What to Expect from Medicare and Medicare Advantage in 2021

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By Dr. Kishlay Anand, President and Co-Founder of Apricus Health 

In 2020, the Centers for Medicare and Medicaid Services (CMS) enacted several key benefits, many of which were in response to the ongoing COVID-19 pandemic. Such benefits include full coverage of the COVID-19 vaccine, extended medication supplies for certain drugs and the use of virtual health services in any geographic area. CMS also introduced acupuncture and capped insulin costs as well.

While certain changes will be removed after the pandemic is over, like coverage of COVID-related testing and treatment, it has become abundantly clear the pandemic has shifted the healthcare landscape long-term. COVID-19 will have a lasting impact on Medicare and Medicare Advantage plans, setting the foundation for permanent changes that will unfold throughout 2021. 

Increased coverage for virtual health services

COVID-19 catapulted virtual care from an ancillary service to a primary component of the healthcare experience. So much so, that Deloitte predicted that Medicare Advantage plans that don’t embrace it “will get left behind.” As virtual health solidifies its place within Medicare Advantage plans, recipients can expect CMS to add additional information outlining coverage for e-visits and virtual check-ins. 

In December of 2020, CMS added two new billing codes that allow providers to bill for virtual check-ins and remote evaluation of patient-submitted videos or images. CMS also announced plans to commission a study on virtual health and pledged their commitment to exploring new opportunities for using it to improve patient care.

Medicare and Medicare Advantage recipients can also expect to see more inclusive coverage of remote patient monitoring tools, modified indirect supervision and care navigators going into 2021. The industry has already seen several changes that have opened possibilities for remote patient monitoring, like allowing certain tasks to be performed by a medical assistant. 

You can also learn more about the advantage and disadvantage of Medicare Advantage plans.

Medicare plans are introducing alternative treatments

For the first time, CMS included coverage of acupuncture for lower back pain in January of 2020. Coverage includes up to 12 acupuncture visits in 90 days for chronic low back pain, as defined by CMS, but coverage for other alternative treatments is still minimal. For example, chiropractic care is currently only covered for spinal subluxation. 

This advancement can lead to more natural remedies for pain in the future, including additional coverage of acupuncture, chiropractic care and massage therapy within the next year. The introduction of acupuncture is a turning point that’ll enable conversations about the effectiveness of alternative treatments and could potentially lead to increased coverage of alternative remedies overall. 

Lower insulin costs

In May 2020, CMS announced that more than 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. This change was put into effect in January and will cap out-of-pocket insulin costs at $35 per month. It’s likely this change will last beyond the pandemic and that similar efforts will be seen around other drugs.

Price Transparency 

The CMS released official guidance around price transparency outlining that every hospital operating in the United States will be “required to provide clear, accessible pricing information about the items and services.” This was a historic change that will have a major and lasting impact on healthcare. One of the recent announcements from CMS was their plan to audit a selection of hospitals starting in January. 

Price transparency is a fundamental change in healthcare, and it puts more information in the hands of the patient. This is a positive trend that will lead to a greater focus on transparency, communication, and value-based care in the future. Most likely, we can expect to see additional CMS policies in 2021 that will further define price transparency.

With so many changes happening in Medicare, it’s more important than ever for Medicare recipients to understand the benefits available to them and to make the most informed decision about their healthcare coverage. The Open Enrollment Period for Medicare goes until March 31^st, and Medicare users can change their plan for any reason until that date.