Get Ready for the Medicare Open Enrollment Period

Medicare’s Annual Open Enrollment Period starts October 15th and runs until December 7th. During this period, all Medicare beneficiaries can make changes to their health or their drug plan coverage.  Changes made during this period start January 1, 2021.  

Beneficiaries already enrolled in a Medicare Prescription Drug Plan or Medicare Advantage Plan should receive information from their current plan by September 30th about what the benefits will be in 2021.  This information should detail any changes to the plan’s coverage or costs for next year.  Everyone is encouraged to review this information to decide whether they should stay with their current plan or join a new plan for next year.  If a Medicare plan will not continue in 2021, enrollees should receive notice in early October that their plan is ending December 31st.   

Beginning October 1, 2020 insurance companies are allowed to start marketing their 2021 plans and Medicare’s website,, will show 2021 plan information.  Activities and materials by Medicare companies as well as agents or brokers who enroll people into Medicare plans are subject to communications and marketing guidelines which can be found here.  PHLP will include information about 2021 Medicare plan offerings in our next newsletter.  

Dual eligibles and people with Extra Help who want to change plans in 2020 must act by September 30th! 

Dual eligibles (people who have both Medicare and Medicaid) and others with Extra Help have a special enrollment period to change their coverage once per quarter between January 1st and September 30th, with the request to change plans becoming effective the next calendar month.  If a dual eligible wants to change their health or drug plan for the remainder of 2020, they must do so by September 30th.  

During the last quarter of the calendar year (October-December) dual eligibles and those with Extra Help can use the Annual Open Enrollment Period to make changes to their coverage, with the new plan starting January 1st.  The Medicare Annual Open Enrollment Period starts October 15th and ends December 7th.  

Medicare Advantage plans are now available to people with End-Stage Renal Disease (ESRD) 

For the first time, people with ESRD will have the option of choosing a Medicare Advantage plan for their Medicare coverage in 2021 during the fall Annual Open Enrollment Period.  People with ESRD interested in joining a Medicare Advantage plan should look carefully at the plan’s network to ensure that their dialysis facility is included.  Also, people should check the plan’s costs for dialysis treatment.  Before joining a Medicare Advantage plan, people will also need to check that their medications are covered, check the costs for other medical care and treatment they get on a regular basis, and make sure they understand the plan’s rules for getting care.   

APPRISE helps Medicare beneficiaries review plan choices 

Assistance through the APPRISE program is still available during the pandemic!  APPRISE staff and volunteers can help people across Pennsylvania review their 2021 Medicare coverage options.  Medicare beneficiaries who need help reviewing their plan options for next year or dual eligibles and people with Extra Help seeking assistance using the special enrollment period to make a change by September 30th are encouraged to call APPRISE at 1-800-783-7067.  

Medicare Part D Costs for 2021 

A Medicare beneficiary who does not qualify for any level of Extra Help from Medicare will pay the following costs for a standard Part D Plan in 2021: 

  • The plan’s monthly premium (the national average premium for a basic drug plan will be $43.07); 

  • An annual deductible of $445; 

  • During the initial coverage period, a 25% co-pay for each covered prescription until the person’s total drug costs reach $4,130

  • After the initial coverage period, a person will continue to pay 25% of the cost of both brand-name and generic drugs (plus a small dispensing fee) until the consumer’s total out-of-pocket expenses reach $6,550; and 

  • During the catastrophic coverage period, a co-pay of $3.70 for generics and $9.20 for brand name drugs, or a 5% co-pay, whichever is greater, for the rest of the year.  

Part D Cost for Those Receiving Extra Help from Medicare:  Anyone who qualifies for the full Extra Help from Medicare will have the following costs in 2021.  This includes all dual eligibles who have Medicare and who receive any benefit from Medicaid: 

  • $0 premium (as long as she enrolls in a Part D plan that provides standard benefits and charges a premium below the 2021 Extra Help Benchmark amount of $37.45) 

  • Small co-pays for their prescription medications: 

    • $1.30/generics and $4.00/ brand names (if income is less than 100% FPL) or 

    • $3.70/generics and $9.20/ brand names (if income is above 100% FPL) or 

    • $0 if someone is on Medicare and receiving Medicaid long term care services in a nursing home or through a Home and Community-Based Services Waiver program 

Those beneficiaries who qualify for partial Extra Help in 2021 will pay the following costs: 

  • A portion of their Part D plan monthly premium depending on the amount of their Extra Help; 

  • A deductible no higher than $92;  

  • 15% co-pays on all of their medications until they reach total out-of-pocket expenses of $6,550;

  • During the catastrophic coverage period, co-pays of $3.70/generics and $9.20/name brands for the rest of the year 

Individuals getting Extra Help in 2020 will get a written notice if there is going to be a change to their Extra Help status next year.  Here's a link to these mailings and others that Medicare beneficiaries are receiving this fall.