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Medicare Advantage in 2021 – What You Need to Know

With Medicare enrollment periods now upon us, it is important to be aware of the important changes coming to Medicare Advantage plans in 2021.

Along with some fluctuations in pricing, there are three primary changes coming to Medicare Advantage plans including the expansion of telehealth services and coverage, more coverage options for long-term care, and expanded options for people with end-stage renal disease.

In this guide, we will examine the upcoming changes so that you can make the most informed decision when choosing the right plan for you.

Increased Telehealth Coverage and Services

Medicare Advantage plans will be experiencing an increase in telehealth services and coverage to allow seniors to receive treatment from medical professionals while staying safe in their homes.

These changes are particularly helpful to people who are not able to get to the doctor easily and to high-risk individuals who want to limit their exposure to disease.

Telehealth enables seniors to video conference with their doctors from their homes, providing both safety and convenience.

As part of the expansion of coverage to include telehealth services, the Centers for Medicare & Medicaid Services (CMS) is giving Medicare Advantage plans the ability to include telehealth providers in different practice areas such as:

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

Long-Term Care Coverage Through Medicare Advantage

Medicare Advantage plans provide the same coverage as Traditional Medicare, meaning they cover rehabilitative care or skilled services for up to 100 days. They also include benefits for supplemental home care services for chronically ill beneficiaries.

As part of the upcoming changes, some Medicare Advantage plans will offer benefits for a variety of additional supplemental home care services.

Benefits can vary by plan and location, and they still don’t provide coverage for assisted living expenses but these changes can make a big difference in care by enabling more seniors to continue living independently.

Here are some of the services that may be added to some Medicare Advantage plans:

  • Adult daycare services: Adult day programs offer seniors an engaging and social environment, along with opportunities to receive memory care and other forms of exercise to improve well-being.
  • Benefits for over-the-counter products: Seniors on Medicare Advantage plans will begin to receive a monthly or quarterly allowance for different OTC products such as pain relievers, allergy and cold medications, and daily supplements.
  • In-home personal care services: Coverage for personal care services will enable seniors to receive assistance with daily activities such as eating, getting dressed, and using the restroom. Having a home health aide help with these activities can delay the need to move to a nursing home.
  • Meal delivery and transportation: As the demand for transportation and meal services increases, some Medicare Advantage plans will now cover services such as Uber and Lyft to help seniors get to doctor’s appointments, fitness centers, and pharmacies. They will also offer benefits for grocery delivery services.
  • Home safety modifications: If a beneficiary falls or has a hard time moving around but isn’t ready to make the transition into assisted living, some Medicare Advantage plans will provide the coverage for safety modifications to the home including wheelchair ramps, stair rails, and grab bars for bathrooms.

Expanded Options For People With End-Stage Renal Disease (ESRD)

Because of changes in the 21st Century CARES Act, seniors with end-stage renal disease (ESRD) will be able to enroll in Medicare Advantage plans starting in January 2021 and will have more coverage options with Medicare.

In the past, individuals with ESRD could only enroll in Medicare Advantage plans under limited circumstances. With the changes, organ acquisition costs of kidney transplants will have coverage under the fee-for-service program instead of Medicare Advantage organizations.

However, there are both positives and negatives to these changes that beneficiaries and caregivers should be aware of. 

For example, a positive is that the benefits offered to dialysis patients through Medicare Advantage plans include case-management service to assess their needs, determine health goals, and provide ongoing support.

Also, Medicare Advantage plans limit out-of-pocket costs to $7,550 per year. In traditional Medicare, seniors with ESRD can face cost-sharing of up to $15,000 per year.

A negative to the changes is that areas with a high number of ESRD patients could face an overall reduction in health care benefits due to the costly nature of treating ESRD.

The problem is that if certain states have a significant number of patients with ESRD, Medicare Advantage plans in those areas are likely to be underpaid and could be forced to raise consumer costs, reduce supplemental benefits, or limit available service for all enrolled beneficiaries.

Changes in Medicare Advantage Premiums

The price for Medicare Advantage plans varies considerably across the country. In some areas, you can find a plan for $0 per month and in others, there are plans for over $300 per month.

According to CMS, the average premium for Medicare Advantage plans for 2021 is expected to be $21 per month.

This is a decrease from a $23 per month average in 2020. Average Medicare Advantage premiums have been steadily declining for the past few years and the average premium for 2021 is the lowest it has been since 2007.

Nearly 24 million people had Medicare Advantage plans in 2020, and CMS projects that this number will grow to 26 million in 2021. Enrollment in these plans has been steadily increasing for the last 15 years.

The total number of Medicare beneficiaries has been growing as well, but the growth in Medicare Advantage enrollment has far exceeded overall Medicare enrollment growth. In 2004, only 13 percent of Medicare beneficiaries had Medicare Advantage plans. By 2020, 36 percent of all beneficiaries were enrolled in a Medicare Advantage plan.

Changes in Medicare Advantage Out-of-Pocket Maximums

Unlike Original Medicare, which does not have a cap on out-of-pocket costs, Medicare Advantage plans are required to cap enrollees’ out-of-pocket costs for Part A and Part B services. The cap does not include the cost of prescription drugs, as those are covered under Medicare Part D, even when it’s integrated with a Medicare Advantage plan.

For the past few years, the cap has been $6,700, however, most plans have had out-of-pocket caps below that level. For 2021, the maximum out-of-pocket limit for Medicare Advantage plans is increasing to $7,550, not including out-of-pocket costs for prescription drugs.

Most plans will likely continue to have out-of-pocket caps below the maximum, but the allowable increase for 2021 is something you should be aware of.

Important Dates

As you take the time to evaluate these changes and determine how you want to proceed going forward, there are several important dates to keep in mind.

If you’re switching from Original Medicare to Medicare Advantage, the Annual Enrollment Period is from October 15, 2020, to December 7, 2020.

If you want to change to a different Medicare Advantage plan, the Medicare Advantage Open Enrollment period is from January 1, 2021, to March 31, 2021.

Finding the Best Medicare Advantage Plan for You

Coverage 2 Care understands that choosing the right healthcare coverage for you can be a complicated decision. There are many factors that impact which plan best fits your needs, budget, and lifestyle. 

Our experienced and professional team of agents want the best for you. That’s why we take the time to discuss the various insurance options with you, and help you determine what plan best fits your individual needs. Give us a call today at 210-361-7096 or contact us via our website and let us sort through the details while you enjoy your golden years.

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