En español | It’s time to take stock of your Medicare coverage. Open enrollment begins on Oct. 15 and you will have until Dec. 7 to think about your health care needs for 2021 and decide whether you need to make any changes in your coverage.
Experts say this assessment is important every year, but it’s especially critical now as the country continues to grapple with the coronavirus pandemic, an illness that disproportionately affects older Americans.
“This is the year it’s really the time to think about what’s best for people who are sick, rather than just what’s best for people who are healthy,” said Tricia Neuman, a senior vice president and director of Medicare policy at the nonpartisan Kaiser Family Foundation. “People tend to make these choices thinking they are going to have the same health status for the rest of the year. But this is no typical year, and the risk of older adults getting seriously ill has been ramped up with the virus.”
During open enrollment, enrollees get to decide whether Original Medicare or Medicare Advantage (MA) — an alternative that relies on private health insurance plans — is best for their health needs. During this period, you can switch from Original to MA or shift from an MA plan back to Original Medicare. You can change MA plans and can also decide whether to enroll in a Part D prescription drug plan or change plans if you already get your drugs through a Part D policy. Any changes you make will take effect in January 2021.
To help you make this decision, you need to consider all of Medicare’s parts. Part A covers hospital and hospice care and some skilled nursing services after you’ve been in the hospital. Part B includes doctor visits, diagnostic tests and other outpatient services. Part C is Medicare Advantage, which combines Part A, Part B and, usually, Part D, which helps pay for prescription drugs.
Neuman says Medicare has really been transformed from the traditional government-operated program to a marketplace that offers beneficiaries dozens of private plans from which to choose.
“It’s become extraordinarily complicated for people to evaluate what’s best for them because there are so many factors to consider,” said Neuman. “The whole idea is that people would review their options each year to choose coverage that’s the best one for them based on their medical needs and preferences based on their income and their ability to cover the costs. The truth is, that doesn’t happen, because it’s gotten so doggone complicated.”
Tips for picking the right coverage
Neuman has some advice about how to proceed: Don’t just look at a plan’s premiums. That’s the easy part. And they aren’t the best gauge of what your total out-of-pocket costs will be during the year.
Check out whether the doctors you see are in the plan’s network you are considering because going out of network can cost you more. Make sure all the drugs you take are covered either in your MA plan or by a Part D plan. Taking a drug that isn’t covered or isn’t considered a “preferred” medication could mean you’ll pay more out of pocket. Copays differ among the plans, so be careful to look at what the 2021 costs will be.
The best place to start is the Centers for Medicare and Medicaid Services (CMS) plan-finder website. The medicare.gov home page will guide you through your enrollment journey. You can compare coverage and costs between Original Medicare and MA plans and get detailed information about Part D choices. The site also includes a cost calculator.
Especially this year, Neuman said, even healthy Medicare enrollees should think about what hospital they might want to be treated at in the event they get seriously ill and make sure, for example, if they are in an MA plan that the hospital they prefer is part of that network.
New for 2021
CMS has created a one-stop online tool to help you learn more about the providers and hospitals that might be included in the Medicare plans you are considering. CMS has consolidated the eight websites that consumers have been able to use to compare and choose providers, including hospitals, doctors, nursing homes and other facilities into one streamlined Medicare online tool.
CMS also continues to expand the availability of telehealth benefits, particularly amid the COVID-19 crisis. Virtual check-ins with doctors and other health care providers are available to all Medicare beneficiaries.
Medicare Advantage plans also are expanding the availability of extra services, particularly for the 73 percent of beneficiaries who have chronic health conditions. These benefits range from meals at home to transportation to health appointments to nutrition counseling to safety improvements to your home. Not all MA plans are offering these benefits, so look carefully at their coverage descriptions on the plan-finder site.
You can also get personalized help as you ponder your open enrollment decisions. Medicare.gov has an online chat feature available during open enrollment, and the toll-free Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week.
Average monthly premiums for Medicare Advantage plans are expected to drop in 2021 to an average of $21 and Part D prescription drug premiums are also slated to slightly increase to an average of $30.50 a month. These are just estimates. Actual premiums and out-of-pocket costs vary for MA and Part D plans based on which plan you select, what it covers and where you live.
The standard monthly premiums for Part B will be $148.50 in 2021 and the annual Part B deductible will be $203. For Part A, the deductible patients will pay for each hospital admission will be $1,484 in 2021.
Editor's note: This story has been updated with 2021 information.