September 30

Medicare and You in the Coming Year

By Rick Banas of Gardant Management Solutions

Our copy of “Medicare & You: The official U.S. Government Medicare Handbook for 2021” arrived in the mail last week.

Whether you already have Medicare health and drug coverage, will be eligible for Medicare in the near future or are a caregiver for an older adult, the handbook is filled with valuable information about how Medicare works, the options that are available, what’s new to Medicare, and the 2020 Open Enrollment Period.

What’s New

The handbook cites several new Medicare benefits that are either now available or will be as of Jan. 1, 2021.  For instance . . .

Back Pain

The handbook indicates that Medicare now covers up to 12 acupuncture visits in 90 days for chronic low back pain. Acupuncture for anything other than chronic low back pain, however, is not covered by Medicare.

Insulin

Starting Jan. 1, 2021, the handbook notes you could save hundreds of dollars each year in out-of-pocket costs for insulin if you join a Medicare drug plan that participates in the “Part D Senior Savings Model.”

End-Stage Renal Disease

If you have End-Stage Renal Disease, you can join a Medicare Advantage Plan during the Open Enrollment Period. The Medicare Advantage Plan coverage will start on Jan. 1, 2021.

COVID-19

For the most up-to-date information on Medicare coverage and benefits in regard to COVID-19, you can visit www.Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Telehealth

Original Medicare now provides some limited telehealth benefits. Medicare Advantage Plans and providers who are part of some Medicare Accountable Care Organizations may offer additional telehealth benefits.

Open Enrollment

Each year, the Open Enrollment Period may be your only chance to change your coverage so be sure to mark these important dates on your calendar. This includes changing from Original Medicare to a Medicare Advantage Plan; changing from a Medicare Advantage Plan to Original Medicare; or changing from one Medicare Advantage Plan to a different Advantage Plan.

 

Mark Your Calendar

Oct. 1, 2020

As of Oct. 1, you can start comparing the Medicare coverage you have now with other options. As your situation and what is covered by Medicare plans and costs can change from year to year, you should review your Medicare health and drug coverage to see if there are plans that could better meet your needs. You may be able to save money or get extra benefits. Click here.

Oct. 15 to Dec. 7, 2020

This is the Open Enrollment Period for 2020. You can change your Medicare health or drug coverage for 2021, if you decide to make a change. You do not need to do anything if you decide to keep the coverages you currently have.

Jan. 1, 2021

If you make a change to a new plan, the coverage and costs of the new plan begins on Jan. 1. If you decided to keep the plan(s) you currently have, any changes to your plan’s cost and coverage also become effective on Jan. 1.

Jan. 1 to March 31, 2021

If you are in a Medicare Advantage Plan, you can change to a different Advantage Plan or switch to Original Medicare and join a separate Medicare drug plan once during this three-month period. Any changes will be become effective the first of the month after the plan gets your request.

 

Assisted Living and Nursing Home Care

Medicare does not cover all health care needs. Unless you are in a Medicare Advantage Plan that covers services not covered by Original Medicare, you will have to pay for the services out of your own pocket.

Some of the items and services noted in the Handbook that Original Medicare does not cover are the following:

▪ Most dental care.

▪ Eye exams for prescription glasses.

▪ Dentures.

▪ Cosmetic surgery.

▪ Massage Therapy.

▪ Routine physical exams.

▪ Hearing aids and exams for fitting hearing aids.

▪ Assisted living.

▪ Most nursing home care.

One of the most common misconceptions I encounter is the belief that if I, my Mom or my Dad needs nursing home care, Medicare will pick up the tab. The reality is that Original Medicare only provides very limited nursing home coverage. The limited coverage may apply only if it is for short-term rehab and only if very specific criteria are met.

Options for Medicare Coverage

As explained in the handbook, there are two main options for Medicare coverage. One option is Original Medicare. The other is Medicare Advantage.

Original Medicare

Original Medicare includes Hospital Insurance (Medicare Part A) and Medical Insurance (Medicare Part B). With Original Medicare, you can also join a separate Medicare Drug Plan (Part D). In addition, you can buy supplemental coverage (Medigap) to help you pay for the out-of-pocket costs associated with Original Medicare.

With Original Medicare, there usually is a co-insurance requirement. You usually pay 20% of the Medicare-approved amount for Part B covered services after you meet your deductible. Unless you have supplemental insurance, there is no yearly limit on out-of-pocket expenses.

With Original Medicare, you can go to any doctor or hospital that takes Medicare in the United States. In most cases, you do not need a referral to see a specialist.

Medicare Advantage

Medicare Advantage is an “all-in-one” alternative to Original Medicare. The plans include Part A and Part B coverage and usually Part D. The plans may have lower out-of-pocket costs than Original Medicare and most Medicare Advantage Plans offer extra benefits that Original Medicare doesn’t cover such as vision, hearing and dental.

Medicare Advantage Plans have a yearly limit on what you pay for out-of-pocket services that Medicare Parts A and B cover.

With many Medicare Advantage Plans, you will need to use doctors and other health care providers who are in the plan’s network and service area. You may need to get a referral to see a specialist.

There are several ways you can get help choosing the coverage option that is right for you.

▪ Personalized counseling is available at no charge from your State Health Insurance Assistance Program (SHIP). To find the SHIP in your state, click here.

▪ You can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

▪ You can click here to find and compare health and drug plans.

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