Most of you are familiar with the acronym CMS which stands for the Centers for Medicare & Medicaid Services, the federal agency which administers Medicare and works with state governments to administer Medicaid and other programs. Each year, they issue a final rule ahead of the 2021 plan year for Medicare Advantage and Part D plans.
As a Medicare Advantage plan sponsor, Aspire Health Plan pays close attention to all rule changes and updates from the Centers for Medicare and Medicaid Services (CMS). Although the 2021 Medicare Annual Election Period (AEP) is still four months away, a lot of these changes will have a positive effect on Medicare Advantage plans and coverage options for those ages 65+. Here are three updates and what they could mean for you.
1. Expanded telehealth options for Medicare Advantage plans.
Last month, CMS finalized requirements that allow Medicare Advantage plans, like Aspire Health plan, to cover a wider range of telehealth services. During the COVID-19 pandemic, many of our members and others nationwide used telehealth services to receive virtual care from the safety of their homes. This could mean more telehealth options for you in 2021.
2. Beneficiaries with end stage renal disease (ESRD) can now enroll in Medicare Advantage plans.
Starting in 2021, all eligible beneficiaries with ESRD can now enroll in a Medicare Advantage plan. If this is you, then that means you now have a choice when looking at coverage options that best meet your needs.
3. Updated Medicare Part D initial coverage limit and the closing of the donut hole (coverage gap).
You may have heard of the term “donut hole” before in reference to Medicare Part D, Medicare’s prescription drug coverage. What is it, exactly? The donut hole is a gap in prescription drug coverage where you may pay more for prescription drugs, depending on what Part D plan you choose (or if you enroll in a Medicare Advantage plan that includes prescription drug coverage). Since 2011, measures have been taken to close the donut hole. Once you reach the initial coverage limit of your Part D plan, you’ll enter the donut hole and need to pay a percentage until you’ve reached the out of pocket (OOP) threshold and exit the donut hole. For 2021, the Part D initial coverage limit is $4,130, up from $4,020 in 2020. For 2021, the OOP threshold is $6,550, up from $6,350 in 2020. In addition, if you reach the donut hole phase, your drug discount for brand name and generic drugs is 75%.
Note that these changes do not change your coverage for the remainder of the 2020 plan year. Check back with us again in October for AEP to see our new plan offerings for 2021 when it is time to make your choice.