Considering recent events, healthcare is on everyone’s mind. While increases in premiums are common for Medicare, 2020 brought changes that go much deeper. These changes are due to the SUPPORT Act, the Bipartisan Budget Act of 2018, and the 2020 Medicare Physician Fee Schedule. This year’s changes include new coverage areas, expansion of benefits, and changes in allowed policies.
New to Medicare Part B this year is treatment for opioid use disorder received at opioid treatment programs (OTPs). This coverage has been expanded in hopes of addressing the opioid epidemic by providing access to more services. Prior to 2020, there was no Medicare coverage for opioid use disorder treatment, including methadone treatment, because it is only provided at OTPs (methadone for pain relief can be obtained elsewhere). Medicare now covers treatment at OTPs, such as treatment medications and the dispensing and administering of them, substance counseling, individual and group therapy, toxicology testing, intake activities, and periodic assessments. There will not be any cost-sharing required once the deductible is met with OTP services in order to minimize barriers to accessing care.
Telehealth benefits, those provided using technology instead of in person, are increasing for substance use disorders as well. Previously, they were only available under limited conditions for people in rural areas. Beginning in 2020, individuals with behavioral health conditions, such as substance use disorders, can now access professional consultations, psychiatry services, and other such services from the comfort of their own homes regardless of where they live.
The new telehealth benefits now covered under Original Medicare Part B also must be covered by Medicare Advantage Plans too. That is their minimum coverage requirement, but they have always been able to cover more telehealth services. The way that Medicare Advantage Plans bill Medicare for these services changed in 2020, which makes it more likely that they were offered to participants. They may not confine a service to telehealth, though; any services offered through technology must also be offered in person, though the costs can vary.
Historically, Medicare Advantage Plans could only offer benefits above and beyond original Medicare benefits if they were primarily health-related. That is changing too. Now they can offer supplemental benefits to individuals with chronic conditions, such as cardiovascular disorders, diabetes, neurologic disorders, chronic heart failure, chronic and disabling mental conditions, cancer, dementia, chronic alcohol or drug dependence, autoimmune disorders, stroke, end-stage renal disease, and many more. Benefits they may provide include meal delivery, transportation for non-medical needs, social needs benefits, complementary therapies, home modifications, and general support. Such services can be specific to certain chronic diseases and do not have to be offered broadly.
Those who are on both Medicaid and Medicare will soon have an easier time, as there are new requirements for their integration and a unified grievance and appeals process. These requirements do not go into effect until 2021, but many providers have started implementing changes this year.
The Medicare Part D donut hole, or coverage gap, is now officially closed. On average, beneficiaries will only have to pay 25% of the cost of both generic and name-brand drugs, though the actual amount at a given time will vary based on copays and coinsurance. Also new to Part D, providers can choose to cover drugs only for certain uses rather than for all of the FDA-approved uses. They must ensure that they cover another drug for the same use and participants may always request exceptions.
New laws requiring that people pay their own Medicare Part B deductibles have eliminated the use of Medigap Plan C and Plan F for people newly eligible for Medicare. Both of those plans pay the Part B deductibles. People who already had the plans, or were eligible to have them prior to January 1, may still purchase and keep them.
Finally, the income-related monthly adjustment amounts (IRMAAs) have increased. These are extra payments that must be made above the Part B and Part D premium for those whose income is above a certain level, based on the tax return from two years prior. Income brackets have increased so that you can now earn more before being subject to the payments.
Whether or not you’re already participating in Medicare, these changes can affect your retirement plan going forward. You don’t need another thing to worry about right now, so remember that we are here to navigate this with you. Call (617) 630-8787 or use the calendar below to reserve a time to talk about your situation.
(Published Feb. 17th, 2021)
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