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Retirement should be a time of joy and freedom, but too often these years can unfortunately be tainted by battles with chronic illnesses. And one of the most common is cardiovascular disease (CVD), often called heart disease. In fact, heart disease is the leading cause of death in the United States. That’s why February marks American Heart Month - a way to bring awareness to heart disease and help spread tips on heart disease prevention. And to help celebrate American Heart Month, we’ll review some of the facts about cardiovascular disease, along with tips to combat it. Then we’ll dive into how your Medicare coverage can help you prevent, treat or manage cardiovascular diseases. What Is Heart Disease? Heart disease, also known as cardiovascular disease CVD is a broad term for several different medical conditions. But generally speaking, heart disease is an illness that affects the heart or circulatory system. The illnesses that fall under the heart disease category include: Coronary artery disease (CAD) Heart rhythm problems Congenital heart disease Infections of the heart tissue Heart valve disease Cardiovascular Disease Risk Factors Many of the biggest risk factors of cardiovascular disease are lifestyle related. And while there’s a general assumption that these factors are the sole cause, many people are actually born with heart disease. It can be congenital and hereditary. But those with lifestyle risk factors have control over heart disease prevention. The main risk factors and causes of heart disease include: Obesity High cholesterol Diabetes Smoking High blood pressure And these causes of heart disease can be directly tied to such behaviors as: Poor diet Poor physical activity Too much alcohol Tobacco use Genetics or heredity Simply put, the lifestyle habits (good or bad) that we form are what lead to the major risk factors for cardiovascular disease. Genetics and heredity may then play a role in whether or not we actually develop heart disease. 4 Tips To Prevent Cardiovascular Disease CVD As we mentioned above, the fact that so many of the risk factors for CVD are lifestyle related can be a silver lining, meaning we can make smart choices and avoid unhealthy behaviors to protect our hearts. Now let’s walk through some healthy habits to maintain good heart health. #1. Stop Smoking Quitting smoking is almost universally hailed as the biggest step to reduce your risk of heart disease. Smoking is considered the most easily avoidable lifestyle factor that leads to cardiovascular disease. So if you currently smoke, make an attempt to stop now. Quitting smoking will also save you money, making this heart disease prevention tip a no-brainer. #2. Eat Healthy Diet also plays a big role in the health of your heart. A poor diet multiplies and compounds risk factors, but a smart, healthy diet can reduce your risks and get your heart in great shape. You should always speak with your doctor about nutrition and heart healthy diet options. But generally speaking a heart healthy diet may include: Fruits and vegetables Whole grains Low-fat dairy products Skinless poultry and fish Nuts and legumes In addition to eating these nutritious foods, another suggested tip is to limit your saturated fat, sodium, and sugar intake. This type of diet fits into the DASH (Dietary Approaches to Stop Hypertension) eating plan. #3. Stay Active There’s no getting around the fact that an active lifestyle is a healthy one. But you don’t have to jump right in and overdo it. In fact, gentle but steady exercises can be great way to help prevent heart disease, including: Walking 30 minutes per day Cycling Swimming The main point is to pick an activity that you enjoy. So if you have a scenic path, beach, or lake nearby, consider talking walks or riding your bike there. You should also have a backup plan for poor weather or to keep safe and healthy during COVID-19. Research home workout apps or programs on platforms like YouTube or you Smart TV. But just remember: If you over-commit to exercise and activity, you may fall off the wagon completely. Instead, start small, and add time and distance gradually. If you make it a firm part of your routine, you’ll stick to it. Again, always be sure to consult your doctor before developing an exercise or activity regimen for heart health. #4. Stay Informed About Your Cardiovascular Disease CVD Risks One of the most important heart disease prevention tips is to stay proactive and empowered about your own personal health. This is especially true if you have a family history or genetic predisposition. Here are some key strategies: Don’t miss or delay your doctor’s appointments. If recommended, make sure you get cardiovascular screenings and tests. If you’re on heart disease medications, be sure to consistently take them and follow your treatment plan. Ask questions and be proactive when it comes to your health and wellbeing. How Does Medicare Cover Cardiovascular Disease CVD? If you’re on Medicare or aging into Medicare,and cardiovascular disease prevention and treatment is important to you, you’re in luck. All aspects of the Medicare program cover heart disease related measures. This includes Medicare cardiovascular screening, treatment, and healthy lifestyle tools. Heart disease prevention and treatments are covered by: Original Medicare Part A Original Medicare Part B Medicare Part D drug plans Medicare Advantage plans (Part C) Medicare Supplement Insurance (Medigap plans) In the most basic sense, Medicare will cover all the stages of cardiovascular disease, including: Annual screenings (covered by Part B) Doctor’s visits, both primary and specialists (covered by Part B) Heart condition medications (covered by Part D) Cardiovascular tests and procedures (covered by Part B) Hospitalizations (when admitted as an in-patient, covered by Part A) When you use Medicare Part B under Original Medicare, you can expect to pay: Part B deductible ($203 for 2021) Part B coinsurance (20% of the Medicare-approved charges) Part B excess charges (up to 15% of the Medicare-approved charges if you use providers who don’t agree to Medicare’s prices) When you use Part A coverage under Original Medicare, your costs may include: Part A deductible ($1,484 per benefit period) Part A coinsurance of $0 per day (after you pay the deductible) for hospital stays of up to 60 days Part A coinsurance of $371 per day for hospital stays over 60 days Medicare Cardiovascular Screenings Medicare covers cardiovascular screenings, which involves a blood test once every five years. But if your doctor orders more frequent cardiovascular screenings and tests, Medicare will cover them. However, you’ll pay your share of costs as we outlined above. Medicare Cardiac Rehabilitation Programs Medicare Part B will cover part of the costs for cardiovascular disease rehabilitation programs. These covered programs include exercise, education, and counselling designed to maintain your heart health. Note: Medicare Part B will cover these cardiac rehabilitation programs, only if any of these scenarios apply to you: You’ve had a heart attack in the last 12 months. You’ve had heart bypass surgery. You’re experiencing stable angina or chronic heart failure. You’ve had a heart of lung transplant. You’ve had a valve or artery repair or replacement. Once again, you’ll pay your standard 20% coinsurance if you use these cardiac rehab programs under Medicare Part B. Cardiac Tests Covered By Medicare Beyond standard cardiovascular disease screenings and rehabilitation programs, Medicare will cover medically necessary cardiac tests ordered by your doctors. These types of heart tests may include: Blood tests Echocardiograms (ECG) Exercise stress tests - MRI or x-rays Just as with the other services, you’ll pay 20% cost-sharing under Part B of Original Medicare. Cardiovascular Medications Most prescription drugs are not covered by Original Medicare. But you may be able to get heart and cardiovascular prescription drug coverage through a Medicare Part D plan. The 2 types of Medicare plans that offer Part D: Standalone Prescription Drug Plans (PDP) and Medicare Advantage plans that include Prescription Drugs (MAPD) It’s important to note that not all drugs are covered by all Medicare Part D drug plans. However, all Part D plans must cover at least two drugs in every therapeutic category, including heart disease or cardiovascular disease. Tip: You can use our prescription lookup tool to see if your drugs are covered under Medicare Part D. Medicare Chronic Condition / Disease Management Programs If you have more than one chronic condition, you can qualify for special disease management programs. These are also covered by Original Medicare, but you’ll still be responsible for your standard cost sharing. You may also have to pay a monthly fee to participate in these chronic care management services. Under these management programs, you’ll work with your healthcare professionals to craft a comprehensive health plan tailored to your heart condition. A chronic care management plan may include: Goal setting and health evaluations Working with all of your specialists Managing your medications Cardiovascular Disease And Private Medicare Plans So far, we’ve reviewed your coverage and costs under Original Medicare. But if you choose a private plan option like Medicare Advantage or Medigap, these plans will cover your cardiovascular health as well. If you enroll in a Medicare Supplement plan, your plan will pay part of the costs you’d normally pay out of pocket. If you enroll in a Medicare Advantage plan, you’ll likely pay small copayments - similar to what you’d pay under Original Medicare. But with Medicare Advantage, you’ll have out-of-pocket spending protection, since these plans put a cap on your annual health spending. Most Medicare Advantage plans and some Medigap plans also offer access to non-Medicare health and wellness benefits. These can include gym memberships, SilverSneakers or other health programs that can help you lower your risks of cardiovascular disease. Conclusion: Medicare & Cardiovascular Disease Coverage With lifestyle and healthy habits, you can control many of the factors that may lead to cardiovascular disease. And if you currently have heart disease, you can manage your condition with a healthy lifestyle and tests, specialists, and medications covered by Medicare. To make the most of your private Medicare coverage (Part C or Part D): Check to ensure your medications are covered by the plan you’re considering. Make sure you’ll remain in-network with your doctors and specialists. And if you want help choosing a Medicare plan, you can work with a licensed insurance agent who can help you find Medicare plans and give you free Medicare quotes (with no obligation to enroll in a plan). Just call 1-800-620-4519 to speak with one of our licensed insurance agents, or use our Medicare plan comparison tool to find Medicare plans in your area. Note: This article is for general education purposes and does not replace the advice of a medical professional. Always seek the guidance of your physician or a medical professional for medical advice, diagnosis, and treatment.

