2021 Medicare Parts A & B Premiums

CMS Press Release Nov 6, 2020 | Medicare Parts A & B

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2021 monthly Medicare Parts A and B premiums, deductibles, and coinsurance amounts in which the Medicare Part B monthly premium remains steady. This news comes as Medicare Open Enrollment started on October 15, 2020 running through December 7, 2020, and follows the announcement that Medicare Advantage (or private Medicare health plans) and Part D prescription drug plan premiums are at historic lows, with hundreds of Medicare Advantage and Part D plans now offering $35 monthly co-pays for insulin starting in January 2021.

“With the 2021 Medicare Part B premium information now available, I encourage everyone with Medicare to take time over the next four weeks to review their options during Medicare Open Enrollment,” said CMS Administrator Seema Verma. “Thanks to President Trump’s leadership, Medicare Part B premiums remain steady and seniors have more plans than ever to choose from, many new benefits, and historically low Medicare Advantage and Part D premiums.”

Read the full release.

Walmart Launches Into the Medicare Plan Distribution Market

Oct. 6, 2020
By Lori Flees, SVP and COO, Walmart U.S. Health & Wellness

Health care can be complicated. But we think quality health care should be within reach of everyone, and pricing should be transparent and affordable. Our money-saving $4 generic prescription program and, more recently, Walmart Health locations are helping customers save money and live healthier. Similarly, our Healthcare Begins Here program has helped customers navigate the very complex health insurance system for years.

 

READ FULL ARTICLE HERE

CMS Released Insulin Manufacturers List

CMS has released a list of Pharmaceutical Insulin Manufacturers that will participate in the Part D Senior Savings Model in 2021.

There are currently three manufacturers involved:

  1. Eli Lilly and Company
  2. Novo Nordisk, Inc. and Novo Nordisk Pharma, Inc.
  3. Sanofi-Aventis U.S. LLC

The Part D Senior Savings Model is part of CMS’ ongoing efforts to keep insulin co-pays at a $35 maximum for the consumer. This is an ongoing list that is subject for updates, you can view the full list HERE.

CSM AGENT COMPLIANCE GUIDES

Cornerstone Senior Marketing Agent Compliance Guide

Best Practices in Medicare Compliance (2020):  Access the Guide

Agent Medicare Marketing Guidelines:  Access the Guide

Agent Life Annuity Marketing Guides:  Access the Guide

 

CMS Added Updates to the Medicare Plan Finder

From the NAHU FMO Council Members:

  • Plan Card Redesign on Plan Results Page –  CMS indicated the changes that were made were based on User Feedback and the change they made for the Default Sort to be “Lowest Drug Cost + Premium”.  Thus they wanted to reduce the size of the Premium font since it is not the most important data point.  CMS agreed to revisit the redundant text “Doesn’t include: $144.60 Standard Part B Premium” which is listed with Every Plan.
  • Upcoming Changes (Pre-AEP)
    • Online Enrollment Form will be pre-filled for Authenticated Users – Name, Address, Medicare Number, Coverage Date.
    • Medigap Quoting Tool – We highlighted our concerns with Medigap quotes varying greatly based on a number of different factors (e.g. Underwriting Rules that vary by State, Birthday Rules in Different States, Underwriting Classes and Prices by Different/Same Carriers in Different States, Varying Household Discount Pricing Rules, etc.).  We requested another deeper discussion/review with CMS prior to a launch of this functionality (currently scheduled for July).
    • Drug Frequency Changes to allow for 1 per 12 months, 1 per 6 months options to be deployed in July-August.  This is a BIG WIN!
    • Pharmacy Search Enhancements to be deployed in July-August – allow user to Search by Name and Distance and improved Map functionality.  Also allow user to edit Pharmacy from Plan Details Page.  Another Big Win!
    • Improved Sort & Filter on Plan Results to be deployed July – August.  Specifically, allow users to Sort by Plan Type (e.g. Cost Plan, MSP, HMO, PPO, and even the new $35 Insulin Priced Plans) This is another item that has been on our list.
    • Tweaks to Print Pages.  Improved spacing to tighten pages and reduce number of pages.  (Plan Comparisons with Drug Level pricing detail will NOT be available.). A couple of other low-hanging fruit that we are requesting:  add the “Zip Code”, “Date Printed” and “Page Numbers” to the Report Printout Header or Footer.
  • Future Changes (2021):
    • Provider Directories Integration – this will be very helpful for Beneficiaries to search for plans that cover their providers.
    • Ability to create an Account without Medicare NumberThis is a change that should address the “Anonymous Search / Save Issue” and will be targeted for 2021.  This function will be available to Beneficiaries, Caregivers, SHIP, Agents, etc that want to be able to save their Drug List information without using their Medicare Number.  CMS has agreed to include NAHU in the Pre-Work Planning meetings for this functionality.

