Major Changes Coming to the MA & PDP Market for 2021

Thinking of selling Medicare Advantage and prescription drug plans for 2021? This is the year to give it a try! Here’s why.

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For 2021, agents and beneficiaries can expect to see six major improvements in several categories associated with the 2021 MA & PDP market: enrollment, affordability, accessibility, value, and plan choice. Keep reading to get all the details!

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1. Unprecedented Enrollment in Medicare Advantage Plans

For 2021, the Centers for Medicare & Medicaid Services (CMS) project 42 percent of individuals will be enrolled in Medicare Advantage plans — that’s up from 36 percent in 2020. While a six-percent increase in enrollment may not seem all too staggering, it’s never been seen in past year-over-year comparisons! In fact, the last time Medicare Advantage enrollment rose six percent, from 30 percent (2014) to 36 percent, it took six years to do so.

CMS projects 42 percent of individuals will be enrolled in Medicare Advantage plans for 2021.

What about PDP enrollment? The 58 percent of Medicare beneficiaries who aren’t enrolled in MA plans, as well as those who are enrolled in MA plans without prescription drug coverage, will still need credible Part D coverage!

2. The Lowest Medicare Advantage Premiums in 14 Years!

According to CMS, MA beneficiaries can expect to see an average plan premium of around $21 per month! That’s 11 percent lower than 2020’s average plan premium of $23.60 per month, and 34.2 percent lower than 2017’s premium of about $32 per month. In fact, it’s the lowest average MA monthly plan premium expected since 2007. This should make private Medicare coverage even more affordable in the eyes of your interested prospects. But, don’t forget: Many carriers are already offering $0-premium MA plans!

See a state-by-state breakout of estimated MA premiums for 2021

As far as Part D goes, beneficiaries can expect the average PDP premium to be $30.50 per month.

3. More Than 1,630 Plans Offering Insulin for $35/Month Copays or Less

Do you work with clients who are diabetic and need insulin? In the past, finding them an MA prescription drug plan or stand-alone Part D plan with affordable cost-sharing may have been difficult. That should change this year. Many Medicare beneficiaries will have access to a plan in their area that offers insulin for $35 per month or less, thanks to the Part D Senior Savings Model. The Medicare Plan Finder will feature an “Insulin Savings” filter to easily display these plans.

Learn more about the Part D Senior Savings Model and participating carriers and plans

4. MA Plans Accepting End-Stage Renal Disease Applicants

In the past, individuals with End-Stage Renal Disease (ESRD) were not eligible to newly enroll in an MA plan. (Someone could stay in an MA plan if they developed ESRD after enrolling in it.) However, a provision of the 21st Century Cures Act allows those with ESRD to apply for MA coverage for 2021 and beyond. As a result, CMS expects that the number of MA members with ESRD will increase 63 percent by 2026.

5. More Telehealth Options & Additional Member Support

Carriers are navigating the 2021 Medicare market a little differently due to COVID-19. For the upcoming plan year, agents and beneficiaries can expect more than 94 percent of MA plans to offer additional telehealth benefits. To put things into perspective, only 58 percent of plans are offering telehealth benefits for 2020. Several MA plans will also offer beneficiaries more access to palliative and integrated hospice care as a value-based insurance benefit, as well as extra supplemental benefits (e.g., adult day health services, caregiver and in-home support, therapeutic massage, healthy foods, transportation) and chronic condition support (e.g., pest control, home cleaning, meal delivery). Additionally, for 2021, plans will be offering lower copayments or reduced cost-sharing to members with certain conditions (e.g., diabetes, congestive heart failure).

Agents and beneficiaries can expect more than 94 percent of MA plans to offer additional telehealth benefits in 2021.

6. Even More Plan Options for Beneficiaries to Choose From

Agents and Medicare eligibles and enrollees will once again see even more MA plans to choose from! Beneficiaries will have an average number of 47 MA plans to choose from in each county for 2021 — an increase of eight plans from this year. Nationwide, beneficiaries can expect to choose from more than 4,800 different MA plans for AEP. Compared to 2017, that’s an increase of 76.6 percent in plans! Of special note, rural county plan options are increasing to 2,900 plans in 2021, up about 18 percent from 2,450 in 2020.

You can view CMS’ 2021 MA and PDP Landscape Excel files here

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According to CMS’ 2021 MA and PDP projections, it’s an ideal time to sell private Medicare plans. Lower premiums and reduced cost-sharing, combined with more expansive benefits and increased accessibility, will help to make the private Medicare market appealing to more individuals turning 65 every day. With the projected number of MA and PDP prospects, enrollees, and plan options on the rise, agents can expect to have an increasing number of potential clients who could need help narrowing down the plan that’s the best fit for their budget and needs, this year, and possibly well into the future.

Editor’s Note: Much of the information above is from CMS’ September 24, 2020, press release: “Trump Administration Announces Historically Low Medicare Advantage Premiums and New Payment Model to Make Insulin Affordable Again for Seniors.” Any facts not from this press release have been otherwise cited via links to their sources.

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