Medicare: What Are the Payment and Coverage Changes to Expect in 2021?

Medicare costs for coinsurance, premiums, and deductibles increase annually. Prospective and existing enrollees have to understand these adjustments. That way, they can make informed decisions for their plans. For 2021, the COVID-19 pandemic made the federal policymakers adjust the coverage of plans. Enrollees can have more affordable and comprehensive coverage.

Medicare: What Are the Payment and Coverage Changes to Expect in 2021?
A physician discussing the procedures with the patient for Medicare

Health care costs rise each year, along with Medicare costs. The CMS (Centers for Medicare & Medicaid), which is under the U.S. Department of Health and Human Services, helps regulate the cost of Medicare. The CMS checks the costs according to the Social Security Act.

The Latest Trends in Health Care

Health care is going through significant changes. Instead of being volume-based, it has become value-based. This involves changing certain methods of reimbursing payments. One strong example is the way health care professionals receive compensation. Through the years, health care providers have been paid based on the number of times they saw the patient. Even if they did not make the patient better, their payment was the same.

In the new health care system, doctors receive payment according to how healthier the patient became. The goal of this new system is to provide more effective and efficient care at a much more affordable cost.

The Medicare Part A Deductible and Coinsurance for 2021

The deductible in Part A applies for each individual benefit period. Medicare will pay for the 60 days of a person’s stay in a facility or a hospital. The payment starts on the first day of the person’s stay. This year, the deductible increases from $1,408 (2020) to $1,484. The increase applies to all enrollees, even if many of them have paid part or all of their Part A deductible.

The Part A coinsurance is the additional coverage paid for by Medicare if the patient needs more care in the hospital or facility. The daily coinsurance charge follows the first 60-day benefit period. In 2021, the coinsurance charge per day goes up from $352 (2020) to $371. This starts on the 61st day of admission and ends on the 90th day.

Medicare will only pay for care at a skilled nursing facility if the patient stayed at a hospital for at least three days before the transfer to the skilled nursing facility. The Part A deductible will cover the first 20 days from the hospital stay to the transfer and stay at the skilled nursing facility. A certain coinsurance applies from the 21st to the 100th day of stay at the skilled nursing facility. For this coinsurance, it goes up from $185.50 (2020) to $176. Based on the information from CMS, the Part C (Medicare Advantage) premiums for 2021 go down from $23 (2020) to $21. These premiums have been decreasing for the past years. The premium for 2021 is the lowest since 2007.

Medicare: What Are the Payment and Coverage Changes to Expect in 2021?
A nurse checking the patient’s blood pressure

ESRD Patients Can Join Medicare Advantage

Medicare Advantage plans have been unreachable to patients with ESRD (end-stage renal disease). But, this is accessible to them if there is an ESRD Special Needs Plan in the patient’s area of residence. That is why it is difficult for all ESRD patients to get the help they need. But this year, Medicare Advantage Plans will be available for all enrollees. This includes patients with ESRD.

This enhancement is the result of the 21st Century Cures Act. This gives ESRD patients access to the Medicare Advantage Plan in their area starting 2021. The primary Medicare, combined with Medigap Plan and the Medicare Part D plan, is still the affordable option when it comes to coverage. In some states, people below 65 years of age cannot enroll in Medigap plans with guaranteed-issue. They can only do this by paying expensive premiums. Other states do not extend the protection for Medigap access to patients with ESRD. If the ESRD patient cannot get a Medigap Plan, a Medicare Advantage plan could be a better solution.

Changes in 2021 Due to the Pandemic

In March 2020, COVID-19 started to spread in the United States. Since then, changes have started to happen to Medicare coverage. The adjustments aim to meet the needs of the enrollees during these difficult times. When 2021 came, the changes continued. These would ensure coverage of the COVID-19 treatments. The coverage includes:

  • A waived three-day stay at the hospital before transferring to a special nursing care facility. This is to make more room at hospitals for COVID-19 patients and other patients who need critical care.
  • A COVID-19 vaccine
  • Coronavirus testing without spending
  • Hospitalizations due to COVID-19
  • Expansion of virtual visits and telehealth services to meet the needs of patients and increase access to them.

Payments for Your Medicare Plans Have Changed in 2021

Rising health care costs each year prompts the rise of Medicare payments. But, the current pandemic has triggered a dramatic change in access to critical care. The adjustments allow availability of free coronavirus treatment. It is also good to know that some aspects of Medicare are evolving to ensure delivery of quality care.

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