Each new year presents new opportunities for Medicare beneficiaries. Some older adults may be fully aware of how health care costs, provider networks and various plan terms and conditions can change every year. But what many beneficiaries underestimate is just how much their benefits can change from one year to the next. 

Here are five key changes to Medicare and Medicare Advantage plans taking effect on January 1, 2021.

Medicare will cover acupuncture for back pain

While a few privately sold Medicare Advantage (Medicare Part C) plans may have covered acupuncture in the past, federally provided Original Medicare (Part A and Part B) has not typically covered alternative medicine and has never before provided coverage of acupuncture. But that’s about to change. 

Beginning in 2021, Medicare Part B will cover up to 12 acupuncture visits within a 90-day window (and another eight sessions if you show improvement) for lower back pain. This means that all Medicare Advantage plans will also now cover acupuncture for back pain, since Medicare Advantage plans are required by law to cover everything that Medicare Part A and Part B cover.

The decision to add Medicare acupuncture coverage is twofold:

• Recent studies have begun to display the merits of acupuncture for lower back pain, and the practice is gaining more widespread credibility.1 
• Medicare is making efforts to combat America’s opioid crisis by providing more coverage of pain relief treatments that do not involve prescription pain medication.

Medicare will offer more telehealth services

Telehealth – conducting doctor’s appointments virtually by way of video conferencing or other technology – took center stage in 2020 amid the COVID-19 pandemic. In response to the coronavirus pandemic, Medicare wasted no time expanding its telehealth benefits to include coverage of a wider net of virtual services. These new Medicare benefits will remain in place at least throughout the public health emergency declaration associated with the pandemic. 

Medicare has already proposed making some of those temporary telehealth benefits permanent, leaving the coverage in place even after the pandemic fades and the emergency declaration is lifted. Beneficiaries may be able to count on having these expanded telehealth benefits well into 2021 and likely beyond.

Some Medicare Advantage plans already covered more telemedicine services than Original Medicare. With these changes to traditional Medicare benefits, Medicare Advantage beneficiaries can now all have access to these benefits.

 Medicare Advantage plans will be available for people with ESRD

Beneficiaries under the age of 65 who qualify for Medicare because of End-Stage Renal Disease (ESRD, or kidney failure) were previously barred from joining most Medicare Advantage plans and were only allowed to enroll in Medicare Special Needs Plans (a certain type of Medicare Advantage plan). 

Beginning in 2021, people with ESRD will be eligible to enroll in any Medicare Advantage plan that’s available where they live, not just Medicare Special Needs Plans. This rule change will open up countless doors for hundreds of thousands of beneficiaries who seek better health care coverage.

Medicare insulin costs will be lower

Medicare beneficiaries with diabetes can expect to see some increased savings on their insulin in 2021. 

Many Medicare Advantage and Medicare Part D plans will cap beneficiaries’ costs for insulin as part of the new Medicare Part D Senior Savings Model. This new payment model caps beneficiary spending on insulin at $35 for a one-month supply, from the beginning of the year until they reach their drug plan’s coverage gap.

Private Medicare plans are expanding access to more beneficiaries

Private Medicare Advantage and Medicare Part D plans continue to see increased enrollment every year. And in 2021, beneficiaries will have plenty of reason to make the switch. 

Medicare Advantage premiums will be at their lowest average since 2007, and Part D average premiums have dropped 12% since 2017.2

Meanwhile, plan selection is up across the board. There will be around 2,100 more Medicare Advantage plans available in 2021 than in 2020. And the average beneficiary will have their choice of 30 standalone Part D plans, the most since 2014.3

2020 has been a tough year for everyone. Here’s to 2021 giving Medicare beneficiaries a little something to look forward to.

Sources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364128.

2. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-historically-low-medicare-advantage-premiums-and-new-payment-model.

3. https://www.kff.org/medicare/issue-brief/medicare-part-d-a-first-look-at-medicare-prescription-drug-plans-in-2021.