Medicare’s Annual Open Enrollment Period started on October 15th and will run through December 7th. During this period, all Medicare beneficiaries can make changes to their health or drug plan coverage. Changes made during this period start on January 1, 2021.
Everyone with Medicare is encouraged to review their current plan’s coverage for next year to see if it will still meet their needs. 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 are encouraged to call APPRISE at 1-800-783-7067.
Details About 2021 Medicare Plan Offerings
Stand-Alone Prescription Drug Plans: There are 33 stand-alone prescription drug plans available across Pennsylvania for enrollment in 2021. Premiums for these plans range from $7.30 to $164.40 per month. There are still ten plans to choose from that are “zero-premium” for individuals who qualify for the full Extra Help (click here for the 2021 list). However, there are a few changes to this list for next year: the Basic Blue Rx Standard plan will no longer be offered; EnvisionRx has rebranded and will be called Elixir; Cigna-HealthSpring Rx Secure plan will be called Cigna Secure Rx; and there is a new zero-premium plan choice called Indy Health SaverRx.
Medicare Advantage Plans: Residents in every county in Pennsylvania continue to have many Medicare Advantage plans to choose from. Dauphin, Lancaster, and Lebanon Counties have the most Medicare Advantage plans (65) and Pike County has the fewest (21). These numbers do not include Medicare Special Needs Plans that limit their enrollment to certain groups of Medicare beneficiaries: dual eligibles, people in nursing homes, and people with certain chronic conditions.
Most, but not all, of the Medicare Advantage plans available include drug coverage. Individuals considering a Medicare Advantage plan for 2021 should check the plan’s costs, benefits, provider network and pharmacy network, list of covered drugs, and any extra benefits offered, such as dental or vision care.
Some Medicare Advantage Plans offer Special Supplemental Benefits for the Chronically Ill (SSBCI) Benefits. These benefits are targeted to people with chronic health conditions, and information about them should be available in the Medicare Plan Finder. Beneficiaries should note that these benefits are not guaranteed, and they will only learn if they are actually eligible for SSBCI benefits after they enroll in the plan.
Special Needs Plans for Dual Eligibles (D-SNPs): These plans only enroll Medicare beneficiaries who also have Medicaid – people who fall into this group are called dual eligibles. It is important to remember that the D-SNP only provides the member with their Medicare coverage and the person still has Medicaid as a separate insurance coverage that often pays second. In 2021, all counties in Pennsylvania will have at least two D-SNPs available. Most counties have six or more D-SNPs available.
All D-SNPs that are currently available continue to operate in 2021 and some D-SNPs are expanding into new counties. Notable changes about Pennsylvania D-SNP options for 2021 are: UPMC for Life Dual will be called UPMC for Life Complete Care; Cigna-Healthspring TotalCare will be called Cigna TotalCare; and Humana has added a second D-SNP offering that is a Preferred Provider Organization or PPO called HumanaChoice SNP-DE available in many counties across Pennsylvania. Click here for the listing of D-SNPs by county for 2021.
Other 2021 Updates and Reminders
Medicare Plan Finder
People can visit www.medicare.gov to get details about health and drug plans available in Pennsylvania next year. Remember that, in order to do a personalized search that can be saved, Medicare beneficiaries will have to create an account at www.mymedicare.gov. No email address is required to create an account.
The APPRISE program and other State Health Insurance Programs around the country are reporting problems with the Medicare Plan Finder since Open Enrollment has started. Problems include: inaccurate pharmacy network information; Extra Help information not displaying in some cases; and some plans not displaying full or accurate drug costs. The Centers for Medicare & Medicaid Services (CMS) is reportedly working with the plans to fix these issues.
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.
Watch out for Extra Help Mailings to Medicare Beneficiaries
The Center for Medicare & Medicaid Services (CMS) sends several mailings each Fall related to Extra Help. Notices are sent when someone’s automatic Extra Help will end this year, when their copay amounts are changing next year, and when someone needs to complete a redetermination form to determine if they will qualify for Extra Help again next year.
Loss of deemed status letter (grey): Mailed in September to those who no longer automatically qualify for Extra Help in 2021. This happens when someone has lost Medicaid between July 2019 and July 2020 and has not requalified for Medicaid coverage. Unless someone goes back on Medicaid before the end of the year, they will need to apply for Extra Help and be approved in order to get this help next year. The loss of deemed status letter includes an Extra Help application which should be completed and sent to the Social Security Administration so a determination of eligibility can be made. If someone goes back on Medicaid before the end of the year (even if they only get help with the Medicare Part B premium), they will automatically qualify for full Extra Help and do not need to apply separately to SSA.
Extra Help redetermination form from SSA: Every year, Social Security chooses a certain number of people to review for continued Extra Help eligibility. Redetermination paperwork is sent in September and must be completed and returned. If the renewal is not completed, Extra Help will end in 2020.
Extra Help Copay Changes: In October, Medicare notifies people who automatically get the Extra Help but whose copay levels are changing next year. This notice is sent on orange paper.
Readers can find more information about mailings to Medicare beneficiaries here.
Dual Eligibles and People with Extra Help Who Want to Change Plans for 2021 Must Act By December 7th!
People can pick a new plan to start January 1, 2021; however, they must choose the new plan before December 7, 2020. As a reminder, dual eligibles and others with Extra Help are now limited to changing their Medicare health or drug plan once per quarter during the first three quarters of the year. Now that we are in the final quarter of the year, people generally cannot make any changes to their Medicare coverage for this year.
Next year, people with Extra Help can change their plan once per quarter between January 1st and September 30th. The request to change plans becomes effective the next calendar month. For example, if a dual eligible beneficiary with Original Medicare made an election to change her Part D plan in April, the change would go into effect May 1st, and she would not be able to make another plan change until the next quarter - July-September. During the last quarter of the calendar year (October-December), dual eligibles and those with Extra Help can use the annual open enrollment period from October 15th - December 7th to make changes to their coverage, with the new plan starting January 1st.