered for any approved treatment by the plan you select.  

2021 Medicare Part A and Part B Premium changes

Medicare Part A and Part B insurance premiums are rising but at a lower percentage than usual.  This is because of COVID-19, it was agreed to keep this years premium increase to a minimum.  

If you did not work enough quarters to qualify for a no cost premium, in 2021 your Medicare Part A insurance premium will be $471 per month if you have less than 30 quarters or $259 per month for people with 30 – 39 quarters. 

The standard Medicare Part B insurance premium amount will be $148.50 in 2021 (or higher depending on your reported annual income in 2019).  If you were a higher wage earner your monthly fee may be increased from the base premium.  

2021 Cost Sharing is increasing

The maximum out-of-pocket allowable limit for Medicare Advantage plans is increasing to $7,550 for 2021, up from $6,350 in 2020 and $5,100 in 2019. 

Your Medicare Part B deductible will be increasing slightly from $198 in 2020 to $203 in 2021.  This increase will affect those individuals who are have Original Medicare with or without a Medigap plan. Even if you have Plan F you will experience a slight increase in your monthly premiums to cover this additional amount.

While your Medicare costs are climbing, many Medicare Advantage plan in California have a max out of pocket cost below $1,000.  This year several plans reduced their max out of pocket cost one again.  The Medicare Insurance carriers say they are on a race to get to zero.  We shall see if one day this actually happens.

It is important that you understand how the max out of pocket cost can affect you as you use your Medicare Advantage plan.  Many Medicare Advantage plans have zero dollar copays and it is not until something major happens that you start receiving your first bills.

If you are in an area that has higher max out of pocket costs, you might want to consider switching to a new Medicare Advantage plan or consider changing back to Original Medicare and purchase a Medicare Supplement.

Part D - Prescription Drug Plan Cost for 2021 plan year

Standard Medicare Part D prescription drug plan coverage overall cost for 2021 have seen some major changes. Your initial Deductible will increase by $10 to $445 in 2021. While some Part D plans can reduce this amount this is the max allowable.  Initial Coverage Limit will increase to $4,130 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.  

Once you have spent $6,550 on your prescription drugs you will enter into what is called the catastrophic coverage phase.  Once in this last phase your cost for drugs should go down substantially.  

As part of the new Part D Senior Savings Model, about 30% 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% discount on the total cost of their brand-name and generic drugs purchased while in the Donut Hole. This includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan.

Medicare Advantage Supplemental Benefits 2021 changes

For 2021 many plans will now include some additional supplemental benefits that you may not have see in the past.  One of these benefits is TeleHealth coverage.  This is a coverage that gives you the ability to call your Doctor verses having to go into the Doctor’s office.  Depending on which Medicare Advantage plan you are covered by you could have a zero dollar copay for this coverage option.  

Your plan may have added or removed Dental and Vision coverage so please ensure you keep a sharp eye on those coverages as well.  These coverages are usually very basic coverages and do not provide comprehensive benefits unless you purchase a separate comprehensive plan option.  A more comprehensive plan can usually be obtained from the same Medicare Carrier or on a standalone bases.

While a free gym membership has been common place for Medicare Advantage plans with Covid-19 many gyms are not open or are only open on a limited basis.  Some benefits we have seen added is the ability to obtain an exercise plan that you can do at home.  

We would love to help you find a Medicare plan that is best suited for you.  Give us a call at 562-735-3553 and we can complete a Medicare plan review.

Integrity Now Insurance Brokers, Inc.