Planning for deadlines, 2021 changes and making the best choice for your medical care
Medicare’ Open Enrollment, also known as Medicare’s annual election period, takes place annually from October 15 through December 7. During this timeframe, Medicare plan enrollees can reevaluate their coverage – whether it’s Original Medicare with supplemental drug coverage or Medicare Advantage. It’s also the time to make changes or purchase new policies if your situation or healthcare needs have changed.
Every year, the federal government makes changes to Medicare rules and regulations. These changes can make a large impact on your coverage, expenses, and even the doctors you visit.
Medicare Open Enrollment Options
During the designated open enrollment period, options available include:
- Changing from Original Medicare to a Medicare Advantage plan
- Changing from a Medicare Advantage plan back to Original Medicare and a stand-alone Part D prescription drug plan
- Changing from one Medicare Advantage plan to another that better meets your needs.
- Changing from one Medicare Part D prescription plan to another.
- Enrolling in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare. (If you haven’t maintained other creditable coverage in the interim, a late-enrollment penalty may apply).
Expected Changes in 2021
Insulin Price Caps
If you have diabetes and require insulin therapy, you’ll be able to join Medicare prescription plans with caps on insulin pricing in 2021. Copays won’t cost more than $35 every month, which can provide you with substantial savings. The Centers for Medicare and Medicaid Services estimates that the average beneficiary who needs insulin and enrolls in one of these plans will see a savings of nearly $450 a year.
Coverage for Kidney Failure/ESRD
People with End-Stage Renal Disease (ESRD), or kidney failure, were previously unable to enroll in Medicare Advantage unless they met some special conditions. But for 2021, under the terms of the 21st Century Cures Act, people with ESRD have the option to enroll in Medicare Advantage for 2021. This could be particularly advantageous for beneficiaries with ESRD who are under age 65 and living in states that don’t allow access to Medigap plans for these younger beneficiaries.
Currently in review is a Trump Administration proposal to expand telehealth benefits permanently for Medicare beneficiaries beyond the COVID-19 public health emergency. This could help if you are living in a rural area, face transportation barriers, need frequent visits to your doctors, or have difficulties traveling a longer distance for medical check-ups and consultations.
Open Enrollment Exceptions
There are a few exceptions to the October-December Medicare open enrollment period:
- Open enrollment does not apply to Medigap plans, which are only guaranteed issue in most states during a beneficiary’s initial enrollment period, and during limited special enrollment periods.
- If you didn’t enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to begin. Instead, you’ll use the Medicare general enrollment period which runs from January 1 to March 31.
Free Help for Open Enrollment
Medicare Open Enrollment can be a confusing time as you want to know all of your options before deciding on the different plans. Fortunately, every state has a designated State Health Insurance Program (SHIP) to offer free, unbiased guidance on Medicare plans and enrollment. Find your local SHIP program by visiting Medicare.gov.
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