COVID-19 – Understanding SEP Time-Frames

CMS RELEASE – FEMA SEP ANNOUNCEMENT

Understanding SEP time-frames

CMS released a new enrollment flexibility clarifying that the FEMA SEP is relevant to COVID and invoked. They added language to clarify the SEP enrollments can be submitted through agents/brokers or any means of submitting an enrollment.

There has been some confusion around the applicable SEP dates.  To clarify, there are two sets of dates:

  • March 17 – June 17 (equal to 3 months) for Medicare Part A and Medicare Part B
  • March 01 – June 30 (equal to 4 months) for Medicare Advantage and Medicare Part D.

IMPORTANT:  The equitable relief applies to those beneficiaries who were otherwise eligible for IEP, GEP, or SEP, but due to COVID-19 were unable to exercise their enrollment rights.  COVID-19 in and of itself is not a trigger for an SEP but, if not for COVID-19, an eligible  beneficiary would have been able to enroll in Medicare.

Read the full CMS release here.

Questions? Please don’t hesitate to reach out to your rep.  We continue to operate under our regular business hours and our experts are committed to providing the answers, resources, and tools you need as we navigate this unusual time.

WellCare Confirmed Special Enrollment Period: COVID-19

WellCare Agent Advisory 5/6/20

Confirmed Special Enrollment Period: COVID-19

As promised, we continue to closely monitor the COVID-19 pandemic and are working hard to keep you informed. At this time, CMS has reversed previous guidance and made the decision to allow for a one-time Special Enrollment Period (SEP) for those affected by COVID-19, in the event they were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This SEP applies to all 50 states, tribes, territories, and the District of Columbia.

Read Full Release

Humana – 2020 Compliance Communication: SEP Notice for Individual Affected by COVID-19

2020 Compliance Communication

SEP Notice for Individuals Affected by Covid-19

CMS has officially announced an SEP is available for individuals affected by Covid-19.  This SEP is available nationwide to residents of all states, tribes, territories, and the District of Columbia. The SEP can be used until June 30, 2020 under the following circumstances.

Who qualifies for this special enrollment period?

A SEP exists for individuals affected by a major disaster who were unable to, and did not make an election during another valid election period.  This includes both enrollment and disenrollment elections.  Individuals will be considered “affected” and eligible for this SEP if they:

  • Reside, or resided at the start of the incident period, in an area for which FEMA has declared an emergency or a major disaster and has designated affected counties as eligible to apply for individual or public level assistance; and
  • Had another valid election period at the time of the incident period; and
  • Did not make an election during that other valid election period.

In addition, the SEP is available to those individuals who don’t live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas.   

 

Nationwide Covid-19 SEP – SEP Start Date March 1, 2020

SEP End Date – June 30, 2020     

What Does This Mean to Agents

If an individual wants to enroll and believes they may qualify for this SEP, agents should:

  • Confirm that they had another election period available during the time of the incident period.
  • Once eligibility has been verified, use election code SEP DST on the application.

Enrollments made pursuant to this SEP are effective the first of the month following the receipt of the enrollment request. For enrollment requests where more than one enrollment effective date is possible, agents will need to determine the applicant’s desired effective date.

The Disaster SEP should never be used as a marketing tool to promote MA or PDP sales.  Agents should not be actively marketing this SEP, but rather, should be aware that it is available in case they are approached by someone who believes they have missed an election period due to the incident.

 

CMS SEP Update

Breaking News from CMS
This afternoon CMS released a new enrollment flexibility clarifying that the FEMA SEP is relevant to COVID and invoked. They added language to clarify the SEP enrollments can be submitted through agents/brokers or any means of submitting an enrollment. You can find details here.The agency is granting equitable relief for those who missed an election period such as the General Enrollment Period to enroll in Part B. This flexibility remains in force until until June 17, 2020.

Source:  NAHU

Important Special Enrollment Period Announcement from NAHU

As of April 3,2020

Medicare Advantage SEP Delayed

CMS told NAHU that the plan to provide an official notice for MA SEP will slip into next week. Beneficiaries rely on agents and NAHU requested CMS consider agents of record in any SEP plan. We also requested extending the OEP through June. You can monitor this link for A/B enrollment updates.

Here are links for C/D to watch for SEP or other enrollment guidance:

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/index

https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicarePresDrugEligEnrol/index

 

Part B enrollment and SSA

CMS is working closely with SSA to coordinate and push out information regarding Part B to ease enrollment challenges. NAHU has let CMS know that local SSA offices appear to operate differently with respect to handling enrollment cases.

 

As of now, CMS will  relax the requirement for wet signatures.  In addition, if the beneficiary is unable to obtain the completed employer form there are alternate forms of documentation that are acceptable. These are documents that they are likely to have in their possession such as tax returns, paystubs, health insurance cards. SSA is also working on creating methods to submit this information via a dedicated fax number and a few other ideas they are considering.

 

Be sure to monitor these web links to get the latest changes in Medicare enrollment. NAHU will continue to be your source for the latest information and we will continue to send out information as event warrant.