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%