October Medicare Must-Knows

RetireMEDiQ strives to keep individuals informed about the latest Medicare news. Each month, we recap the top information consumers need to know about recent developments in the Medicare industry and how it may affect you.

Medicare Annual Enrollment Period Begins Oct. 15

Medicare’s Annual Enrollment Period (AEP) begins on Oct. 15 and runs through Dec. 7. Over this seven-week period, Medicare beneficiaries who are currently on Original Medicare can enroll in Medicare Advantage. If you want to change your Supplement (also known as Medigap) coverage to a Medicare Advantage plan, you can also do so during this time. Those currently on Medicare Advantage plans can purchase additional coverage, such as a prescription drug plan, during AEP.

You may notice that your health care needs can change significantly over the course of a year. If your needs have changed or you have questions, reach out to one of our client advisors at RetireMEDiQ.

CMS Lowers Medicare Advantage Premiums for 2021

On Sept. 24, the Centers for Medicare and Medicaid Services (CMS) announced a decrease in monthly premiums for Medicare Advantage plans in 2021.

The average premium cost will drop to $21 in the new year, compared to the previous average of $23.63. Continuing a trend of lower premiums for Medicare Advantage beneficiaries, this is the lowest price available in over a decade. According to CMS, lower premiums have saved beneficiaries nearly $1.5 billion since 2017.

Additionally, diabetic seniors will have more than 1,600 Medicare Advantage and Medicare Advantage with Prescription Drug (MAPD) plans to choose from that provide insulin for a monthly copay of $35 or less.

For more information on the benefits of Medicare Advantage and MAPD plans, click here.

Source: Becker’s Hospital Review

CMS Issues New Guidance on COVID-19 Nursing Home Visits

The Centers for Medicare and Medicaid Services (CMS) updated their guidelines regarding nursing home visits during the Coronavirus pandemic, encouraging nursing homes to provide more options for indoor and outdoor visitation. This updated guidance, issued in a memo on Sept. 17, allows visitors to meet with their loved ones in nursing homes under certain conditions:

  • Limited number of visitors at a time
  • Limited visitor movement within facility (for indoor visits)
  • Screening of visitors for fever and COVID-19 symptoms
  • Hand hygiene practices
  • Use of face coverings (mouth and nose) for visitors
  • Use of personal protective equipment for staff
  • Social distancing of at least six feet between visitors and residents
  • Regular COVID-19 testing for staff and residents

Communal dining and activities may resume so long as facilities implement social distancing, face coverings, and hand hygiene. However, indoor visits may be restricted based on the infection rate in your county. For example, if the current rate of positive cases is zero to 10 percent, indoor visitation is allowed. If infection rates in the county climb above 10 percent, visitation can only be held outdoors or may be prohibited. As has been the case throughout the pandemic, exceptions for indoor visitation apply in compassionate care and end-of-life circumstances.

Updated Payment Model for Cancer Treatment Under Medicare

In collaboration with the CMS Innovation Center, the Centers for Medicare and Medicaid Services (CMS) announced a new payment model for Medicare patients receiving radiation oncology treatment for cancer. The Radiation Oncology (RO) Model is effective Jan. 1, 2021.

Previously, patients receiving radiation oncology paid for each treatment individually. The new model, rather than charging item-by-item for treatment, bundles all payments for radiation oncology into a 90-day flat rate. This means that over a 90-day period, you pay the same amount no matter how many treatments you receive. The model is designed to incentivize health care providers to consolidate treatments into fewer visits, which can save patients time and travel expenses while also making their payments more predictable.

The new initiative requires participation from providers and covers radiation oncology for 16 different cancer types: anal cancer, bladder cancer, bone metastases, brain metastases, breast cancer, cervical cancer, CNS tumors, colorectal cancer, head and neck cancer, liver cancer, lung cancer, lymphoma, pancreatic cancer, prostate cancer, upper gastrointestinal cancer, and uterine cancer. As a Medicare beneficiary, you can still choose your provider as part of this new payment model.

CMS Supports Oregon Patients During Wildfires

On Sept. 16, a public health emergency was declared due to the wildfires in Oregon. In response, the Centers for Medicare and Medicaid Services (CMS) announced a series of steps to make health care facilities in the affected areas accessible for Medicare patients.

First, CMS will issue waivers to health care providers on certain services for Medicare, Medicaid and CHIP patients, as well as unenrolled patients who may be eligible for these programs. A special enrollment period is also being created for wildfire victims, ensuring faster access to healthcare during this emergency. Special enrollment periods give individuals time to sign up for Medicare, Medicaid, or CHIP coverage, change their plan, or add further coverage.

CMS has also prepared a Disaster Preparedness Toolkit for State Medicaid Agencies: an inventory of Medicaid and CHIP resources that states can utilize during public health emergencies. In the past, CMS provided similar relief to Medicare beneficiaries in the local area.

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