What You Should Know About Medicare in 2021

Clare Louise 4 years ago 3 min read

The year 2020 has brought many changes to our lives and most of us are ready for 2021 to arrive. The new year will bring some changes to Medicare, America’s federal insurance program for seniors age 65 or older, and people with certain disabilities. There are many misconceptions about Medicare, such as the cost, health questions, and COVID-19 coverage. It is important to learn about Medicare before enrolling, as Medicare can be a difficult subject to learn. Here is what you should know about Medicare in 2021.

Medicare costs have changed

Many seniors are shocked when they find out that Medicare is not free. Yes, you pay for Medicare and the prices have gone up for 2021.

Most beneficiaries do not pay a premium for Medicare Part A (inpatient coverage) because they have a qualifying work history. However, if you have not worked at least 40 quarters and paid FICA taxes, you will pay a premium of up to $471 per month. The Part A deductible has increased by $76 to $1,484 for 2021.

Medicare Part B (outpatient coverage) was expected to have a significant increase in premiums, but it only increased by $4. The Part B premium in 2021 will be $148.50 per month, and the finalized annual Part B deductible will be $203.

Medicare does not cover 100% of your health care costs. For example, Medicare Part B only covers 80% of Medicare-approved services. Therefore, many beneficiaries purchase a Medigap or Medicare Advantage plan for cost-sharing help.

When comparing the costs of Medicare Advantage plans to those of Medigap plans, it is like comparing apples to oranges. A Medigap plan offers more coverage with a higher monthly premium while a Medicare Advantage plan typically comes with a lower monthly premium but higher cost sharing and co-insurance when you visit the doctor.

For people with pre-existing conditions who missed their window of opportunity to get a Medigap plan with no health questions asked, Medicare Advantage plans are appealing as beneficiaries only have to answer “no” to one health question to get this coverage, “Do you have end-stage renal disease?”

With the changes coming in 2021, even that question will be no more.

New protections for those with ESRD

Prior to 2021, Medicare Advantage plans were not required to cover people with end-stage renal disease (ESRD) unless they qualified for an ESRD Special Needs Plan in their area. Now, however, all Medicare Advantage plans are required to enroll individuals with ESRD.

This means there are officially no health questions asked to enroll in a Medicare Advantage plan, providing a great option even for those with ESRD.

There is a way to avoid Medigap underwriting

Every beneficiary has a six-month Medigap Open Enrollment that begins that day their Part B becomes effective. When you apply for a Medigap plan during those six months, an insurance carrier cannot ask you health questions or deny coverage for a pre-existing condition.

You can apply for a Medigap plan outside your Medigap Open Enrollment. However, you likely will be subject to underwriting and can be either denied a Medigap plan or be charged a much higher premium due to pre-existing health conditions.

Medicare covers COVID-19 care

COVID-19 is a respiratory virus that disproportionately affects senior citizens and people with underlying health conditions. Medicare has adjusted its coverage for seniors to ensure they get the health care they need during these unprecedented times.

There are two coronavirus tests available: The nasal swab and the antibody test. Medicare Part B covers both tests at 100% when you get the test from a doctor’s office, hospital, pharmacy, laboratory, and select drive-thru locations. Medicare beneficiaries will not have to pay the Part B deductible or coinsurance for a COVID-19 test.

The coronavirus CARES Act includes requirements for Medicare to cover a COVID vaccination once available. The Food and Drug Administration has officially approved the Pfizer-BioNTech and Moderna COVID vaccines, and Medicare Part B will cover these vaccines at 100%. Deductible and coinsurance requirements are waived.