Harmony Healthcare International (HHI) Blog

Open Enrollment (Annual) 2021 Reimbursement

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The Medicare Annual Election Period is often referred to as the Open Enrollment Period, and it occurs from

 

October 15, 2020, through December 7, 2020.

 

During this period, current Medicare beneficiaries can make changes regarding

 

  • Medicare,
  • Medicare Advantage, and
  • Part D for calendar year 2021.

 

Beneficiaries can switch from Original (Traditional) Medicare to Medicare Advantage plans or vice versa during this period. They can also switch from one Medicare Advantage plan to another. Medicare premiums, deductibles, and coinsurance rates are adjusted every year at this time.

 

Medicare Part A

 

(Hospital Insurance) covers hospital, skilled nursing facility, and some home health services. Most beneficiaries, about 99%, receive Part A insurance at no cost since they have at least 40 quarters of Medicare-covered employment. A premium is charged for this coverage if requirements such as the specified number of quarters of coverage (QCs) based on their earnings and the Federal Insurance Contributions Act (FICA) tax or the QCs of a spouse, parent, or child are not met.

 

  • The Medicare Part A deductible for 2021 is $1,484, an increase of $76 from 2020.

 

  • The coinsurance after the first 60 days of Medicare-covered inpatient hospitalization that applies to the 61st through 90th day of hospitalization is $371 per day (in a benefit period) and is $742 per day for lifetime reserve days.

 

  • In a skilled nursing facility, the 2021 daily coinsurance for days 21 through 100 is $185.50, an increase of $9.50 from $176.00 in 2020.

 

Medicare Part A Deductible & Coinsurance Amounts

 

2020

2021

In-patient hospital deductible

$1,408

$1,484

Daily hospital coinsurance for days 61-90

$352

$371

Daily hospital coinsurance for lifetime reserve days

$704

$742

Skilled nursing facility coinsurance for days 21-100

$176.00

$185.50

 

Medicare Part B

 

(Medical Insurance) covers physician services, outpatient hospital services, some home health services, durable medical equipment, and certain other services not covered by Part A.

 

  • The annual deductible is $203.00.
  • The standard monthly premium for Part B is $148.50 for 2021.
  • The monthly premium increases based on a beneficiary’s income is shown in the following table.

 

 

Medicare Part B Premium

2021 Monthly Adjustments Based on Income

 

Individual Tax Returns with income:

Joint Tax Returns with income:

Monthly Adjustment Amount

Total Monthly Premium

< or = to $88,000

< or = to $176,000

$0.00

$148.50

> $88,000-$111,000

> $176,000-$222,000

$59.40

$207.90

> $111,000-$138,000

> $222,000-$276,000

$148.50

$297.00

> $138,000-$165,000

> $276,000-$330,000

$237.60

$386.10

> $165,000-$500,000

> $330,000-$750,000

$326.70

$475.20

> $500,000

> $750,000

$356.40

504.90

 

 

Medicare Part C

 

Medicare Advantage Plans are offered by private Medicare-approved insurance companies that must follow the rules established by Medicare. Beneficiaries will have both their Part A and Part B coverage from their Medicare Advantage Plan plus prescription drug benefits, or other benefits may be included. Types of Medicare Advantage Plans include:

 

  • Health Maintenance Organizations (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee for Service (PFFS) plans
  • Medical Savings Account (MSA) plans
  • Special Needs Plans (SNP) plans

 

Medicare Advantage providers are paid a fixed amount for coverage each month from Medicare. The plans vary regarding requirements for accessing services such as referrals to specialists, and members pay certain out of pocket costs. Medicare Advantage plans frequently change their coverage, benefits, and policies, so examining the details every year is important. The maximum out of pocket limit for Medicare Advantage Plans is increasing to $7,550 for 2021. Starting in 2021, Medicare Advantage Plans are available for beneficiaries with End Stage Renal Disease (ESRD). Medicare Advantage enrollment is expected to increase to a projected 26 million for 2021.

 

Medicare Part D

 

Prescription Drug Coverage plans for Original (Traditional) Medicare Part A beneficiaries assists with medication costs. The deductible you pay each year before the Part D plan pays its share varies with different plans.

 

  • The maximum deductible for 2021 is $445, an increase of $10 from 2020.      

 

  • The out of pocket threshold (where catastrophic coverage begins) will increase to $6,550 in 2021.

 

Medicare beneficiaries with Part D coverage (either a stand-alone Part D plan or when part of Medicare Advantage) have access to insulin with a copay of $35 a month starting in January 2021. This change is expected to be significant savings for individuals who are prescribed insulin.

 

Harmony Healthcare International (HHI) encourages all facilities to help residents understand their choices as they make important decisions about their health insurance. Resident’s confusion about insurance coverage can translate into innumerable problems, including diminished revenue and care options for the nursing facility. There can be a huge gap between reality and what a resident thinks their insurance plan will cover.

 

Harmony Healthcare International (HHI) has resources to facilitate discussions with residents and their representatives and educate them regarding their Open Enrollment choices. HHI strongly recommends using reports from your software, the HHI tracking tool, and a step-by-step process to ensure that residents understand their choices and take advantage of the opportunity during Open Enrollment to make thoughtful decisions and changes.

 

Click below to view the HHI Open Enrollment Tracking Tool

Click Here to View

 

Kris and the HHI Team thank you for all of your hard work caring for the senior population and reiterate that you are all heroes. Due to the national surge in COVID-19 cases, HHI is offering a free webinar on Tuesday November 24, 2020 @ 1:00 p.m. EST. titled COVID-19 Skilling, Infection Control and Testing Requirements. 

Click below to register for the HHI Thank You Tuesday Free Webinar!

Click Here to Register

 

COVID-19 blog image

Topics: Reimbursement


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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