Today Medicare Open Enrollment begins and runs through December 7. At this time, Medicare enrollees can reevaluate their existing coverage & make changes or enroll in new policies, should healthcare needs have changed. It is also important to note that the federal government makes changes each year to Medicare rules and regulations which can affect: coverage, expenses, and doctors. Reviewing your policy ensures all of your needs are met and you are well taken care of.
During the designated open enrollment period, options available include:
Changing from Original Medicare to a Medicare Advantage plan
Changing from a Medicare Advantage plan back to Original Medicare and a stand-alone Part D prescription drug plan
Changing from one Medicare Advantage plan to another that better meets your needs
Changing from one Medicare Part D prescription plan to another
Enrolling in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. (If you haven’t maintained other creditable coverage in the interim, a late-enrollment penalty may apply).
Expected Changes in 2021
Medicare Part A (inpatient care)
2021 Part A premium
No premium – for most beneficiaries who paid into Medicare through payroll taxes.
$263/month – for those who worked / paid into Medicare between 7.5 and 10 years ( $252/month in 2020)
$478/month – for those with a work history of less than 7.5 years ($458/month in 2020)
2021 Part A deductible
$1,452 ($1,408 in 2020)
Covers up to 60 days in the hospital
Deductible is per benefit period, NOT per year. Once a beneficiary has been out of the hospital for at least 60 days, a new benefit period would start if and when they needed to be hospitalized again.
Supplemental coverage, including Medigap plans, will pay some or all of the Part A deductible on your behalf.
2021 Part A coinsurance:
$363 per inpatient day (days 61-90 in the benefit period for which the deductible applied; $352 per day in 2020)
$726 per inpatient day for day 91 and beyond during the benefit period. Referred to as lifetime reserve days, and you only get 60 of them over the course of your lifetime. They only start to be used up once you’ve spent 90 days in the hospital during a single benefit period. But if you do use up all your lifetime reserve days and don’t have supplemental coverage, you’re responsible for all hospital costs after the lifetime reserve days are used up (the lifetime reserve day coinsurance in 2020 is $704 per day.)
Medicare Part A covers 100% of the cost of skilled nursing facility care for the first 20 days, as long as you had at least a three-night inpatient hospital stay prior to the skilled nursing facility stay. Coinsurance for days 21-100 in a skilled nursing facility is projected to be $181.50 per day in 2021 ($176 per day 2020). After day 100, Medicare no longer covers skilled nursing facility charges and you will be responsible for the full cost.
Supplemental coverage, including Medigap plans, are designed to pay the Part A coinsurance on your behalf. And all of the standardized Medigap plans will also pay for up to 365 additional days in the hospital after Medicare benefits are exhausted. Most Medigap plans also cover at least a portion of skilled nursing facility coinsurance costs.
Medicare Part B (outpatient care)
2021 Part B premiums:
The Part B premium for 2021 is projected to be $153.30 per month for most enrollees in 2021 depending on income ( $144.60/month in 2020).
High-income enrollees pay a higher Part B premium ranging from about $215/month to $521/month.
Part B premiums are also higher (due to a penalty) for some beneficiaries who delayed their enrollment.
2021 Part B deductible:
Enrollees who receive Part B-covered treatment during the year must pay the Part B deductible, which has not been established for 2021 yet ($198 in 2020).
Medigap plans C and F will pay the Part B deductible for you, but they’re no longer available for newly-eligible Medicare enrollees. (Plan G is still available for newly-eligible enrollees; it’s the same as Plan F except enrollees cover the Part B deductible themselves.)
Part B coinsurance:
Once you’ve paid your Part B deductible, you are then responsible for 20% of the Medicare approved amount for the Part B services you receive, and there is no limit on how high your coinsurance bills can get. But Medigap plans cover some or all of the Part B coinsurance.
If your doctor doesn’t accept assignment, they can charge you up to an additional 15%, unless your state imposes a lower limit. (Medigap plans F and G cover this excess charge; Plan G is still available to newly-eligible enrollees, although Plan F is not.)
Medigap
Medigap premiums:
Plan G, which tends to be a little less expensive than Plan F (because it doesn’t cover the Part B deductible) is now the most comprehensive plan available to newly eligible enrollees, and more than a quarter of Medigap enrollees nationwide were already enrolled in Plan G as of 2019.
There are eight other standardized Medigap plan options with premiums that vary from one insurer to another, although not all plan designs are available in all areas.
Medigap out-of-pocket costs
The out-of-pocket costs you’ll pay after your Medigap plan pays its share will depend on the plan design you select.
Medicare Part C (Medicare Advantage)
2021 Medicare Advantage premiums:
Part B premium (projected to be $153.30/month in 2021) + Medicare Advantage premium
The average premium for Medicare Advantage plans is expected to decrease to $21/month ($23/month in 2021).
2021 Medicare Advantage maximum out-of-pocket:
$7,550 in 2021 (does not include prescription drug costs).
Medicare Part D prescription drug coverage
Part D premiums:
The average premium for a basic stand-alone Medicare Part D plan is expected to be about $30.50/month in 2021 - enhanced plans will have higher premiums ($13/month in 2020).
High-income enrollees pay a higher Part D premium (the threshold for high-income is projected to increase for 2021 to $88,000 for a single person and $176,000 for a married couple).
Part D deductible:
Maximum of $445 in 2021 ($435 in 2020). Some plans have no deductible at all.
Part D out-of-pocket costs after deductible:
Not to exceed 25% of the cost of brand-name and generic costs.
After a beneficiary’s costs reach the catastrophic coverage threshold of $6,550 in 2021 (up from $6,350 in 2020), additional out-of-pocket costs are capped at the greater of 5 % of the cost of the drug or a copay of $3.70 for generics and $9.20 for brand-name drugs.
Part D plans are required to cover a broad range of insulins for no more than $35/month in 2021.
Open Enrollment Exceptions
There are a few exceptions to the October-December Medicare open enrollment period:
Open enrollment does not apply to Medigap plans, which are only guaranteed issue in most states during a beneficiary’s initial enrollment period, and during limited special enrollment periods.
If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to begin. Instead, you’ll use the Medicare general enrollment period which runs from January 1 to March 31.
Free Help for Open Enrollment
Need help? Our local Senior Medicare Advice Agent is here to help. Our service is always free so contact us today & let us assist you with your Medicare decisions.
Comments