The coronavirus pandemic has taken a heavy health toll on older adults, which is why seniors will want to be particularly choosy when selecting a Medicare Advantage plan for 2021.
Fortunately, more plans are available this year in Florida, and many have enriched their benefit offerings and lowered their premiums.
Nationally there has been a 76% increase in the number of Medicare Advantage plans to choose from. South Florida seniors can choose from 53 plans in Broward and 48 plans in Palm Beach County, up slightly from the 47 plans offered in each of those counties last year.
“I am amazed at the number of plans we have,” said Edith Gooden-Thompson, who oversees Medicare counseling for the SHINE program offered by the Area Agency on Aging Broward. "We have more choices than most areas in the country do. "
The good news for seniors is Medicare Advantage average monthly premium, $21, will be the lowest in 14 years (since 2007) for the over 26 million Medicare beneficiaries projected to enroll in an advantage plan. In Broward, the average monthly premium is $12.16 and in Palm Beach it is $13.42 — significantly lower than the national average.
However, that doesn’t mean you necessarily will pay less for coverage. You may have higher co-pays, or in some cases, your plan may not cover the drug you take or the plan may have moved it to a higher co-pay tier. When you shop for plans, you will need to have a list of your medications and check the deductibles. In 2020, most Medicare Advantage insurers waived cost-sharing requirements for COVID-19 testing and treatment, which likely will continue in 2021.
A big change to Medicare Advantage plans in 2021 is the extended telehealth benefits that allow seniors to receive care in a virtual format from their own homes. This offering has become popular during the pandemic and for 2021, more mental health services also are available via telehealth in many of the plans.
“With the pandemic, we saw a tenfold increase in telehealth utilization, which is why we expanded our telehealth capabilities,” said Roger Rodriguez, CEO of UnitedHealthcare Medicare and Retirement in South Florida. “We think telehealth will continue to augment, not replace, in-person visits.”
Another change in the 2021 Medicare Advantage options comes in the drug plans with a feature often referred to as the “donut hole.” This is the time period when the cost of medications reaches a specific level, and you are in what is called a coverage gap. Historically when this happened, your drug costs would rise dramatically. But this year, the Medicare Part D change is raising the amount of money it takes to reach this donut hole — so it will take longer to reach that gap. The amount it took to reach this gap in 2020 was $4,020, and it has been raised in 2021 to $4,130.
For diabetics, the Centers for Medicare & Medicaid Services (CMS) has released a new model for drug coverage that will provide lower, set costs for insulin (no more than a $35 monthly copay beginning in January). In Palm Beach County, nine providers will participate in this new model, and in Broward County, eight will participate. .
During the pandemic, certain provisions of Medicare Advantage plans may become more important considerations. For seniors who are staying close to home, the meal delivery benefit could be a key consideration. For someone who formerly relied on public transportation, a plan that covers non-emergency transportation services could be desirable. A handful of Medicare Advantage plans also are offering palliative care and integrated hospice care.
As the highly infectious coronavirus continues to spread, people who spend time in Florida but have a primary residence somewhere else may want to look for a plan that includes a “passport”-like feature to ensure coverage benefits in two different states.
“This is the year to review your options and see what is out there,” said Christian Worstell, a licensed health insurance agent and writer for MedicareAdvantage.com. “You might find more coverage at a lower price or better coverage for the health services you utilize.”
Worstell suggests you review the annual notice that outlines changes for 2021 in your existing plan and use that to do a comparison.
Rodriguez at UnitedHealthcare Medicare and Retirement said seniors need to take a holistic approach to evaluate the coverage they need during this challenging time.
“Copays or cost-sharing is important but you may also want to consider the network of providers within a plan and the stability of that network — how large it is and how you can access it,” Rodriguez said. “Look for stability in partners and carriers and ask yourself, ‘Is your provider going to be there when you need them?’”
Desirae Mearns, project director for the SHINE program in Palm Beach and Treasure Coast, said she advises seniors to do research and avoid assumptions when picking a 2021 plan.
“Every year, not just during the pandemic, it is important for folks to check with their healthcare providers to make sure they will continue to accept their Advantage plans or ask them what plans they are going to accept for 2021,” Mearns said. “A lot of people assume their providers will stay in-network and while they might, it is always good to double-check.”
For example, in September in Broward County, Memorial Healthcare System told its patients with Blue Cross Blue Shield of Florida to find another insurer if they want to continue using Memorial’s six facilities at in-network rates. About six weeks later, Florida Blue announced its members will again be able to use Memorial Healthcare System hospitals at in-network rates under a new multiyear contract agreement reached by the two companies.
Medicare open enrollment period for 2021 runs from Oct. 15 through Dec. 7. Any changes made during this time will go into effect on Jan. 1 of the following year.
Health reporter Cindy Goodman can be reached at firstname.lastname@example.org.
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