Analysis of the 2021 Medicare Advantage Plan Landscape
Annual Medicare plan changes · published Oct 1, 2020
The 2021 Medicare Advantage plan information recently released by the Centers for Medicare and Medicaid Services (CMS) shows that Medicare beneficiaries can expect a few more Medicare Advantage plans in most areas; continued low monthly premiums; more Medicare Advantage plans offering some Donut Hole coverage; and increased out-of-pocket spending limits ( MOOP).
First, here are five important points about Medicare Advantage plans
(1) A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization coverage), Medicare Part B (out-patient and physician coverage), and may include prescription drug coverage (MAPD) or can be offered without drug coverage (MA).
(2) A Medicare Advantage plan may include supplemental healthcare benefits such as vision, dental, or fitness coverage. A Medicare Advantage plan may also include non-health related benefits such as meal delivery and non-health related transportation.
(3) You cannot add a stand-alone Medicare Part D plan (PDP) if you are enrolled in a Medicare Advantage plan that does not include drug coverage (MA) – unless your Medicare Advantage plan is a PFFS or MSA plan.
(4) Starting in 2021, even if you are a Medicare beneficiary suffering from End-Stage Renal Disease (ESRD), you can join a Medicare Advantage plan. This new rule also applies to employer/union Medicare plans (EGHP); but, depending on your state, may not include Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs). You can click here for more details.
(5) A Medicare Advantage plan is not a Medicare Supplement (Medigap plan) and cannot be used with a Medicare Supplement.
Here are highlights of the 2021 Medicare Advantage plan landscape:
(1) The total number of 2021 Medicare Advantage plans will increase.
Across the country, there will be 13% more Medicare Advantage plans offered in 2021 – with 4,568 Medicare Advantage plans (MAs and MAPDs) available, as compared to 4,047 Medicare Advantage plans offered in 2020. You can click here to read more about the number (and type) of 2021 Medicare Advantage plans.
As in past years, around 92% of 2021 Medicare Advantage plans will include prescription drug coverage (MAPDs). You can click here to read more about the annual changes in the number of Medicare Advantage plans with, or without prescription drug coverage.
(2) Even with more Medicare Advantage plans offered in 2021, many counties will see significant changes in their Medicare Advantage plan landscape.
When viewed in detail, many 2020 Medicare Advantage plans will be terminated in 2021 or merged into other 2021 plans. As an example, Monroe County, PA will lose 11 of the 50 Medicare Advantage plans that are currently offered in 2020, however 7 new 2021 Medicare Advantage plans will be introduced. You can see more 2021 Medicare plan changes using our 2020/2021 Medicare Advantage plan compare tool: MA-Compare.com/2021. You can click here to read more about changes in Medicare Advantage plan availability across the country.
(3) Monthly 2021 Medicare Advantage plan premiums will remain low.
As in past years, close to 83% of all 2021 Medicare Advantage plans will have a monthly premium under $50, with around 48% of the 2021 Medicare Advantage plans having a $0 premium. You can click here to read more about changes in Medicare Advantage plan premiums and see a chart of how plan premiums have changed since 2017.
(4) More 2021 MAPDs have a $0 premium and $0 drug deductible ($0/$0 plans).
Thirty percent (30%) of all 2021 Medicare Advantage plans that include prescription drug coverage (MAPDs) will have a $0 premium and $0 drug coverage deductible (up from 26% in 2020). You can click here to read more about the 2021 $0/$0 Medicare Advantage plans with prescription drug coverage.
(5) About 29% of all 2021 Medicare Advantage (MAPD) plans will offer low-cost Insulin coverage.
As part of the new CMS "Part D Senior Savings Model", twenty-nine percent of all 2021 Medicare Advantage plans with prescription drug coverage will offer different types of insulin at a maximum co-pay of $35 per month throughout all phases of your drug coverage: deductible, initial coverage, and the Coverage Gap (Donut Hole). These plans show the text “insulin coverage $35 or less” in our Medicare Advantage Plan Finder (MA-Finder.com). You can click here to learn more about low co-pay insulin coverage.
(6) The Donut Hole “closed” in 2020, but you still may pay more for your drugs if you reach the 2021 Coverage Gap.
