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 (
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
) 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
(3) You cannot
add a stand-alone Medicare Part D plan
) if you are enrolled in a Medicare Advantage plan
that does not include drug coverage (MA) –
unless your Medicare Advantage plan is a PFFS
(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
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
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
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
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
, 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
(4) More 2021 MAPDs have a $0 premium and $0 drug deductible ($0/$0
Thirty percent (30%) of all 2021 Medicare Advantage plans that include prescription
drug coverage (MAPD
s) 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.
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
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
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
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 (
) 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
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
(9) Most Medicare Advantage plans are
The majority (around 67%) of 2021 Medicare Advantage plans will be Local HMO
s (Health Maintenance Organizations). However, there will be a 24% increase in 2021
(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
(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.
2021, Medicare Medical Savings Accounts (MSA
s) 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
) for their drug coverage.