Health coverage amid COVID-19
During pandemic, Medicare Advantage plans offer more benefits to seniors
The coronavirus pandemic has taken a heavy health toll on older adults, which is why seniors willwant to be particularly choosy when selecting aMedicare Advantage plan for 2021.
Fortunately, more plans are available this year in Florida, and many have enriched their benefit offerings and lowered their premiums.
Nationally there has been a 76% increase in the number ofMedicare Advantage plans to choose from. Orange County seniors can choose from 49 plans, up from 41 last year.
“I am amazed at the number of planswe have,” said Edith GoodenThompson, who overseesMedicare counseling for the SHINE program offered by the Area Agency on Aging Broward.“We have more choices than most areas in the country do. “
The good news for seniors isMedicare Advantage average monthly premium, $21, will be the lowest in14 years (since 2007) for the over 26 millionMedicare beneficiaries projected to enroll in an advantage plan. In Orange County, the average premium is $12.09, significantly lower than the national average.
However, that doesn’t mean you necessarily will pay less for coverage. Youmay have higher co-pays, or in some cases, your plan may not cover the drug you take or the plan may have
moved it to a higher co-pay tier. When you shop for plans, you will need to have a list of your medications and check the deductibles. In 2020, most Medicare Advantage insurerswaived cost-sharing requirements for COVID-19 testing and treatment, which likely will continue in 2021.
A big change toMedicare Advantage plans in 2021 is the extended telehealth benefits that allowseniors to receive care in a virtual format from their own homes. This offering has become popular during the pandemic and for 2021, more mental health services also are available via telehealth in many of the plans.
“With the pandemic, we sawa tenfold increase in telehealth utilization, which is whywe expanded our telehealth capabilities,” said Roger Rodriguez, CEO ofUnitedHealthcareMedicare and Retirement in South Florida. “We think telehealth will continue to augment, not replace, in-person visits.”
Another change in the 2021Medicare Advantage options comes in the drug plans with a feature often referred to as the “doughnut hole.” This is the time period when the cost of medications reaches a specific level, and you are in what is called a coverage gap. Historically when this happened, your drug costswould rise dramatically. But this year, theMedicare PartDchange is raising the amount of money it takes to reach this doughnut hole— so it will take longer to reach that gap. The amount it took to reach this gap in 2020was $4,020, and it has been raised in 2021 to $4,130.
For diabetics, the Centers forMedicare& Medicaid Services (CMS) has released a new model for drug coverage that will provide lower, set costs for insulin (no more than a $35 monthly copay beginning in January). In Orange County, 10 providerswill participate in this new model.
During the pandemic, certain provisions ofMedicare Advantage plans may become more important considerations. For seniors who are staying close to home, the meal delivery benefit could be a key consideration. For someone who formerly relied on public transportation, a plan that covers non-emergency transportation services could be desirable. A handful of Medicare Advantage plans also are offering palliative care and integrated hospice care.
As the highly infectious coronavirus continues to spread, people who spend time in Florida but have a primary residence somewhere else maywant to look for a plan that includes a “passport”-like feature to ensure coverage benefits in two different states.
“This is the year to review your options and see what is out there,” said ChristianWorstell, a licensed health insurance agent and writer forMedicareAdvantage.com. “You might find more coverage at a lower price or better coverage for the health services you utilize.”
Worstell suggests you review the annual notice that outlines changes for 2021 in your existing plan and use that to do a comparison.
Rodriguez atUnitedHealthcareMedicare and Retirement said seniors need to take a holistic approach to evaluate the coverage they need during this challenging time.
“Copays or cost-sharing is important but youmay alsowant to consider the network of providers within a plan and the stability of that network— howlarge it is and how you can access it,” Rodriguez said. “Look for stability in partners and carriers and ask yourself, ‘Is your provider going to be there when you need them?’ ”
DesiraeMearns, project director for the SHINE program in Palm Beach and Treasure Coast, said she advises seniors to do research and avoid assumptionswhen picking a 2021 plan.
“Every year, not just during the pandemic, it is important for folks to check with their healthcare providers to make sure theywill continue to accept their Advantage plans or ask them what plans they are going to accept for 2021,” Mearns said. “A lot of people assume their providers will stay in-network and while they might, it is always good to double-check.”
For example, in September in Broward County, MemorialHealthcare System told its patients with Blue Cross Blue Shield of Florida to find another insurer if theywant to continue usingMemorial’s six facilities at in-network rates. About sixweeks later, Florida Blue announced its members will again be able to useMemorialHealthcare System hospitals at in-network rates under a new multiyear contract agreement reached by the two companies.
Medicare open enrollment period for 2021 runs from Oct. 15 through Dec. 7. Any changes made during this time will go into effect on Jan. 1of the following year.