Medicare open enrollment is here for 2021: Know your options, experts say
Nancy Lund has a good track record picking the right prescription drug plan every fall for the coming year.
“Sometimes I can stick with a plan for two years,” Lund, 86, said. “Other times the plan has changed so much it isn’t right for me.”
It’s a ritual for the Naples resident, shared by millions nationwide on Medicare during “open enrollment” from Oct. 15 until Dec. 7.
That’s when Medicare beneficiaries are advised to look at their health and drug coverage and potentially make switches effective Jan. 1.
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Check for changes
Benefits and costs fluctuate from year to year with traditional Medicare run by the federal government and with private Medicare Advantage plans. Seniors’ needs also may have changed during the year, especially with prescriptions.
Lund takes several medications for asthma and chronic obstructive pulmonary disease. Her physicians may add a medication and drop another one during the year.
Every fall she reviews the slate of stand-alone Part D prescription drug plans being offered for the new year in Florida for people like her on traditional Medicare.
Help for seniors
There is help for seniors to sort through Part D plans’ benefits and costs from volunteers with Southwest Florida for Serving Health Insurance Needs of Elders (SHINE).
“Do take advantage of SHINE and the wonderful volunteers to help sort through it,” Lund said. “It is complicated.”
She’s also found that some Part D plans require seniors to use one retail pharmacy over another.
Lee County has 199,759 residents on Medicare and Collier has 103,674, according to August data from the Centers for Medicare & Medicaid Services.
Of the total, 87,620 Medicare enrollees in Lee are on stand-alone drug plans and 69,912 are on Medicare Advantage plans with prescription benefits included. Another 42,227 Medicare beneficiaries have drug coverage through the VA, employers or other group plans or don’t have coverage.
In Collier, 56,376 Medicare beneficiaries have stand-alone drug plans and 25,350 are on Medicare Advantage plans with prescription benefits, according to the Centers for Medicare & Medicaid Services. Another 21,948 get their drug coverage through the VA, employers, other group plans or don’t have coverage.
Volunteers with SHINE traditionally each fall provide in-person assistance and conduct group presentations about Medicare and Part D plans.
The Florida Department of Elder Affairs, which runs SHINE, put an end to that due to the COVID-19 pandemic, said Hallie Devlin, a program coordinator in Southwest Florida.
“However we are doing phone counseling from home and Zoom-based presentations,” she said.
A lot to learn
Donna Treiser, a retired elementary school teacher in Naples, started on traditional Medicare Oct. 1 with her 65th birthday later this month.
She selected a Part D plan for the remainder of this year and will stick with the same prescription plan in 2021. She takes two prescriptions.
Getting familiar with Medicare and Part D plans can be overwhelming but SHINE helped her with comparisons, Treiser said.
“I looked at the top three that worked for me and each had a different deductible and co-pay and you must select the pharmacy,” Treiser said. “I learned a lot. With Medicare Part D, it is very individual because everybody is on different prescriptions.”
For 2021 in Florida, 28 standalone drug plans are being offered for people on traditional Medicare, which is one more than this year, Devlin said. Some existing plans have changed their names slightly.
“The average premium is about $33,” Devlin said. “Pennies less than this year.”
Nationally, the Centers for Medicare & Medicaid Services reported the average Part D premium next year will be $30.50.
Premiums have been declining an average of 12% since 2017, and Medicare beneficiaries have saved nearly $1.9 billion in premium costs over that period, according to the Centers for Medicare & Medicaid Services.
There will be four stand-alone Part D plans in Florida that have a zero deductible; the lowest premium is $62.70, according to Devlin.
“Most of the other drug plans have annual deductibles of $445, which is going up $10 from this year,” she said.
In most stand-alone Part D and Advantage plans, the prescription deductible applies only to the Tier 3 and higher drugs and not to lower cost medications, she said.
Collier residents next year will have 49 private Medicare Advantage plans they can choose from and Lee residents will have 52.
The number of Medicare Advantage plans offered nationally has been increasing in recent years with about 2,100 plans being offered next year across the U.S. with the average monthly premium of $21, according to the Centers for Medicare & Medicaid Services.
This year, the average Medicare Advantage premium is $23.60, according to the federal agency.
Millions of Americans enroll
About 27 million Americans are projected to enroll in Advantage plans for next year compared to 24.4 million currently enrolled in the private plans, according to the Centers for Medicare & Medicaid Services.
“The Advantage plans are allowed to offer additional services,” Devlin said, referring to benefits like membership to fitness programs.
Other benefits in enhanced Medicare Advantage plans are meal delivery, transportation assistance, adult day health services and home-based palliative care, according to the federal agency.
People considering Medicare Advantage need to check what additional benefits each plan is offering, Devlin said.
Insurers offering prescription plans may alter from one year to the next their approved drug list of what’s covered. Seniors need to review their medications against the approved drug list of each plan they are considering for new year, Devlin said.
A notable change for 2021 is the price of insulin because the federal government has launched an initiative of a co-payment of $35 a month and multiple types of insulin are included.
“People need to ask if the plan they are considering offers the maximum $35 co-pay for insulin,” she said.
Ten of the stand-alone plans for next year in Florida are taking part in the insulin initiative to offer the $35 a month co-payment; 12 of the Medicare Advantage plans in Collier and 10 in Lee are taking part.
For seniors who select a plan with the insulin cap at $35 a month, they will save 66% of what they pay or an average of $446, according to the Centers for Medicare & Medicaid Services.
Seniors in Part D plans will reach the prescription drug coverage gap, or doughnut hole when their spending combined with what their plan pays reaches $4,130 next year, up from $4,020 this year.
For seniors who reach the coverage gap, the most they will pay is 25% for covered medications.
Seniors will exit the coverage gap in 2021 when their spending with their plan reaches $6,550 and they move into catastrophic coverage with significantly lower costs out of pocket.
HOW TO GET HELP
Medicare beneficiaries should call the Elder Helpline at 866-413-5337 to set up a phone appointment for assistance.