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Reminder of three important 2020 changes to Medicare Part D and Medicare Advantage plans that can affect your 2022 healthcare coverage

Category: Annual Medicare Plan Changes
Published on 2021-09-01 14:09:08

As a reminder, don’t forget that there were some key changes to the Medicare Part D and Medicare Advantage programs in 2020 and these changes are worth emphasizing as we head toward the 2022 annual Open Enrollment Period (AEP) and you may be considering your 2022 Medicare plan coverage.

(1)  Medicare Advantage plan now accept members with ESRD or kidney failure.

Even if you are a Medicare beneficiary suffering from End-Stage Renal Disease (ESRD), you can join a Medicare Advantage plan.  This new-in-2021 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.  

Please note, we now have more Medicare Advantage plan coverage details online within our Medicare Advantage Plan Finder (https://MA-Finder.com), including dialysis cost-sharing.

(2)  Many Medicare drug plans cover insulin for only $35 per month.

As part of the Medicare Part D "Senior Savings Model", about 30% of 2021 Medicare prescription drug plans 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 (or Donut Hole).

The coverage of insulin at a maximum copay of $35 per month can be provided by: (1) stand-alone Medicare Part D plans (PDPs) with enhanced alternative features, (2) Medicare Advantage plans that include drug coverage (MAPDs), and (3) Chronic Illness or Institutional Special Needs Plans (SNPs).  You can click here to learn more.

We updated our Medicare Part D Plan Finder (https://PDP-Finder.com) and our Medicare Advantage Plan Finder (https://MA-Finder.com) to include information about a plan’s participation in the Senior Savings Model.

For example,  we have a "filter" at the top of the Plan Finder search box so you can check "Insulin $35 or less plans" to only see Medicare plans that include the Senior Savings Model (in this example, 10 Medicare Part D plans in Florida).


Example of Q1Medicare Plan Finder showing plan covering insulin under SSM
For more information about the $35 insulin coverage and examples of how to find Medicare Part D drug plans with $35 insulin coverage, please see our Frequently Asked Question "How will I know if my Medicare Part D drug plan covers insulin for $35 or less?"

(3)  Medicare Advantage plans can increase their maximum out-of-pocket limit (MOOP) to $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).

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.

Key Take-Away:
Be prepared to read your September 2021 Annual Notice of Change Letter (ANOC) to see if your 2022 MOOP is increasing – this may help you determine how much you need to budget in 2022 for in-network Medicare Part A and Medicare Part B coverage.

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.