The 2021 Donut Hole discount remains 75% for all formulary medications -- you pay 25% of retail for both brand-name and generic formulary medications purchased while in the Coverage Gap. Remember, although the Donut Hole closed in 2020, this phase of your Medicare Part D coverage did not go away and you may pay more for your medications if you enter the Donut Hole. You can click here to read more on the 2021 Donut Hole.
(7) Slightly more 2021 MAPDs will offer supplemental Donut Hole coverage.
Almost 40% of MAPD plans will offer some level of additional gap coverage beyond the Donut Hole discount. For brand-name drug purchases in the Donut Hole, the 70% brand-name drug manufacturer’s Donut Hole discount is applied to this supplemental gap coverage.
(8) Slightly more 2021 Medicare Advantage plans will offer a lower Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit.
CMS will allow 2021 Medicare Advantage plans to increase their Maximum Out-of-Pocket limit ( MOOP) to $7,550 from the 2020 MOOP limit of $6,700. The $7,550 MOOP applies to in-network Medicare Part A and Medicare Part B eligible medical cost-sharing. Please note that local and regional PPO Medicare Advantage plans can have a combined maximum MOOP of $11,300 (in-network and out-of-network).
The number of 2021 Medicare Advantage plans having the statutory maximum MOOP will decrease to 12% of all 2021 Medicare Advantage plans. However 23% of 2021 Medicare Advantage plans will have a MOOP of either $7,550 or $6,700. The number of Medicare Advantage plans with a MOOP at, or under, $3,450 will decrease to 17% of all 2021 Medicare Advantage plans. You can click here to learn more about the Maximum Out-of-Pocket Limits for 2021 Medicare Advantage plans and how MOOP limits have changed since 2017.
And this means: You may see your Medicare Advantage plan covered healthcare expenses increase slightly, but Part A & Part B expenses will not exceed $7,550 for in-network cost-sharing.
(9) Most Medicare Advantage plans are HMOs.
The majority (around 67%) of 2021 Medicare Advantage plans will be Local HMOs (Health Maintenance Organizations). However, there will be a 24% increase in 2021 Local PPO (Preferred Provider Organization) Medicare Advantage plans. You can click here to read more about the different types of 2021 Medicare Advantage plans.
(10) More 2021 Medicare Advantage Special Needs Plans (SNPs).
Although about 15% of the 2020 Medicare Advantage Special Needs Plans (SNPs) will be discontinued in 2021, plan losses will be offset by the introduction of new SNPs, resulting in a 14% actual increase in the total number of 2021 SNPs, with a 23% increase in chronic illness SNPs (c-SNPs). The vast majority of SNPs remain Dual-Eligible (D-SNPs) (61%). You can click here to learn more about 2021 Medicare Advantage Special Needs Plans and how the SNP landscape has changed since 2018.
(11) 2021 Medicare Medical Savings Accounts (MSAs) will be more widely available.
In 2021, Medicare Medical Savings Accounts (MSAs) will be available in 38 states (2,337 counties) across the country. In 2020, MSAs were available to Medicare beneficiaries in only 1,883 counties across 29 states. Unlike other Medicare Advantage plans, MSAs are made up of a high-deductible health plan and a medical savings account funded by an annual tax-free deposit. MSA members can use the medical savings account to pay for healthcare costs before the health plan deductible is met. MSA members can enroll in any available stand-alone Medicare Part D plan (PDP ) for their drug coverage. Need an overview of Medicare Advantage plan options in your area?
To get you started with your review of 2021 Medicare Advantage plans available in your area, just click on your state and then click on your county name: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY .
You can also use our 2021 Medicare Advantage plan finder (MA-Finder ) to review plans in your area -- found directly at: MA-Finder.com/2021. The MA-Finder currently displays the plan premium, prescription deductible, supplemental Gap or Donut Hole coverage, and Medicare Part A and Part B Maximum Out-of-Pocket limit (MOOP). The 2021 Medicare plan drug tier cost-sharing, health coverage information, formulary information, and star ratings are coming soon.
You can use our 2020/2021 MA-Compare tool to see how your 2020 Medicare Advantage plan is changing in 2021. Our Medicare Advantage comparison tool can be found directly at: MA-Compare.com/2021.
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