Using Medicare & You in 2021

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Each year I devote space in this column to a review of the annual publication Medicare and You.

Before beginning this review, I want to quickly look back on the 2021 Medicare Open period. Like everything else in our lives, COVID-19 changed the Medicare Open Enrollment period.

In thinking about this year’s Open Enrollment, I was particularly interested in two questions. First, how did this year’s virtual enrollment compare to last year? Also, I was interested in the impact that the constant drumbeat of several Medicare Advantage Plan TV commercials might have had on counselors.

Who knew that Hall of Fame quarterback Joe Namath was also an expert in Medicare plans? For answers to these questions I again turned to Joan Hyde, Aging Services supervisor with the Oneida County HIICAP program.

How did the 2021 Open Enrollment go this year? According to Hyde, “Open Enrollment went very well, but the numbers of contacts were definitely down from previous years.”

Her staff also felt that virtual enrollment went quite well. The staff prepared for the phone enrollments by sending packets of information to clients who sent them back prior to their appointments. This gave the counselors the time to gain the information necessary to find plans that would work for clients.

“What we saw this year was that most people on an Advantage plan stayed where they were,” Hyde said.

She said the major problem this year was once again finding the right Part D plan for those with Original Medicare. Most of these clients use at least one Tier 3 medication, such as an inhaler or a brand name drug, which causes higher deductibles to take effect.

The impact of TV advertisements. Hyde said ads on TV always cause problems. Clients call and ask to be put on the plans “that the TV says have everything you need. We have to explain to them that in order to receive your premium of $144.60 back, you have to be low income.”

Another problem was that “Freedom Care,” a plan which was extensively advertised, was not available in Oneida County. Many were looking for the “extras,” such as dental and vision benefits, touted in the advertisements. Counselors screened all clients to see if they qualified for the Extra Help programs that are based on income. They also sent out all the information about Advantage programs which offer some of these “extras.”

After working with and observing the HIICAP program for years, this was clearly one of the most challenging times for the HIICAP program. We should all thank these dedicated professionals for the excellent work they did under very difficult circumstances this fall.

Medicare and You. For those new to Medicare, prior to the Open Enrollment period all beneficiaries receive a publication from the Centers of Medicare & Medicaid Services entitled Medicare & You (2021). You now have a choice of receiving the publication in either electronic or paper format (I still prefer the paper booklet edition).

This publication contains important information. If you have never read this guide, I would urge that you read it once from cover to cover. After you have become familiar with the contents, you can read the publication for annual updates. As will be discussed below, the inside cover of the publication always lists the most important updates and changes with page number references.

Each year there are both additions and deletions. This year’s edition contains fewer changes than in past years. However, there are the usual formatting changes, including placing boxes around some material to emphasize importance as well as two new symbols placed beside important text. The first symbol is a set of scales placed next to material that shows comparisons between Original Medicare and Medicare Advantage. The second is a magnifying glass that highlights information about costs and coverage of services. These are explained on Page 6.

What is new for Medicare in 2021? On the inside cover is a listing of the important changes to Medicare for 2021. These include:

Coronavirus disease 2019 (COVID-19). The latest information on the virus will be posted on the Medicare.gov website. Or, call 1-800-MEDICARE (1-800-633-4227).

Lower out-of-pocket costs for insulin. Costs are lower for all those who participate in a “Part D Senior Saving Model” drug plan (see Page 84 for a complete explanation).

Medicare Advantage & End-Stage Renal Disease (ESRD). Beginning in 2021, if you suffer from ESRD you can be covered under a Medicare Advantage Plan (see Page 59).

Acupuncture for back pain. Medicare now covers up to 12 acupuncture visits in 90 days for chronic low back pain (see Page 30).

Telehealth & other virtual visits. Medicare will now cover medical visits that generally occur in an office setting by using interactive audio and video (see Page 48). Medicare now covers some virtual services, such as E-visits (see page 39) and Virtual check-ins (see page 50).

Medicare.gov/plan-compare. Remember that the Medicare Plan Finder continues to be updated throughout the year. If you find that you need to make a change in your coverage during the year, the Plan Finder is still there to help you.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, N.Y. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

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