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Medicare Advantage Plans for 2021

With the annual enrollment period approaching, it’s important to understand your options.

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With the annual enrollment period approaching, it’s important to understand your options. Medicare Advantage (MA) plans offer you a chance to cover all your Part A and Part B benefits. MA Plans also known as “Part C” are sold by private companies through contracts with Medicare. With many different companies offering competitive plans how are you to know which plan is right for you.
There are five things you will want to consider when choosing coverage: Cost, Coverage, Supplemental Coverage, Prescription drugs, as well as doctor and hospital choices. MA plans have a yearly limit on your out of pocket cost. MA plans must cover all of the services that Original Medicare covers, but also come with extra benefits. With a MA plan, you can’t use a Medigap policy, also known as Medicare Supplement. Most Medicare Supplement plans include drug coverage. Is your doctor in your plan’s network? How about your hospital

Medicare Advantage (Medicare Part C)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance).

 Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs), and Medicare Medical Savings Account (MSA) Plans. 

If you are enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and are not paid for through Original Medicare. Most Medicare Advantage plans offer prescription drug coverage

Today, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2021 Rate Announcement, finalizing Medicare Advantage (MA) and Part D payment methodologies for CY 2021.

 The final policies in the Rate Announcement will continue to modernize and maximize competition within the MA and Part D programs. 

COVID-19 Outbreak

The health and safety of America’s patients and provider workforce in the face of the Coronavirus Disease 2019 (COVID-19) outbreak is the top priority of the Trump Administration and CMS. We are working around the clock to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.

The 2021 Rate Announcement is an example of how CMS is focused on implementing the policies that matter most for ensuring continuous and predictable payments across the health care system and ensure care can be provided where it is needed.

While the Rate Announcement does not catalog CMS’ actions related to the COVID-19 outbreak, an overview of CMS’ actions related to the outbreak for MA organizations, PACE organizations, and Part D sponsors.

The agency is also communicating with stakeholders, responding to inquiries through the HPMS system, and developing further guidance on issues related to the COVID-19 outbreak.

2021 Rate Announcement

After considering all comments received, CMS is finalizing updates and changes to the methodologies used to pay MA organizations, PACE organizations, and Part D sponsors discussed in Parts I and II of the CY 2021 Advance Notice.


Medicare Advantage plans could see payments drop in 2021


Dive Brief:

  • The COVID-19 outbreak appears to have impacted claims patterns for Medicare Advantage enrollees, according to a new analysis by Avalere Health. Even though seniors are historically the most vulnerable population health-wise, their claims were down dramatically during the month of April.

  • The survey suggests it could impact risk score factors for MA plans in 2021, driving them down by at least several percentage points. As a result, some MA health plans could wind up getting paid less for their enrollees than projected in 2021, which could impact their overall profitability as well as their medical loss ratios.

  • Avalere recommends that MA health plan managers carefully analyze their own claims data patterns and potential impact in order to be better prepared for a turbulent 2021.

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