Insulin copaymentA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment. for a 30-day supply have been capped at $35 for qualified Medicare beneficiaries.
End-Stage Renal Disease (ESRD) patients can enroll in Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). starting in 2021
Telehealth and telemedicine coverage will extend to 2021, along with Covid-19 lab and antibody tests.
For the first time, acupuncture may be a benefit for chronic low back pain.
Each year, the Centers for Medicare & Medicaid Services (CMS) adjusts its rates and policies based on several factors, including data and need. The changes coming to Medicare in 2021 go well past the usual standard rate hikes. If you’re enrolled in Medicare or are planning to enroll in Medicare in 2021, here are some notable changes.
Find a local Medicare plan that fits your needs
Your Medicare coverage in 2021 may expand to provide lower costs and more services. This year will bring a cap on insulin prices and extended coverage for telehealth and COVID-19 services. Medicare Advantage coverage expands to acupuncture and beneficiaries with end stage renal disease.
Lower prices for insulin
One of the most significant changes in store for Medicare beneficiaries in 2021 will come from lowered out-of-pocket costs for insulin. During the fall’s annual enrollment period, eligible Medicare beneficiaries can enroll in the Part D Senior Savings Model. This model’s plans offer several types of insulin for a maximum copayment of $35 for a 30-day supply. [i] The impact of this change promises to be wide-reaching; according to CMS, one in three Medicare beneficiaries has diabetes, and 3.3 million take some form of insulin. [i]
Medicare Advantage will cover End-Stage Renal Disease (ESRD)
Starting in 2021, Patients with ESRD can enroll in a Medicare Advantage plan. Now, those with ESRD can take advantage of the out-of-pocket maximums many Medicare Advantage plans offer. And while MA beneficiaries may have different costs and restrictions than those with Original Medicare, MA plans can’t charge more for critical services such as outpatient dialysis and immunosuppressant drugs.
Telehealth & Telemedicine still in use
CMS expanded telehealth and telemedicine services in 2020 as a way of keeping seniors safe during the COVID-19 pandemic. [i] Those expansions will remain in place for 2021. That means you can take advantage of services like E-visits, check-ups, and more — all via your computer’s camera and microphone. This development should have a significant impact on Medicare in 2021 as recent studies show that 68% of Medicare-eligible adults had access to a computer and the internet at their homes. [i]
Back pain? Acupuncture is now covered
Those suffering from chronic lower back pain may find some relief in 2021 thanks to new acupuncture benefits. If you qualify, you can receive 12 acupuncture treatments in 90 days. If your doctor determines you’ve shown improvement during those initial visits, you can be approved for eight additional treatments (no more than 20 in a year).
To be eligible, your back pain must:
- Have lasted 12 weeks or longer
- Not be associated with pregnancy or past surgery
- Not have a known cause such as cancer or inflammatory diseases
Covid-19 testing still covered
Medicare will continue to cover Covid-19 testing services in 2021. [i] This is true of Original Medicare and Medicare Advantage beneficiaries. Beneficiaries will receive free lab tests for Covid-19 with no out-of-pocket costs. If you were previously diagnosed or think you had a Covid-19 infection in the past, you may qualify for a no-cost antibody test. Medicare will also cover all medically necessary hospitalizations related to Covid-19. CMS has also said Medicare would cover a vaccine when/if one becomes available.
A small increase to Part B premiums
Like other years, Medicare beneficiaries will pay a higher Part B monthly premium in 2021 than in 2020, but the increase is small.
- The Part B premium for 2021 will be $148.50, an increase of $3.90 from the 2020 premium of $144.60 (a 2.7% increase). For comparison, the premium increased 6.7% from 2019 to 2020.
- The Part A premium — which must only be paid by enrollees who paid Medicare taxes for less than 10 years (40 quarters) through an employer — also experienced modest increases. The premium for those who paid Medicare taxes for 30-39 quarters increased from $252 to $259; those who paid for less than 30 quarters, it increased from $458 to $471.
If you have questions about any of these changes to Medicare or how they affect your coverage, GoHealth can help. We have experienced, licensed insurance agents that will review your plan and let you know what to expect in 2021.