The popularity of Medicare Advantage plans is growing at a rapid pace. In 2020, more than 36% of all Medicare beneficiaries were enrolled in Medicare Advantage health care plans. Whether you’re already in a Medicare Advantage plan, you’re curious about them, or you’ve never heard of them, this Medicare Advantage guide is for you. In this in-depth Medicare Advantage guide, we’ll provide a Medicare Advantage overview that will answer your frequently asked Medicare questions and cover the following topics: What is Medicare Advantage and who qualifies for it The different types of Medicare Advantage plans and how they work The difference between Original Medicare and Medicare Advantage What Medicare Advantage plans cover Who should consider getting Medicare Advantage How much Medicare Advantage costs Medicare Advantage and special scenarios Medicare Advantage plan ratings When to enroll in Medicare Advantage How to enroll in Medicare Advantage What Is Medicare Advantage? Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. The Medicare Advantage program is a way for beneficiaries to access their benefits and rights under Original Medicare, but through a private insurance company instead of the Federal Government. A Medicare Advantage plan is a contract between a private insurance company and the Medicare program. By law, every Medicare Advantage plan must cover everything covered by Original Medicare (Medicare Part A and Medicare Part B. This means that if you choose to enroll in a Medicare Advantage plan, you can be confident that you’ll receive all the benefits you’re entitled to under Original Medicare. Who Qualifies For Medicare Advantage? To qualify for Medicare Advantage, you must be enrolled in Original Medicare Parts A and B. You also must continue to pay your Part B premium in order to keep your Medicare Advantage coverage. There are no age restrictions for Medicare Advantage plans. If you’re enrolled in Part A and B before age 65 due to a disability or chronic condition, you’re still eligible for Medicare Advantage coverage. How Do Medicare Advantage Plans Work? Medicare Advantage health care plans work like the employer-sponsored health insurance plans you may be used to from your previous or current job. Medicare Advantage plans provide comprehensive coverage, and you usually need to stay in-network to receive care. You’ll typically have some out-of-pocket expenses when you receive services and procedures under your Medicare Advantage policy. These costs typically come in the form of copayments or coinsurance that you’ll pay to your provider when you receive care. An important point to remember is that all Medicare Advantage plans have an annual out-of-pocket (OOP) maximum that limits the total amount you can spend in any year. But you do not have an OOP with Original Medicare. What Types Of Medicare Advantage Plans Are Available? There are 6 types of Medicare Advantage plans, including: Medicare Advantage HMOs (Health Maintenance Organizations) Medicare Advantage PPOs (Preferred Provider Organizations) Medicare Advantage PFFS (Private Fee-For-Service Plans) Medicare Advantage SNP (Special Needs Plans) Medicare Advantage HMO-POS (HMO Point-Of-Service Plans) Medicare Medical Savings Plans (MSPs) In this Medicare Advantage guide, we’ll focus on Medicare Advantage PPO plans and Medicare Advantage HMO since they’re the most common types of MA plans. The Difference Between Original Medicare and Medicare Advantage The primary difference between these programs is that Medicare Advantage is an alternative to Original Medicare. When you join a Medicare Part C plan, you no longer receive your Medicare benefits through Original Medicare. Medicare Advantage plans are offered and administered by private insurance companies. But these private insurance companies must comply with many rules and regulations set by the Medicare program. Pros And Cons Of Medicare Advantage Plans vs. Original Medicare Medicare Part C plans have many advantages when compared to Original Medicare. The 3 biggest pros of Medicare Advantage plans are: Annual Out-of-Pocket Maximum spending cap Availability of prescription drug coverage* Extra benefits for things not covered by Original Medicare *Note: Some MA plans are available without prescription drugs. These additional benefits from Part C make Medicare Advantage a more complete coverage option than Original Medicare. MA plans can have their drawbacks in comparison to Original Medicare, depending on your healthcare needs. The 3 biggest pros of Original Medicare are: #1. You can see any doctor or go to any facility anywhere in the country, as long as they accept Medicare. #2. There are no networks. Most Medicare Advantage plans have some kind of network restrictions. #3. You don’t need referrals to see specialists. With some Medicare Advantage health care plans, such as HMOs and Special Needs Plans, you usually need referrals from your primary care physician to visit a specialist. What Does Medicare Advantage Cover? Medicare Advantage plans provide coverage that matches Original Medicare Parts A and B. Generally speaking, your Medicare Advantage plan will cover the same service or procedure as Original Medicare. But there is one exception to this rule, which we’ll cover below. Medicare Advantage plans cover the following services. Medicare Part A Services Medicare Part A covers services that take place in healthcare facilities or institutions like: Inpatient hospital stays Skilled nursing services (not room and board) Hospice care In-home care Note: Hospice care is usually not covered by Medicare Advantage plans. Instead, hospice care is covered under Original Medicare, even if you’re enrolled in a Medicare Advantage plan. However, a new test program in 2021 will explore Medicare Advantage plans providing hospice benefits. Medicare Part B Services Medicare Part B services and procedures are considered more routine and non-emergency in nature than Part A. Common Medicare Part B services include: Doctor’s visits, including specialists Physical and occupational therapy Lab and diagnostic testing services like blood work and x-rays Durable medical equipment Mental health services Ambulance services Some cancer treatments, including chemotherapy As mentioned, Medicare Advantage plans cover all of these services with the exception of hospice care. Medicare Advantage And Prescription Drugs Most Medicare Advantage plans offer prescription drug coverage. These plans are also known as Medicare Advantage Prescription Drug Plans (MAPDs), and they include Medicare Part D. Medicare Advantage Extra Benefits When considering Medicare Advantage pros and cons, it’s essential to take extra benefits that Medicare Advantage could offer to you. Many of these benefits are not provided through Original Medicare. Medicare Advantage benefits may include: Fitness programs: SilverSneakers, gym memberships, and fitness trackers. Vision care: Eye exams, contact lenses, and sometimes eyeglass frames. Hearing care: Exams and often discounted hearing aids. Dental coverage: Some plans have basic dental benefits built in, others offer dental coverage for an extra premium. Transportation: Rides to and from medical appointments. Meal Deliveries: For qualified people returning home from the hospital or skilled nursing facility Telemedicine services and virtual healthcare. Note: Medicare Part C plans have the ability to choose which, if any, extra benefits to offer. These insurance companies may also make changes to their Medicare benefits and offerings each year. Who Is Medicare Advantage Good For? You should consider enrolling in Medicare Advantage if: You want to put a cap on your total out-of-pocket spending under Original Medicare. You want prescription drug coverage without paying for a separate Part D drug plan. You need some of the extra benefits (vision, hearing, private home aides) that come with many Medicare Part C plans. You don’t want to pay for Medicare Supplement (Medigap) plans. You don’t mind using a network of doctors and facilities. You don’t mind needing referrals to see specialists. You don’t mind paying small copays each time you see a doctor. How Much Does Medicare Advantage Cost? Medicare Advantage plans have several costs associated with them. Before we dive into each cost, it’s important to remember that you always have to pay your Part B premium in order to have Medicare Advantage. Now, some Medicare Advantage plans offer a benefit that covers part, or all, of your Part B premium. But check the plan benefits closely to see if this is offered by a specific Medicare Advantage plan. Beyond this Part B premium, you might face the following Medicare Advantage plan costs: Monthly premium Annual deductible Copayment Coinsurance You might have a monthly premium for your Medicare Advantage plan, but many plans do not have them. If they do, these premiums tend to be low. Some Medicare Part C plans have an annual deductible, but again, many do not. If your plan does have an annual deductible, this means you’ll have to pay a certain amount before the plan begins paying benefits. Note that there may be separate deductibles for drug coverage and medical benefits. Beyond premiums and deductibles, the most common expenses you’ll have with Medicare Advantage plans are copayments and coinsurance. These two terms are referred to as “cost-sharing.” This is what you’ll pay out of pocket when you receive covered services. All the amounts you pay during the year count towards your annual out-of-pocket cap. Examples Of Medicare Advantage Costs Let’s look at 3 examples of how