Medicare Changes For 2021

Medicare Changes For 2021

Each year there are changes to Medicare benefits, this presentation is great to introduce those changes for the current year.

Part A Updates

Premium

• For individuals who’ve worked less than 30 quarters paying Medicare taxes, their Part A premium for 2021 will be $471/month – a $13 increase from 2020


• For individuals who’ve worked between 30-39 quarters paying Medicare taxes, their Part A premium for 2021 will be $259/month – a $7 increase from 2020


• For individuals who’ve worked 40 or more quarters paying Medicare taxes, their Part A premium will continue to be $0/month.

Inpatient Hospitalization
• Deductible per benefit period: $1,484 – a $76 increase from 2020
• Days 1-60: $0 coinsurance
• Days 61-90: $371/day – a $19 increase from 2020
• Days 91 and beyond (Lifetime Reserve Days): $742/day – a $38 increase from 2020

Skilled Nursing Facility
• Days 1-20: $0 coinsurance per day
• Days 21-100: $185.50/day – a $9.50 increase from 2020.

Part B Updates

Premium:
• $148.50 per month – a $3.90 increase from 2020 Income Related Monthly Adjustment Amount for individuals making $88,000 or more, or married couples filing jointly making $176,000 or more per year, they will pay a higher Part B premium depending on their Modified Adjusted Gross Income (MAGI) from 2 calendar years ago.

The Part B premium can range from $207.90 per month all the way up to $504.90 per month.

Deductible:
• $203 per calendar year – a $5 increase from 2020

Part D Updates

Each year, CMS releases a Standard Model which MAPD and PDP plan sponsors must follow when designing their Part D benefit. The 2021 standard model is:


• Deductible: up to $445 – a $10 increase from 2020
• Initial Coverage Limit: $4,130 – a $110 increase from 2020
• Max out-of-pocket in the coverage gap: 25%
• Out-of-Pocket Threshold: $6,550 – a $200 increase from 2020
• Catastrophic Coverage
• Generic/Preferred multi-source drugs: $3.70 copay – a $.10 increase from 2020
• All other drugs: $9.20 copay – a $.25 increase from 2020

Senior Savings Model
This program allows Part D plans to offer a month’s supply of a wide range of insulins for no more than a $35 copay each. Participating plans will vary by state & county, and the insulin must be covered by the plan’s formulary. You can toggle the Senior Savings Model on Medicare.gov’s plan finder to see the MAPD and PDP plans that are part of the program.

Income Related Monthly Adjustment Amount
Like Part B, the Part D premiums are based on an individual’s MAGI from 2 calendar years ago, and can add anywhere between $12.30 to $77.10 per month to their Part D premium.

Medicare Advantage Updates

Out-of-Pocket Updates
The highest Maximum-out-of-pocket (MOOP) a Medicare Advantage plan can offer has increased from $6,700 to $7,550. MOOPs vary by plan but have averaged around $5,500 over the past 5 years. MA beneficiaries whose MOOP was increased should have received their Annual Notice of Change in late September/early October. 2020

Qualification Updates
Individuals with End Stage Renal Disease (ESRD) can now enroll into a Medicare Advantage plan with a 1/1/21 effective date or beyond. These individuals have not been able to enroll into a Medicare Advantage plan unless there were some special circumstances. Many ESRD patients qualify for Medicare regardless of age, and now have the ability to choose coverage through a MA plan in their service area.


Now, the only qualifications for a Medicare Advantage plan are:
• Enrolled in Part A and Part B
• Live in the plan’s service area (county)
• Can make an informed decision

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