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What’s new in the Medicare landscape for 2021?

  • Medicare Advantage plans are available for people with End-Stage Renal Disease (ESRD) as of 2021.
  • Medical Advantage plans have the flexibility to include telehealth provider in practice areas including primary care, cardiology, dermatology, psychiatry, gynecology, and endocrinology
  • Standard Medicare Part D prescription drug plan coverage parameters are new in 2021. Initial Deductible will increase by $10 to $445 in 2021. Initial Coverage Limit will increase to $4,130 in 2020 from $4,020 in 2020; Out-of-Pocket Threshold will increase to $6,550 from $6,350 in 2020. Coverage Gap (Donut Hole) will begin once you reach your Medicare Part D plan’s initial coverage limit of $4,130 in 2021 from $4,020 in 2020 and will end when you spend a total of $6,550 out-of-pocket in 2021.
  • The threshold for entering the catastrophic coverage phase (where out-of-pocket spending decreases significantly) is increasing to $6,550.
  • As part of the new Part D Senior Savings Model, about 30% of all 2021 stand-alone Medicare Part D plans and Medicare Advantage plans with drug coverage will offer coverage of different types of insulin at a maximum co-pay of $35 per month.
  • This is the second year Part D enrollees will receive a 75% discount on the total cost of their brand-name and generic drugs purchased while in the Donut Hole. This includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan.
  • The maximum out-of-pocket limit for Medicare Advantage plans is increasing to $7,550 for 2021, up from $6,350 in 2020 and $5,100 in 2019.
  • The income brackets for Medicare Part B and D are projected to start at $88,000 for a single person, (from $87,000 in 2020) and the high-income surcharges for Part D and Part B will increase in 2021.
  • The standard Part B premium increased to $144.30 from $135.50 in 2020. The Centers for Medicare and Medicaid Services has not yet announced the standard Part B premium for 2021.
  • The average Medicare Advantage (Medicare Part C) premiums for 2021 is expected to be lower — $21/month in 2021, down from $23/month in 2020.