these Medicare Advantage costs work in a Medicare Advantage HMO plan. (Note: These costs are not the actual costs for any specific plan, but rather, in the range of costs for plans that you may have access to.) Scenario 1: Medicare Part B Services You injure yourself shoveling snow on your property, and you go to the doctor for an examination. You’ll pay a copay of $20 to see your primary care physician who then refers you to an orthopedic specialist. Your orthopedic specialist charges you a $35 copay for the office visit and wants you to get x-rays. You pay a $50 copay for the x-rays. Fortunately, nothing is broken or torn, so your specialist refers you to physical therapy. You pay a copay of $40 for four physical therapy sessions. Your total out-of-pocket spending for this injury is $265, spread out over a month-long period. All of these costs count towards your Medicare Advantage out-of-pocket maximum. Scenario 2: Medicare Part A & B Services You experience the symptoms of an irregular heartbeat, so you’re admitted to the hospital as an inpatient. You spend two nights in the hospital. You pay a copay of $300 per day, which amounts to a total of $600. After you’re released from the hospital, you continue to see a cardiologist, and you pay a $35 copay to see this specialist each time you visit. Scenario 3: Cancer You’re diagnosed with a treatable cancer, and you’re given chemotherapy. The copay for this treatment is 20% of the Medicare-approved cost. Although 20% amounts to more than $20,000, you hit your annual out-of-pocket maximum, so your costs are capped at $5,900 for the year. When Can You Enroll In Medicare Advantage? You can normally enroll in or change your Medicare Advantage coverage during 3 periods of time: Your Initial Enrollment Period (IEP) when you’re first eligible for Medicare. The Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. The Medicare Advantage Open Enrollment Period from January 1 to March 31 each year - however, this MA open enrollment is only for those already in a Medicare Advantage plan. Enrolling In Medicare Advantage For The First Time If you’re turning 65, you can enroll in Medicare Advantage during your Initial Enrollment Period (IEP). Your IEP lasts for 7 months, which begins 3 months before your 65th birthday, includes that birthday month, and ends 3 months after you turn 65. If you’re under 65, your first chance to enroll in Medicare Advantage starts: After your 24th month of receiving Social Security disability benefits, or At any age if you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gherig’s Disease, or if you have End-Stage Renal Disease (ESRD). Changing Your Medicare Coverage During AEP The Medicare Open Enrollment Period, also called the Medicare Annual Enrollment Period or Annual Election Period, is a good time to decide whether Medicare Advantage or Original Medicare is right for you. Also keep in mind that Medicare Advantage plan benefits can change annually. So if you have a MA plan, you should check to make sure the plan still meets your needs. Here are the actions you can take during AEP: Change from Original Medicare to a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Disenroll from your Medicare Advantage plan and go back to Original Medicare. Change from one prescription drug plan (Medicare Part D) to another. Enroll in a prescription drug plan. Cancel your prescription drug coverage. If you enroll in, or switch your Medicare Advantage insurance during AEP, your new coverage will be effective on January 1st of the following year. You may also be able to enroll in a Medicare Supplement plan if you drop your Medicare Advantage coverage during AEP. The Medicare Advantage Open Enrollment Period If you’re enrolled in a Medicare Advantage plan, you have access to another enrollment period beyond AEP: The Medicare Advantage Open Enrollment Period (MA-OEP). MA-OEP runs from January 1 to March 31 of each year. During the MA-OEP, you can: Change from one Medicare Advantage plan to another. Drop Medicare Advantage, and return to Original Medicare. Add a Prescription Drug Plan if you return to Original Medicare. It’s important to keep in mind that the MA-OEP is only for people who already have a Medicare Advantage plan. If you change plans during the MA-OEP, your new coverage will be effective on the first day of the month after you enroll. Medicare Advantage & ESRD Coverage As of January 1, 2021, End-Stage Renal Disease (ESRD) patients are now able to enroll in or switch Medicare Advantage plans. Previously, there was an exclusion for people with ESRD, also known as permanent kidney failure. ESRD patients could not get new Medicare Advantage coverage at that time. Medicare Advantage And Other Special Scenarios We mentioned earlier that Special Needs Plans (SNPs) are a type of Medicare Advantage insurance. Let’s take a look at some common types of SNPs, and how Medicare Advantage health plans are also helping people to get access to care and benefits during the coronavirus pandemic. Medicare Advantage And Chronic Conditions There are Medicare Advantage plan options for people with chronic conditions like diabetes and heart disease. These plans are known as Chronic Special Needs Plans (Medicare C-SNPs), and the benefits are tailored to help you treat and manage your chronic condition. These health plans often provide you with a care coordinator to make sure your needs are being met. These Special Needs Plans have Special Enrollment Periods (often called SEPs), so if you qualify for a C-SNP, you can enroll in it at any time. You won’t have to wait for an annual enrollment window. Medicare Advantage And Medicaid Another kind of Special Needs Plan exists for “Dual Eligibles” – people who are eligible for both Medicare and Medicaid. These plans, called Dual Eligible Special Needs Plans (D-SNPs), have cost-sharing that conforms to the Medicaid program, which means that most costs are $0. D-SNPs incorporate various prescription drug discount programs, depending on your income level - so you’ll save money on your prescriptions if you qualify. D-SNP plans also have more favorable enrollment windows, which allow you to access the benefits once you become eligible for Medicaid or extra help and at certain times during the year without waiting for an annual enrollment window. Medicare Advantage And COVID-19 Medicare provides Coronavirus coverage to help people combat the virus, which includes: No-cost lab testing. Antibody testing. All medically-necessary services and procedures, including hospitalizations and doctor’s visits. Coronavirus vaccine coverage, when one becomes available. Many Medicare Advantage health plans are waiving cost-sharing for these services. In this case, you wouldn’t pay a copayment or coinsurance for seeing a doctor or going to the hospital if you have COVID-19. Medicare has also approved an expanded role for telehealth and virtual doctor’s visits. And many Medicare Advantage health care plans offer these no-contact services with no out-of-pocket cost to you. Medicare Advantage Plan Ratings Every established Medicare Advantage plan is given a Medicare Star Rating by the Centers for Medicare & Medicaid Services (CMS). Star ratings range from 1 to 5, with 5 stars being the highest. Here’s a breakdown of what each rating means: 5-star rating: Excellent 4-star rating: Above Average 3-star rating: Average 2-star rating: Below Average 1-star rating: Poor Medicare Advantage plans are rated on several different metrics and are given an overall rating. This Medicare star ratings system is designed to help you get a feel for the level of quality and satisfaction a MA plan offers. Star ratings also give you an idea of how well a plan treats its members. Plans are rated on how quickly it responds to appeals and complaints and how they cover health screenings and preventative services. Plans are also rated for both medical benefits and prescription drug benefits, if the plan has drug coverage. How To Enroll In A Medicare Advantage Plan If you want to enroll in a Medicare Advantage plan, you’ll want to consider 3 things before joining: Make sure you find a plan that’s available in your area. Most Medicare Advantage plans are restricted to specific counties or states. Make sure your current doctors and medications are covered. This is especially important if you’re looking at a Medicare Advantage HMO plan. You’ll have to use the doctors that are in-network, and you’ll only get coverage for medications that are on the plan formulary. So make sure you investigate these before enrolling. Pay attention to star ratings. This can help you compare the overall quality among different plans. But keep in mind that new plans are not given star ratings until enough data has been collected for CMS to calculate a rating. Once you’ve found a plan, you have a few options to enroll, including: Online, by phone, or paper enrollment directly with the insurance company. Working with a licensed health insurance agent who can help you find, compare, and enroll in a Medicare Advantage plan of your choice. Medicare Advantage Guide Conclusion Medicare Advantage plans can be a great way to manage your out-of-pocket spending while enjoying extra benefits we covered, if you qualify. And they can offer some compelling advantages over Original Medicare, depending on your healthcare needs. So if you'd like to learn more about Medicare Advantage plans in your area, call 800-620-4519 to reach a licensed insurance agent who may be able to guide you to the right plan for your needs. You can also try our online Medicare plan comparison tool.

