people are reluctant to change their Medicare Part D or Medicare
Advantage plan coverage year-to-year. However, millions of Medicare
beneficiaries will see significant changes in their 2021 Medicare costs
If you are staying with your current 2020 Medicare plan into next year, please be sure to review
your plan’s Annual Notice of Change (ANOC) letter and use this list to
help you look for important coverage changes that might impact your 2021
And remember, starting in 2021
there are no health-related questions should you decide to change your
Medicare Advantage plan or Medicare prescription drug plan (however,
Medicare Advantage Special Needs Plans require
that you meet the plan’s specific “need”).
(1) Your 2020 Medicare plan may no longer be offered in 2021.
Over 1.1 million
people are currently enrolled in a 2020 Medicare Advantage plan (MA
) that will no longer be available in 2021. The counties seeing the largest number of terminated 2021 Medicare Advantage plans are: Monroe County, PA
losing 11 plans and Lackawanna County
and Luzerne County
in PA both losing 10 plans. You can click here
to read more in our article about Medicare plans being discontinued in 2021.
(2) You may be automatically reassigned to a different 2021 Medicare plan.
Over 1.3 million
people enrolled in 2020 Medicare Advantage plan and an additional 187,000
people enrolled in a 2020 stand-alone Medicare Part D plan will be automatically “crosswalked
” or merged into another 2021 Medicare plan. For example, members of the 2020 Texas Mutual of Omaha Rx Value (PDP
) will be automatically reassigned
to the 2021 Mutual of Omaha Rx Plus (PDP). You can click here to read more
about Medicare plan mergers or consolidations.
(3) Your 2020 Medicare plan may change its name.
Over 1.8 million
people are currently enrolled in a 2020 Medicare Part D plan that is changing names in 2021 –
the plan ID (example: S7694-014) stays the same, but the plan now has a
different name and possibly different features. For example, over 700,000
members of the 2020 EnvisionRxPlus (PDP)
will find their plan’s name changing to the 2021 Elixir RxSecure (PDP)
with a similarly-sized formulary, changes in cost-sharing for Tier 3
and Tier 4, and higher premiums (for example, members in Ohio will see a
90% premium increase
). You can click here to read more
about Medicare Part D plan name changes.
(4) Your monthly 2021 Medicare Part D premium may be increasing.
Almost 3 million
Medicare beneficiaries will see their monthly 2021 Medicare Part D premium increase 20% or more. Over 900,000 people
currently enrolled in a 2020 Part D plan will see their plan premium double
in 2021. The good news is about 6.5 million people will see a 2021 premium decrease of 10% to 63%
You can click here to see
examples of 2020 Medicare Part D plans that are increasing their 2021
premium. Please keep in mind that, in addition to lower-premium Part D
plans, there may be low- or $0 premium
Medicare Advantage plans (MAPDs) available in your area.
(5) Your plan’s Initial Deductible may increase.
The standard 2021 Medicare Part D deductible
will increase to $445, up from the standard 2020 deductible of $435. Over 1.6 million
Medicare beneficiaries are enrolled in a Part D plan having an even larger initial deductible increase – ranging from $20 to $190
. You can click here to read more
about initial deductible changes and examples of Medicare Part D plan’s increasing their 2021 initial deductible.
(6) Your 2021 Medicare plan’s Initial Coverage Limit (ICL) may change.
Although almost all
stand-alone 2021 Medicare Part D plans use the standard Initial Coverage Limit
(ICL) of $4,130, some 2021 Medicare Advantage plans offer an ICL other than the standard – ranging from $3,885 to $10,000
. Your drug plan’s ICL
sets the boundary between your Medicare Part D plan's Initial Coverage
Phase and the Donut Hole or Coverage Gap. The ICL is measured by the
total retail value of your prescription drug purchases. You can click here to read more
about 2021 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.
(7) Your 2021 Medicare drug plan’s formulary or drug list may cover fewer medications.
Although some 2021 Medicare prescription drug plans will be adding more medications, based on our analysis
, over 2 million
Medicare beneficiaries currently enrolled in a stand-alone 2020
Medicare Part D plan will see at least 100 fewer medications on their
2021 formulary. In addition, some of your low-cost generic medications,
particularly tier one and two generics may have moved to a higher drug tier
Please remember that a larger formulary does not necessarily mean that
the Medicare drug plan will cover all of your medications. Check to
make sure your medications are affordably covered
by your chosen 2021 Medicare Part D plan.
(8) Your 2021 Medicare plan’s prescription drug cost-sharing may increase.
Medicare plans can change their fixed copayments from year-to-year (for example
you now pay $1 for a Tier 2 drug and in 2021 you will pay $5 for the
same Tier 2 drug) – or plans may increase the co-insurance percentage
(you now pay 35% of the retail drug price and in 2021 you will pay
46%). And some Medicare drug plans may change between co-insurance
(percent of retail price) to copayment as a cost-sharing model.
You can click here to see
an example of how the Humana Walmart Value Rx plan will change from a
$47 co-pay to 17% co-insurance for Tier 3 Preferred Brands (meaning, you
will save money in 2021 if your Tier 3 drugs have a retail cost under
$276) – this change will affect almost 890,000
current plan members.
(9) Your Medicare plan’s cost-sharing can vary significantly between “preferred” and “standard” network pharmacies.
About 98% of all 2021
stand-alone Medicare prescription drug plans (PDPs) will use different
cost-sharing for preferred vs. standard network pharmacies. As an
example, the California SilverScript Choice (PDP)
will have a co-payment of $0 for a Tier 1 medication at preferred
network pharmacies and, for the same Tier 1 drug, a $5 co-pay when
purchased at a standard network pharmacy. You can click here
to see more examples of standard and preferred pharmacy cost-sharing.
And, you can contact your plan’s Member Service department to find
preferred pharmacies in your area.
(10) Your 2021 Medicare Advantage plan’s Maximum Out-of-Pocket (MOOP) limit may change.
Medicare Advantage plan MOOP threshold limits how much you will spend
on co-payments and co-insurance for in-network, eligible Medicare Part A
and Part B coverage. In 2021, slightly fewer Medicare Advantage plans
will offer a MOOP limit at or below the $3,450 voluntary maximum. In
fact, 78% of 2021 Medicare Advantage plans have a MOOP greater than
$3,450. You can click here to learn more
about the maximum out-of-pocket limits for 2021 Medicare Advantage plans.
The Bottom Line to our Top 10 List.
you decide to stay with your current 2020 Medicare Part D or Medicare
Advantage plan into 2021 – AND you understand how your Medicare plan is
– you do not need to do anything
– you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for 2021.
your 2020 Medicare plan is being terminated in 2021 and you are not
merged or “crosswalked” to another 2021 Medicare plan, you may be
without Medicare plan coverage on January 1st.
The Good News:
You still have plenty of time to review your 2021 Medicare plan options
during the annual Open Enrollment Period (AEP) that continues through
December 7th. For more information, Medicare beneficiaries can
telephone Medicare at 1-800-633-4227 and speak with a Medicare
Need a fast way to see how your 2020 Medicare Advantage or Medicare Part D plan is changing in 2021?
tools allow you to compare changes in all stand-alone Medicare Part D
prescription drug plans (PDPs) or Medicare Advantage plans (MAs or
MAPDs) across the country.
Our comparison tools show
changes in monthly premiums and plan designs, as well as changes in
cost-sharing rates for different drug tiers. Both PDP-Compare and
MA-Compare also show the Medicare plans that will be discontinued,
merged, or added in 2021. MA-Compare includes links to the health
coverage details for all 2020 and 2021 Medicare Advantage plans.