IBM Medicare Via Benefits part D 2021 Planfinder (for 2021 plan selection) Update

October 31, 2020 update:

 According to CMS, the problems with Medicare planfinder function are fixed.  If you decide to switch to a new part D plan, before you make the change, call the phone number at the bottom of the detailed information for the plan that is in planfinder and verify the drug coverage and costs.  If you are making a switch by calling Via Benefits or 1-800-MEDICARE, do the same thing.  Write down the name of the person you speak to at the insurance company, the time and the date.  This way if there is a problem in January you have the ability to contest and change to another plan because of "special circumstances". You do that by calling 1-800-MEDICARE and using the phrase "special circumstances SEP" when you ask to change to another plan.

October 26, 2020 post:

There are, once again, problems with the Medicare planfinder function.  The "add a drug" function is incomplete because the drug selection list doesn't have all the drugs covered by Medicare. If a drug is covered, it is no guarantee it will be covered for you if you are using it for an "off label" condition even though your doctor prescribed it. The price stated might not be the price you will pay in 2021.

It is very hard  to figure out if all of drugs a user wants are covered by a given plan unless the user goes into deep details on the plan.  The most confounding aspect is there is no guidance to tell users that if a drug is not covered, then the cost of that drug does not "count" in the calculations to determine costs for the three drug phases.  

Complain, complain, complain to your federal and STATE government representatives.  How are seniors supposed to be able to make good choices when they have bad data?  Complaining to HHS is a waste of time.  Complaining to your drug plan is even more so.  Complain to your elected officials.  Complaint to your governor, your state and federal representatives, your state attorneys general, and your consumer protection agencies.  COMPLAIN

IBM Medicare Via Benefits Medicare Hospital cost data for 2021

 In 2019 I wrote a blog post about the significant difference in cost for a hospital stay coverage for Original Medicare with an "N" Medicare Supplement insurance policy, and a Medicare Advantage (MA) plan with a $0 premium, but an out of pocket maximum cost (MOOP). 

MA plans are significantly more expensive if you need a lengthy hospital stay. It also is expensive if you are unlucky and have several hospital stays 60 days apart. I updated the table comparison for 2021 since that MA MOOP number has significantly increased.  The original post explains more about the table and was written  September 21, 2019: http://ibmmedicare.blogspot.com/2019/  

The table update for 2021. The average premium of an "N" plan is about the same in 2021. The highest premium for an N plan (which is NYC) is about $200/mo:

Phase	Original Medicare +  Medigap N at $150/mo	Sample (actual) 2021 Medicare Advantage plan $0 premium
Hospital Benefit Period (Every 60 days)	$1452 deductible Paid by Medigap N plan	No deductible
Hospital Days copays Every Benefit Period	$0 days 1-60  $363 days 61-90  $726 for 60 lifetime days All copays paid by Medigap N	$400 days 1-5 $0 days 5-90 $? lifetime days (not described in planfinder)
If exceed 150 days in hospital	All Medigaps provide this extra benefit of 365 addition lifetime days with $0 copay	No Medicare Advantage plans have this benefit  Patient pays all hospital costs after 150 days
Maximum hospital stay cost for 2021	$1800 for 2021 (Medigap premium $150 x 12)	$7,550 for 2021 (if within 150 day limit)

 

   

IBM Medicare Via Benefits Medicare costs for 2021 relating to Fall Enrollment choices

 CMS has not published the 2021 fee for Medicare part B enrollment yet (this is the amount you must pay to the government irrespective of the structure of your Medicare insurance), but they have published important cost information for Medicare Advantage plans and for part D prescription drug insurance plans (for people with original Medicare).  That is important information to consider when you are selecting your insurance for 2021. 

1. Part D prescription drug plans or part D coverage in Medicare Advantage plans:
     
   The deductible amount maximum for this category of insurance (no matter how you get drug coverage) is $445 in 2021 (in 2020 it is $435).  This is the maximum a plan can have before you start paying copays.  During the deductible phase of part D coverage, you are responsible for the full negotiated cost of prescriptions. The deductible does not apply to tier 1 generic drugs.  It is mostly for brand name drugs. As mentioned in earlier posts, this amount is only relevant to consider in two situations.  If you don't take any drugs, then you might want a plan without a deductible so that you get immediate insurance benefit should you be prescribed a drug during the year.  The second reason is if you have a cash flow problem and cannot afford an upfront out of pocket payment of $445 even though the total annual cost of drugs for your plan might be higher.  The best way to "pick" a part D plan is by the estimated total annual cost for the plan (premiums + copays). Plans with low or no deductibles will have higher monthly premiums and/or copays.   
     
   The other aspect of part D coverage is consistent no matter how  you get your prescription drug coverage.  When your drug costs exceed thresholds, you move to the next 2 phases where the insurance company is just administering the accounting.  In 2021 you move into phase 2 when the total cost of  your drugs is $4130 in 2021  ($4020 in 2020).  It is what you pay + what the insurance company pays.  You stay in phase 2 until "out of pocket" costs are $6550 in 2021 ($6350 in 2020). It includes what you paid in phase 1 (not what the insurance company paid) + what you pay in phase 2 (25% of the drug cost) + the pharmaceutical company discount (75% of the drug cost).  When that total is $6,350 you move to phase 3,  the catastrophic phase.  You stay in phase 3 for the rest of the year.  In phase 3 you pay 5% of the drug cost and CMS pays 95% of the cost of the drug.
      
2. Medicare Advantage  Plan Maximum Out of Pocket Cost (aka MOOP)
     
   This subject is the least understood and the most important part of Medicare Advantage plans.  It is the maximum annual cost you might incur (excluding premiums) in a given year.  It is also eye popping how much this amount has increased from 2020 to 2021.  In 2020 it was $6,700. In 2021 it is $7,550.  That is a 12.7% increase.  This maximum cost does NOT include the cost of your drugs.  It only relates to "health services".  If you have a Medicare Advantage plan that is a PPO, it also does not include any out of network provider costs.  The cap on out of network provider costs can be any amount the plan decides up to $11,300. For example, one plan set it at $11,000 but it is complicated. Plans are required to have a total $11,300 limit on the combined in and out of network costs. I originally thought there was no out of network limit and earlier wrote:  NO ceiling for out of network costs.  Here's how MOOP (in network) cost has changed over the last 10 years. As I have said in other posts, administrations matter:

Year	MOOP Amount	Increase	% increase Prior year
2012	$4,317	$36	.8%
2013	$4,352	$35	.8%
2014	$4,826	$226	5%
2015	$5,052	$226	4.6%
2016	$5,257	$205	4.1%
2017	$5,332	$85	1.6%
2018	$6,700	$1,368	25.6%
2019	$6,700	$0	0%
2020	$6,700	$0	0%
2021	$7,550	$850	12.7%