Before the Medicare Part D program started in 2006, thousands of Medicare beneficiaries faced high price tags on drugs and had little help with curbing those costs. But now, Medicare Part D plans, also known as Medicare Prescription Drug Plans, give Medicare beneficiaries prescription drug coverage options. So if you’re soon becoming eligible for Medicare Part D plans, or thinking about switching your existing Medicare coverage, this Medicare Part D guide will cover all the basics and answer your questions, including: What is Medicare Part D? Who is eligible for Medicare Part D? When can you enroll in Medicare Part D? What does Medicare Part D cover? How does Medicare Part D work? How much does Medicare Part D cost? How can I get help with Medicare prescription drug costs? What is the Part D Senior Savings Model? Tips to shop for Medicare Part D plans What Is Medicare Part D? Medicare Part D is one of the four “parts” of the Medicare program. Under Original Medicare, also known as Medicare Parts A and B, only very limited drug coverage is provided. Any medications covered are generally restricted to medicines that must be administered by a doctor. So as we mentioned before, the Medicare Part D program was created to help combat the high cost of prescription drugs. Medicare Prescription Drug Plans (PDPs) are available through private insurance companies. These plans help Medicare beneficiaries with the cost of medications, and are available in 2 forms: Standalone Prescription Drug Plans (PDPs) Medicare Advantage Prescription Drug Plans (MAPDs) Standalone Medicare drug plans work with Original Medicare. You stay enrolled in Medicare Part A and/or B, and obtain your prescription drug coverage through a Part D plan from a private insurance company. An MAPD plan is an alternative to the Original Medicare program, and combines all the benefits of Medicare Part A and B with drug coverage. All these benefits are provided by a private insurance company. Many private insurance companies provide Medicare Part D drug plans, including large nationally known ones and smaller, local companies. You can get Medicare Part D drug coverage in all 50 States. Who Is Eligible For Medicare Part D? Medicare Part D eligibility depends on meeting two criteria. To be eligible, you must be either: 1) Enrolled in Medicare Part B, or entitled to Medicare Part A; and 2) Live in the plan service area. If you qualify for Medicare Part A or are actively enrolled in Medicare Part B, then you can sign up for a standalone Medicare Prescription Drug Plan. Note: You must have both Medicare Part A and B if you want to enroll in Medicare Advantage. Medicare PDPs are a great fit for those who are Medicare-eligible and don’t have other creditable drug coverage. Examples of other prescription drug coverage include: Employer or retiree coverage Union coverage Certain military coverage, like VA benefits or Tricare, may provide good drug coverage. But they may not meet the criteria of “creditable coverage." Medicare Part D Enrollment Periods Medicare Initial Enrollment Period You generally have an initial enrollment window when you first become eligible for Medicare Part D. This first enrollment window is known as your Initial Enrollment Period (IEP), which lasts for seven months that include: Three months before the month you become eligible for Medicare The month you become eligible for Medicare Three months after the month you become eligible for Medicare Note: Your IEP lasts for seven months, regardless of whether you’re entering Medicare because you turn 65, or if you will enter due to permanent disability. If you have other creditable drug coverage, like from an employer or spouse’s employer, then you can delay enrollment into Part D without being subject to a penalty. Be sure that your drug coverage is considered creditable though. If you enroll in Medicare Part D after your IEP and don’t have other creditable drug coverage, then you will be subject to a late enrollment penalty. You can be subject to this penalty for either of 2 reasons: You had no drug coverage at all after becoming eligible for Medicare. You had drug coverage from another source, but it wasn’t considered creditable by Medicare. Your late enrollment penalty will increase for each month that you go without creditable coverage. So it’s very important to get Medicare Part D drug coverage as soon as you’re eligible, or make certain that your non-Medicare drug plan will satisfy Medicare coverage requirements. Medicare Part D Special Enrollment Periods Beyond your IEP, you may qualify for a Special Enrollment Period (SEP) that will allow you to enroll in, or change, your Medicare Prescription Drug Plan. Generally, you’ll qualify for an SEP when you experience abrupt changes in your circumstances. Some common SEPs include: Moving out of your plan’s service area. Losing creditable drug coverage from your employer. Your Medicare Drug plan doesn’t renew its contract with the Centers for Medicare & Medicaid Services (CMS). During a Special Enrollment Period, you generally will only have one chance to enroll in a Medicare Part D drug plan. Medicare Annual Enrollment Period Everyone eligible for Medicare can enroll in or switch Medicare Part D plans during the Annual Election Period (AEP), also called the Medicare Open Enrollment Period. AEP runs from October 15 to December 7 each year. If you enroll in a plan during this window, your coverage will be effective on January 1 the following year. During the Medicare AEP, you can: Change from one Prescription Drug Plan to another PDP. Switch from a Medicare Prescription Drug Plan to a Medicare Advantage Prescription Drug Plan (MAPD). Switch from one Medicare Advantage Prescription Drug Plan to another MAPD. Switch from Original Medicare to an MAPD. Drop your MAPD plan and return to Original Medicare with the option to add a standalone drug plan. Medicare Advantage Open Enrollment Period If you’re enrolled in a Medicare Advantage plan, you have access to an additional enrollment window: the Medicare Advantage Open Enrollment Period (MA-OEP). The MA-OEP is from January 1 to March 31 each year. During the MA-OEP, you can: Switch from one Medicare Advantage plan to another with or without drug coverage. Drop MAPD and return to Original Medicare. You’ll get a chance to enroll in a standalone Medicare Part D plan if you do this. How Does Medicare Part D Work? Medicare Prescription Drug Plans provide coverage for many prescription drugs. These Medicare PDPs are required to cover certain kinds of medications and prohibited from covering others. Generally, medications that are approved for therapeutic use are covered by Part D. It’s important to know, however, that Medicare Part D plans are not required to cover every drug that’s on the market. Instead, Medicare drug plans are allowed to choose which drugs they will cover. There are certain requirements that plans must use when they create their lists. The list of covered drugs is known as a formulary. Because of this freedom, each plan’s formulary is unique. Every Medicare drug plan formulary is organized into tiers. Each tier includes certain kinds of drugs in the following manner: Tier 1 – generic drugs Tier 2 – preferred brand name drugs Tier 3 – non-preferred brand name drugs Tier 4 – specialty drugs Medicare Part D Coverage For Vaccines Medicare Part D covers many vaccines, including: Hepatitis B (if you are not considered intermediate or high risk for Hepatitis B) Shingles Tdap (tetanus) boosters Note: While Medicare PDPs do not cover flu or COVID-19 vaccines, they are covered by Part B. How Do Medicare Part D Costs Work? The amount you pay for a medication changes during the year, depending on your coinsurance, copay, and how much you and your plan have paid for prescriptions. Your costs change as you move through four coverage stages. The 4 stages are: Annual Deductible Stage – you pay full price until you’ve paid $445 (for 2021). Initial Coverage Stage – you pay a small copayment or coinsurance for each prescription until the amount you pay plus what your plan pays hits $4,130 (2021 amount). Coverage Gap Stage (also known as the Medicare donut hole) – you pay 25% of the total cost for both generic and brand name drugs. Catastrophic Coverage Stage – once your total costs, plus the value of manufacturer discounts exceeds $6,550, then you pay no more than 5% of the cost for any medications for the rest of the year. You begin each year at the first coverage stage and move through them as the year progresses. Note: Only drugs on your plan’s formulary count against these coverage stages, so it’s very important that you find a Part D plan that covers your medications. How Much Do Medicare Drug Plans Cost? You pay a monthly premium to the insurance company for Medicare Part D coverage. In exchange, you pay less for many prescription drugs than if you paid cash at the pharmacy. You will likely pay some or all of these costs under Part D: Annual deductible Copayments Coinsurance If your plan has a Medicare Part D deductible, you’ll