While on Medicare, you should expect changes to the program each year. Most changes are small and take effect on January 1st. However, occasionally, you’ll notice some more significant updates in the new year. Here are just a few of the important things to know about Medicare in 2021.
There are crucial enrollment periods for new and active Medicare beneficiaries
Medicare has many enrollment periods, some more crucial than others. If you age into Medicare in 2021, you’ll experience two very important enrollment periods – your Initial Enrollment Period and your Medigap Open Enrollment period.
Active Medicare beneficiaries should prepare for the Annual Election Period that occurs each year in the fall.
Initial Enrollment Period (IEP)
The Initial Enrollment Period is the first chance you have to enroll in Medicare Part A and Part B. It generally overlaps with the Initial Election Period, which is the first chance you have to enroll in either a Part D or Medicare Advantage plan. Your IEP begins three months before your 65th birthday month starts and ends three months after your 65th birthday month ends. For example, if you turn 65 on May 7, 2021, your IEP begins February 1, 2021 and ends August 31, 2021.
Medigap Open Enrollment Period
The Medigap Open Enrollment period is critical because once it ends, you will likely have to answer health questions when applying for a Medigap plan and could be denied due to pre-existing conditions. This period begins on your Part B effective date, which for most people is the 1st of their 65th birthday month and ends six months later. For example, if your Part B starts May 1, 2021, your Medigap Open Enrollment ends October 31, 2021.
Annual Election Period (AEP)
The Annual Election Period occurs every year from October 15th through December 7th. This period only affects you if you already have Part A and Part B and need to enroll in, drop, or change a Part D or Medicare Advantage plan. If your IEP runs through AEP, your IEP trumps the AEP, meaning you won’t use the AEP until the following year.
End-stage renal disease patients can qualify for a Medicare Advantage plan now
One of the more attractive features of Medicare Advantage plans than Medigap plans is that there is only one preliminary health question. If you can answer no, then you’re guaranteed approval. The health question asked is, “Do you have end-stage renal disease (ESRD)?”
However, as of January 1, 2021, Medicare Advantage plans can’t ask you this question. Therefore, ESRD patients can now qualify for Medicare Advantage plans. This is especially helpful to ESRD patients who missed their Medigap Open Enrollment period and can’t pass medical underwriting for a Medigap plan.
Insulin-dependent beneficiaries can save money on their Part D insulin
The Centers for Medicare and Medicaid Services (CMS) announced a new Medicare Part D savings program last year, called the Part D Senior Savings Model. The Part D Senior Savings Model limits a 30-day supply of Part D insulin to a $35 copay. Currently, there are nearly 1,800 Medicare Advantage and Part D plans participating in this new program.
If you’re insulin-dependent and enrolling in Part D for the first time in 2021, you should enroll in a participating Part D plan that includes your specific insulin. While participating plans are required to limit insulin to $35, they still have the right to pick which insulins they cover on their formulary.
One of the most impressive things about this savings program is that your copay is limited to $35 throughout the year, regardless of which Part D stage you’re in. For example, whether you’re in the deductible stage or the coverage gap, your copay will be no more than $35. Also, carriers can do better than the $35 copay. You may be able to find a Part D plan that covers your insulin at an even lower copay.
Conclusion
Medicare brought many changes in 2021, and you should expect to see more within the next couple of years. It’s recommended you research Medicare’s changes annually to prepare for what the new year will bring.
A good time to do this is in September each year as this is the month Medicare Advantage and Part D plans are required to send their Annual Notice of Change documents. Staying up to date on Medicare and your specific plans will make for a smooth year on Medicare.