pay the full price for medications until you’ve met the deductible. For 2021, the maximum Part D deductible is $445. While many PDP plans don’t have an annual deductible, most do, and the average 2021 Medicare Part D deductible across all Part D plans is expected to be around $345. For those plans without deductibles, you would pay a copayment or coinsurance amount for medications starting with your first prescriptions. Premiums for higher-earning Medicare beneficiaries can be higher. Thanks to IRMAA (Income Related Monthly Adjustment Amount), you can expect to pay higher premiums for Medicare Part D coverage if you are single and have an adjusted gross income over $88,000, or if you file jointly and have gross income greater than $176,000. The additional cost of Part D coverage increases in several income bands: The first IRMAA band adds $12.30 per month to the cost of your Medicare Part D coverage. The highest band for single incomes over $500,000 and joint incomes above $750,000, adds an additional $77.10 per month to the cost of your Part D drug coverage. How To Get Help With Medicare Prescription Drug Costs While your Medicare drug plan can help with the cost of medications, you may still find prescriptions to be unaffordable. While there are several possibilities for obtaining lower-cost medications, the first place you should look is the Extra Help Program, also known as the Part D Low Income Subsidy program. Extra Help is provided and designed to help people with limited incomes pay for the costs of prescription drugs, including: Premiums Deductibles Coinsurance/copayments Extra Help benefits are available for those with limited means - both an overall asset or resource limit and an income limit. These limits depend on your marital status. The resource limit does not count the value of your personal residence, vehicles you own, or certain other assets. But the income limits are: $19,140 for single individuals $25,860 for married households Depending on the level of Extra Help you receive, you can expect to pay significantly less on prescriptions. At the full subsidy level, you’d pay no more than $3.70 for each generic drug filled, and no more than $9.20 for each brand name drug prescription filled. What Is The Part D Senior Savings Model? One of the 2021 changes to Medicare is the Part D Senior Savings Model. This program is a voluntary agreement between CMS and Medicare Part D plan sponsors. And it’s intended to bring down the cost of insulin for millions of Medicare beneficiaries. Not all Part D plans are participating, but there is at least one participating plan in every state. Enrollees in participating Medicare Part D plans, including both standalone drug plans, and MAPD plans, will pay no more than $35 for a one-month supply of many kinds of insulin. This is expected to save people an average of $446 per year. Tips To Shop For Prescription Drug Plans When finding Medicare prescription drug coverage, the first thing to understand is how you’re receiving your Part A and B benefits. As an example, if you’re enrolled in Original Medicare, combined with a Medicare Supplement plan, then you’ll want to look for standalone Prescription Drug Plans. But if you’re enrolled in a Medicare Advantage plan or will be, then you’ll want to look for MAPD plans. But it’s important to know that you typically can’t have a Medicare Advantage plan and a standalone Prescription Drug Plan at the same time, so make sure you know your circumstances. Once you know what kind of Medicare Part D drug plan you need, you can start to compare Part D plans. You should pay close attention to such details as: Monthly premiums Annual Part D deductibles Availability of the drugs you need on the plan formulary Tip: Every Part D plan has a different formulary, and two different plans can assign the same medication to two different tiers. So it’s important to look up your medications to get a feel for anticipated out-of-pocket costs for your medications. Also, if you take insulin, look for a Medicare Part D plan that participates in the Senior Savings Model. This alone can save you hundreds of dollars per year in insulin costs. Medicare Part D Guide Conclusion Medicare prescription drug plans are available to help lower the burden of prescription drug prices for Medicare beneficiaries. Some of our final Part D takeaways include: Be sure to sign up for a Medicare PDP during your Initial Enrollment Period or as soon as your creditable coverage ends to avoid a Part D penalty. Do plenty of research, whether you’re signing up for a Medicare Part D plan for the first time or considering switching during an open enrollment period. Look up all of your drugs to ensure they will be covered. If this seems daunting, you can get started by using our Medicare plan comparison tool to compare Part D plans and see if your drugs are covered. You can also call 800-620-4519 to get help from a licensed insurance agent and discuss your Part D options.

Original Medicare provides basic hospital and medical insurance coverage to Medicare enrollees. Depending on your healthcare needs, this could leave you with coverage gaps. But there are two primary ways to close them: through a Medicare Advantage plan or through Medicare Supplement Insurance (also known as Medigap). In this Medicare Supplement guide, we’ll review all of the basics, including: What is a Medicare Supplement plan? What services and benefits are covered under Medicare Supplement? Who is eligible for Medicare Supplement? Medicare Supplement costs When are the Medicare Supplement enrollment periods? How does Medicare Supplement work with other insurance plans? Medicare Supplement and special scenarios What’s the difference between Medicare Advantage and Medicare Supplement? Pros and cons of Medicare Supplement plans What Is Medicare Supplement Insurance (Medigap)? Medicare Supplement, also known as Medigap, is a category of Medicare insurance products offered by private insurance companies. Medigap plans are designed to work with Original Medicare, and they can close some, or all, of the gaps in your Original Medicare coverage. In other words, these plans are designed to reduce your out-of-pocket spending in Medicare. There are 10 standardized Medigap plans, each identified by letters: A, B, C, D, F, G, K, L, M, and N. There are also high-deductible versions of plans F and G. Each plan covers a different mix of your out-of-pocket costs under Original Medicare. Medicare Supplement benefits are standardized across 47 states: Minnesota, Wisconsin, and Massachusetts have their own regulations. That said, this Medicare Supplement guide will focus on the 10 standardized Medigap plans. Below is a breakdown of what each Medigap plan covers. Medigap Plan A The most basic Medigap plan is Plan A, which covers your: Part A coinsurance/copay for an additional 365 days in the hospital (beyond Original Medicare) Part B coinsurance/copayments First three pints of blood Part A hospice care coinsurance/copay Medigap Plan B Plan B offers a little more coverage, including everything offered by Plan A, plus the Part A deductible. Medigap Plan C Plan C covers what Plans A and B do, plus the following: Skilled nursing facility coinsurance/copayments Part B deductible Emergency foreign travel Plan C is no longer available for people who became eligible for Medicare after 12/31/2019. But if you became eligible for Medicare before that date, Plan C remains available to you. Medigap Plan D Plan D covers everything covered by Plan C, except for the Part B deductible. Medigap Plan F Plan F is the most comprehensive Medicare Supplement Insurance plan available. It closes many gaps, covering everything Plan C covers, plus Part B excess charges. But like Plan C, Plan F isn’t available to those who became eligible for Medicare after 12/31/2019. Medigap Plan G Plan G is the next-most comprehensive plan. Plan G covers all of the gaps except for the Part B deductible. Medigap Plan K Plan K has an unusual structure, covering 50% of many of the gaps. Plan K covers: 100% of Part A coinsurance/copays for up to 365 additional hospital days 50% of Part B coinsurance/copays 50% of the cost of your first three pints of blood 50% of Part A hospice care coinsurance/copays 50% of Skilled Nursing Facility care coinsurance 50% of the Part A deductible Out-of-pocket maximum of $6,220 (2021 amount) Plan K does not cover: Part B deductible Part B excess charges Foreign travel Medigap Plan L Plan L covers 75% of a range of items (i.e. Part A deductible, Part B coinsurance, first three pints of blood, Part A hospice copayment, Part A skilled nursing coinsurance). Plan K, by comparison, covers those same items, but only at 50%. The out-of-pocket maximum for Plan L is $3,110 in 2021. Medigap Plan M Medigap Plan M covers everything that Plan D covers, except that Plan M only covers 50% of the Part A deductible. Medigap Plan N Medigap Plan N covers everything plan D does, with the exception of a copayment of up to $20 for Part B services and up to $50 for emergency room visits (this is waived if you’re admitted as an inpatient). What Services Are Covered Under Medicare Supplement? All of the services and procedures covered by Original Medicare are covered by Medicare Supplement, depending on which standardized plan you choose. Original Medicare Part A All Medicare-approved services and procedures covered by Medicare Part A are eligible, including: Inpatient hospital stays Skilled nursing care (non-custodial only) Hospice care Home health care Original Medicare Part B Medicare Supplement insurance can help pay for your share of costs under Medicare Part B, including: Doctor’s visits Lab work and diagnostics Vaccines Durable medical equipment Physical therapy Some cancer treatments Extra Benefits Provided By Medigap Plans Some Medicare Supplement insurance plans offer additional benefits beyond what Original Medicare covers. However, these benefits are not guaranteed and can change from year to year. Some of the most common extra Medigap benefits include: Gym memberships and fitness programs like SilverSneakers Discounts on vision, hearing, and prescription drugs Access to nurse hotlines Note: Insurance companies are not required to offer extra benefits, so some do not. Who Is Eligible For Medicare Supplement? As a basic rule, you must be eligible for Medicare Parts A and B in order to qualify for Medigap plans. However, Medicare Supplement eligibility is also subject to federal and state laws. This means that the federal government imposes basic regulations, and some states add additional requirements. For instance, federal law requires that Medicare Supplement insurance plans offer coverage to people age 65 and older. However, some states require Medicare Supplement insurers to allow people younger than age 65 to enroll, if they’re eligible for Medicare. We’ll be reviewing some of the costs of Medicare Supplement in the next section, but for now, know that Medigap coverage is usually better for those age 65 and up because premiums for people under age 65 can be expensive. Since Medigap is designed to work with Original Medicare, you must remain enrolled in Part A and Part B at all times. Medicare Supplement Costs While Medicare Supplement insurance is designed to lower your out-of-pocket spending, there are certain costs that you’ll still have to pay. Your specific costs will vary based on which standardized plan you choose, but you can expect to pay some or all of these costs: Part B premium (paid to Social Security regardless of which Medigap plan you choose) Monthly premium for Medigap coverage (paid to your insurance company and can increase over time) Deductibles (Part A and/or B, or some percentage of the Part A deductible) Coinsurance (whatever amount your Medigap plan doesn’t cover) Example: Let’s say you have Medicare Supplement Plan G. Your monthly premium at age 65 might be $135 per month, in addition to your Part B premium of $148.50. You go to the doctor in January and have bloodwork, imaging (x-ray, or MRI), and a minor outpatient surgery performed. And your total Medicare-approved costs are $600. Since plan G doesn’t cover the Part B deductible, you must pay the first $203 for Part B expenses. Your Medigap plan will then cover the rest of your bills. And you won’t pay out of pocket for any other Medicare-approved services for the rest of the year. When Are The Medicare Supplement Enrollment Periods? There are two types of enrollment into Medicare Supplement plans: Guaranteed issue Medically underwritten (We’ll cover these more in depth in a bit). You’ll get a Medigap Open Enrollment Period when you meet these two criteria: You are age 65, and You are enrolled in Medicare Part B Your open enrollment period won’t start until both of these conditions are true. So if you work beyond age 65 and delay enrollment in Part B, your Medigap Open Enrollment Period won’t begin until you actually enroll in Part B, even if it’s after your 65th birthday. On the other hand, if you enter Medicare before you turn 65 (say, due to disability), your open enrollment period doesn’t begin until you actually turn 65. Whenever your Medicare Supplement Open Enrollment Period begins, it will last for six months. You can enroll in any Medicare Supplement insurance plan available in your state during this time, and your enrollment is guaranteed. Note: Your Medigap Open Enrollment Period is not the same as the Medicare Open Enrollment Period. Medicare Supplement Guaranteed Issue With guaranteed issue, you can’t be declined coverage, charged a higher premium based on your health status, or be subject to a waiting period. You may have the opportunity to get Medigap coverage (or switch from one plan to another) on a guaranteed issue basis in other limited situations, including when: You permanently move out of your plan’s service area. You leave your first Medicare Advantage plan after trying it out for 12 months or less (Trial Right). Your Medicare Advantage plan loses, or fails to renew, its contract with CMS. You lose certain employer or retiree coverage. If you don’t qualify for guaranteed issue, you’ll have to apply for a medically-underwritten Medigap policy. Medical Underwriting If you apply for Medicare Supplement insurance outside of your Open Enrollment period and you don’t qualify for a guaranteed issue period, you’ll be subject to medical underwriting. This means that you’ll answer questions about your health on your application. It also means you can be declined coverage for health reasons, or you can be charged a higher premium. A plan can also impose a waiting period for services relating to a pre-existing condition. This waiting period can be up to six months. For these reasons, you are better off getting Medigap when you’re first eligible, during your Open Enrollment Period. How Does Medicare Supplement Work with Other Insurance Plans? Medicare Supplement insurance is designed to work with Original Medicare. You cannot combine Medigap coverage with a Medicare Advantage plan. However, you can get drug coverage from a standalone Medicare Part D Prescription Drug Plan. Medicare Supplement & Dual Eligibility If you’re on Medicare and Medicaid at the same time (often called dual eligibility), you may not be able to get Medicare Supplement Insurance, except in very limited circumstances. What’s The Difference Between Medicare Advantage And Medicare Supplement Plans? While both of these Medicare plan types are offered through private insurance companies, they have several major differences. Medicare Advantage plans are an alternative to Original Medicare. Meanwhile, Medigap plans are designed to work with Original Medicare. You’ll stay in Parts A and B, and Medigap supplements your coverage by paying for some or all of your out-of-pocket costs. Many Medicare Advantage plans offer prescription drug coverage. But no modern Medicare Supplement plan (after 2006) provides drug coverage. Instead, you’ll need to combine your Medigap coverage with a Prescription Drug Plan. Most Medicare Advantage plans are either HMOs or PPOs that use a network of doctors and facilities. Medicare Supplement insurance, though, retains all of the flexibility of Original Medicare. This means you can see any provider in the nation that takes Medicare patients. There are no plan networks, and you generally don’t need a referral to see specialists. What Are The Pros And Cons of Medicare Supplement Plans? Medicare Supplement plans are very useful for lowering your out-of-pocket Medicare costs, but they’re not for everyone. Here are some pros and cons. Pros of Medicare Supplement Insurance Maximum flexibility (no network or referral restrictions). More comprehensive plan with less out-of-pocket expenses than Original Medicare or Medicare Advantage (depending on which Medigap policy you choose). More likely to provide coverage while you’re travelling outside of the United States. Cons of Medicare Supplement Insurance More expensive than Original Medicare or Medicare Advantage (initial premiums are usually higher, and they rise over time). You must also get drug coverage in a separate Prescription Drug plan, which adds costs. Medicare Supplement Plan Comparison Chart Click here to compare 2021 Medicare Supplement plans and get a complete breakdown of benefits, coinsurance costs, and deductible amounts. Medicare Supplement Guide Conclusion In this Medicare Supplement guide, we’ve reviewed the basics of coverage and given examples of how Medigap plans work. Overall, Medicare Supplement plans can be a great way to lower or eliminate your out-of-pocket healthcare costs under Original Medicare. And these plans are especially good for those who can comfortably afford the premiums, don’t want network or referral restrictions, or travel outside of the U.S. frequently. If you’re looking for Medicare coverage that offers more flexibility, we can help you find the right Medicare Supplement Insurance plan to fit your lifestyle. Call 800-620-4519 (TTY 711) to speak with one of our licensed insurance agents about your Medicare Supplement plan options.

The transition from 2020 to 2021 offers many opportunities for people on Medicare. Whether you use Original Medicare, Medicare Advantage, or Medicare Supplement Insurance, you’ll find plenty of changes on the horizon. In this guide to 2021 changes to Medicare, we’ll review what happened during 2020, and dive into the Medicare changes and opportunities for 2021. Review of 2020 Medicare Changes To say that a lot happened in 2020 is a cosmic understatement. The big disruptor, of course, was COVID-19. The pandemic led to some sizable changes in the Medicare program. Some of the highlights from 2020 include: Medicare Supplement (Medigap) Plans C, F, and High Deductible F (HDF) were no longer available to newly-eligible beneficiaries as of 1/1/2020. For the second year in a row, the infamous “Donut Hole” was closed for Part D drug plans. Medicare expanded access to telehealth/virtual doctor appointment services. Many insurance companies, including the major Medicare Advantage plan sponsors, reduced or waived copayments for COVID-19-related care. Other than the COVID-19-related changes, the loss of Medigap Plans C, F, and HDF was probably the biggest change to Medicare for 2020. Those plans became unavailable for beneficiaries who first became eligible after 12/31/2019. This leaves Plan G as the most comprehensive Medigap plan available to all new Medicare beneficiaries. This plan will cover 100% of your Medicare deductibles, copayments, and coinsurance except for the Part B deductible. You’re responsible for the first $198 in Part B expenses for 2020. 2021 Medicare Costs 2021 Medicare Part A Costs Most people don’t pay a Part A premium because they paid Medicare taxes while working. So if you don’t get premium-free Part A, you pay up to $471 each month. Hospital Stays In 2021, you pay: $1,484 deductible per benefit period. $0 for the first 60 days of each benefit period. $371 per day for days 61–90 of each benefit period. $742 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime). Skilled Nursing Facility Stays In 2021, you pay: $0 for the first 20 days of each benefit period. $185.50 per day for days 21–100 of each benefit period. All costs for each day after day 100 of the benefit period. Medicare Part B Costs Most people will pay the Part B premium of $148.50 for 2021, but Social Security can share your exact Part B premium amount. You can also refer to the 2021 Medicare Costs guide from Medicare.gov for a complete breakdown of Medicare Part B premiums. Medicare Advantage Plan Changes For 2021 Many of the most exciting and notable 2021 changes to Medicare encompass Medicare Advantage plans. These plans, which are also known as Part C plans, are a private insurance alternative to Original Medicare. Medicare Advantage And ESRD The single biggest piece of news about Medicare Advantage for 2021 relates to those with End Stage Renal Disease (ESRD), also known as kidney failure. Beginning 1/1/21, Medicare beneficiaries with ESRD will be able to get coverage through Medicare Advantage plans. Prior to 2021, Medicare Advantage plans were generally able to exclude people with ESRD. This left ESRD patients in a tough spot, since under Original Medicare Part B, they paid 20% of the cost of dialysis. And this can get expensive very quickly since there was no out-of-pocket cap on their expenses under Original Medicare. Everyone with ESRD will now be able to get Medicare Advantage coverage. This may not reduce the amounts ESRD patients pay early in the year, since many Medicare Advantage plans charge a 20% coinsurance for dialysis as well. However, the great news for ESRD patients is that every Medicare Advantage plan has an annual out-of-pocket maximum. So once ESRD patients hit their annual spending caps, they’re not required to pay for any more medical expenses the rest of the year. Medicare Advantage And Hospice Benefits Another 2021 change to Medicare Advantage is a small test program for delivering hospice benefits. Historically, hospice coverage was provided by Original Medicare, even if you were in a Medicare Advantage plan. Starting in 2021, 53 Medicare Advantage plans across the country will provide hospice and palliative care. This is a very small number of plans, so it won’t affect most people at this point. However, if the test program works, you may see more Medicare Advantage plans offering this benefit in the future. Extra Benefits Through Medicare Advantage Plans Medicare Advantage is the subject of other big 2021 changes to Medicare. Beginning in 2021, additional benefits will be available. Extra benefits are benefits offered by Medicare Advantage plans that are not covered by Original Medicare. Examples may include: Dental coverage Vision and hearing coverage Chiropractic care For 2021, new Medicare benefits will be available. Many of them are designed to help you get care at home, and lend some support to caregivers. The new extra Medicare benefits in 2021 available through some Medicare Advantage plans include: Caregiver support Adult day health services In-home support services Therapeutic massage Acupuncture (for chronic low back pain only – this is also now covered under Original Medicare) But these extra benefits are not required or guaranteed. Instead, they are optionally provided by Medicare Advantage plans, and they can be changed or discontinued from year to year. Still, the availability of adult day health services and caregiver support will be beneficial for many of those on Medicare who struggle to care for themselves. For 2021, Medicare Advantage plan premiums are lower on average than in the past. In fact, the average Medicare Advantage plan premium is expected to be 11% lower in 2021 than in 2020. For 2021, the average Medicare Advantage plan premium will be $21 per month. On the other hand, the annual out-of-pocket maximum for in-network services is rising to $7,550. This is the highest it can be. Many plans will continue to offer lower out-of-pocket maximums. 2021 Changes To Medicare Drug Plans The other big news in 2021 changes to Medicare is the Part D Senior Savings Model. This model program, which is essentially a five-year test, will cap the price of a 30-day supply of many insulins at $35. Under this new program for 2021, beneficiaries will have access to about 1,700 MAPDs (Medicare Advantage plans with Part D drug benefits) and stand alone Prescription Drug Plans that cap the cost of insulin. Another great detail about this program is that the cost for insulin won’t change, even if you enter the coverage gap during the year. You’ll still pay the same capped copayment. In addition, you won’t have to meet a deductible to get the $35 copay price. While not every plan has chosen to participate, CMS expects there to be at least one plan in all 50 states, the District of Columbia, and Puerto Rico. Given the effect of diabetes on the kidneys, patients with ESRD are in position to grab some great new benefits for 2021 and beyond. How To Prepare For 2021 Changes To Medicare For starters, you should make note that we expect a slight increase in Original Medicare costs, for 2021. Though we still don’t know what they’ll be, we expect there to be some increase in the Part B premium, even with the caps that will limit the total rise in costs. You can expect the same thing with deductibles. As with a normal Medicare Open Enrollment Period, also called the Medicare Annual Election Period (AEP), you should review your current coverage to see if switching plans for 2021 makes sense. New plans are available each year, so Medicare beneficiaries have until December 7 of each year to make a change to their plans for the following year. When comparing plans during the Medicare Open Enrollment Period, be sure to look at: The monthly premium (if any) Annual deductibles (if any) Cost structure, like copays and coinsurance amounts for Medicare Advantage and Prescription Drug Plans Out-of-pocket maximum amounts for Medicare Advantage plans Networks of doctors and medical facilities for Medicare Advantage plans Tip: It’s important to not just jump into a new plan because it has one appealing feature. You want to make sure that your doctors accept any new plan and that your current medications will be covered. If you use insulin, you may want to consider one of the standalone Prescription Drug Plans or MAPD plans participating in the Senior Savings Model program, if available. It’s estimated that those on insulin could save more than $400 per year on average. Besides savings on insulin through the Senior Savings Model program, ESRD patients who don’t currently have Medicare Advantage plan coverage should consider it for 2021. Moving to Medicare Advantage could help ESRD patients in 2 different ways: Moving from Original Medicare to Medicare Advantage Moving from Medicare Supplement Insurance to Medicare Advantage In the first case, you can take advantage of the out-of-pocket spending cap that a Medicare Advantage plan can offer. The out-of-pocket cap could be a real benefit for ESRD patients since it’s not only dialysis treatments that could count against the Medicare out-of-pocket maximum (OOPM). All spending on Medicare-approved services and procedures count towards the OOPM, so an ESRD patient might “max out” their spending during 2021 and get substantial relief the rest of the year. On the other hand, if you have ESRD and are currently covered by a Medigap (Medicare Supplement) plan, you might be able to save money on your monthly premium by switching to Medicare Advantage. And you might save money or come close to breaking even by switching from Medigap to Medicare Advantage, depending on the premiums and out-of-pocket maximums for plans in your area. Just be sure you run the numbers before making this move. Note: It can be difficult to get Medicare Supplement insurance coverage back after you move away from it. You might have to go through medical underwriting, which means you may be declined coverage as an ESRD patient with a pre-existing condition, unless you qualify for a guaranteed issue period. Due to the complexities of Medigap coverage, it’s a great idea to talk to a licensed insurance agent to see if switching to Medicare Advantage is a good idea. Get Help With Medicare If you still have questions about 2021 changes to Medicare and how they impact you, call 800-620-4519 to get help from one of our licensed insurance agents. Or you can try our free Medicare plan comparison tool to find Medicare plans in your area. There is no obligation to enroll in a plan.

The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Open Enrollment or the Medicare Annual Election Period, starts on October 15. If you’re eligible for Medicare, you’ll probably receive lots of information over the next few weeks and throughout AEP. And this information can be overwhelming. But we’re here to help you with this useful Medicare guide. So let’s dive into the Medicare Annual Enrollment Period, what it is, how to prepare, and what you can do during AEP. Then, we’ll cover some tips for choosing the right Medicare plan for your healthcare needs. What is the Medicare Annual Enrollment Period? The Medicare Annual Enrollment period happens each year from October 15 to December 7. During this time period, you have the option to make changes to your Medicare coverage. Your new coverage would then take effect January 1. But if you’re satisfied with your current Medicare coverage, you don’t have to take any action during Medicare AEP. There are no penalties involved if you do nothing. Medicare plan details can change annually, though, so it’s wise to review your Medicare coverage each year. We’ll cover more on this shortly. What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period? The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods. The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage. What Changes Can I Make During the Medicare Annual Enrollment Period? The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time. But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period: Change from Original Medicare to a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Disenroll from your Medicare Advantage plan and go back to Original Medicare. Change from one prescription drug plan (Medicare Part D) to another. Enroll in a prescription drug plan. Cancel your prescription drug coverage. 5 Tips to Prepare for the Medicare Annual Enrollment Period There are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs. 1. Mark Your Calendar This may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan. You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1. Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities. 2. Review Your Medicare Annual Notice of Change You’ll receive lots of information over the next month or so, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read. Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1, 2022. Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year. While evaluating your current Medicare plan, you may want to ask yourself questions like: Did the plan cover the services I needed? Did I use out-of-network providers? Did I spend more out of pocket than I originally anticipated? Has something changed with my health (new diagnosis, new prescriptions, etc.)? The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any). Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company. 3. Make A List of What’s Important To Your Health Keeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period. Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any. We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget. For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs. Another thing to consider is whether or not you have an elective surgery planned for 2022. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan. 4. Check Your Plan’s Drug Formulary Your Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance customer service representative to see if your prescription drugs will be covered for the 2022 plan year. If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them. 5. Talk To Your Doctor Another “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period. So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year. What Are The Benefits of A Medicare Advantage Plan? Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or disenroll from Medicare Advantage plans during AEP. Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. While Original Medicare offers you a number of benefits, it may not cover health and medical services you might need. Medicare Advantage plans might be an attractive option because some plans include extra benefits that could save you money. These benefits may include: $0 monthly plan premiums Prescription drug coverage Dental, vision and hearing coverage Access to fitness programs Rides to medical appointments Help managing certain chronic conditions (congestive heart failure, COPD, diabetes) Medicare Advantage plans may also cover a number of in-home services to keep you safe and healthy at home, especially during these uncertain times due to the coronavirus pandemic. These benefits may include: Telemedicine services (also known as telehealth) Home-delivered meals Home-delivered prescriptions Private home aides Another potential perk of Medicare Advantage plans is that they include annual out-of-pocket maximums, which means your costs will be capped. But it’s important to note that Medicare Advantage plans vary by county and zip code. One way to compare Medicare Advantage plans and get Medicare quotes is through our easy-to-use quoting tool. Just enter your zip code to see Medicare Advantage plans that are available in your area. More Medicare Options for People With Kidney Failure One major change happening for the 2021 plan year is that people with End Stage Renal Disease (ESRD), also known as kidney failure, will now have the option to enroll in a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) estimates that more than 80,000 people living with ESRD will enroll in a Medicare Advantage plan by 2026 - a significant increase of 63%. Medicare Advantage plans may provide ESRD patients with better coverage compared to Original Medicare. Many Medicare Advantage plans include access to coordinated care, which helps ensure all your doctors are on the same page regarding your treatment. What Are Medicare Advantage Special Needs Plans? Medicare beneficiaries also have access to Medicare Advantage plans designed for unique needs. These are called Special Needs Plans (SNPs). Like other types of Medicare Advantage plans, SNPs vary based on location. You may be able to switch to a Special Needs Plan during the Medicare Annual Enrollment Period if one of these situations apply: You’ve been diagnosed with a serious medical condition by a doctor. There are SNPs for certain chronic conditions, such as kidney and heart failure, diabetes and dementia. Services are tailored to the specific condition the plan covers. You need or have received skilled nursing care for at least 90 days at your home or at an institution, such as a nursing home or long-term care facility. You qualify for both Medicare and Medicaid. Medicaid eligibility is based on your income and assets. If you qualify, Medicaid will pay most of the costs for your Medicare Special Needs Plan. Special Needs Plans include all the same benefits as regular Medicare Advantage plans, plus some expanded coverage. For example, all Special Needs Plans must include prescription drug coverage, which is usually tailored to the specific condition the plan covers. Although most regular Medicare Advantage plans include prescription drugs, some do not. Some SNPs also provide a care coordinator to help you stay on track with your doctor appointments and treatment plan. What If My Income Has Changed in 2021? The coronavirus crisis has affected the financial well-being of many Americans, including those on Medicare. If you’ve experienced a decrease to your income or assets, the Medicare AEP 2020 season is a great time to switch to a more affordable plan. If you have limited income, you might qualify for extra savings on Medicare costs through these programs: Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office. Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP. How To Enroll During the Medicare Annual Enrollment Period To enroll in an eligible plan during the Medicare Annual Enrollment Period, you can visit Medicare plan comparison websites like healthinsurance.com or Medicare.gov. Or, you might prefer to talk to a licensed insurance agent to get help enrolling in Medicare. Whatever option you choose, be sure to have 3 items handy before you enroll in a plan or make changes to your current plan during AEP: Your Medicare card Your list of doctors, prescriptions and what is important to your health Pen and paper to take notes More on Medicare Eligibility Medicare is a federal health insurance program developed in 1965. To be eligible for Medicare you must meet one of the following criteria: You are age 65 or older You are under age 65, disabled, and have been receiving Social Security disability benefits for at least 24 months. You have End Stage Renal Disease or Lou Gehrig’s Disease (also known as Amyotrophic Lateral Sclerosis or ALS). You can visit Medicare.gov to see if you’re eligible for Medicare and calculate your estimated premiums for certain plans. How To Find A Medicare Advantage or Prescription Drug Plan You don’t have to go it alone when choosing a Medicare Advantage plan or Prescription Drug Plan. We’re here to help you navigate the Medicare Annual Enrollment Period through a number of ways, including: Our Medicare plan comparison tool Our online Medicare resources You can also call 800-620-4519 to speak to a licensed insurance agent about your options. You can also read through some of our articles to learn more about Medicare. Medicare 101 Guide Top Medicare Frequently Asked Questions Understanding Original Medicare vs. Medicare Advantage