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Medicare Advantage Coverage Expansion for 2021 Plan Year

By: Lindsay Malzone
Tel: 800-845-2484
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The Centers for Medicare & Medicaid Services (CMS) have implemented several requirements for Medicare Advantage plans in the year to come. Among the new features of Medicare Advantage plans, the changes aim to help patients and providers stay safe by allowing treatment to happen at home through telehealth. The ultimate goal of the changes is to provide the best coverage for beneficiaries through the pandemic and beyond.

Greater Access to Telehealth for Medicare Advantage Patients

As part of a bigger attempt to expand telehealth, CMS's changes will widen its availability for Medicare Advantage patients. Medicare beneficiaries tend to be more vulnerable to the effects of COVID-19. Thus, access to care at home is crucial. Telehealth makes this at-home care possible.

More Options for Rural Areas

CMS is encouraging Medicare Advantage plans to provide more benefits and options for those living in rural areas. Due to limited networks, Medicare Advantage enrollment tends to be lower in these areas.

The new options include covering telehealth appointments with specialists, such as cardiologists, psychiatrists, and dermatologists. Advantage plans will offer these options due to the new flexibility provided by CMS.

This change will significantly increase the health care choices for those living in rural areas. With access to many providers within the comfort of their homes, rural residents covered by Advantage plans will experience more comprehensive health care. Further, the increased plan options will help Part C plans build networks in rural areas.

Inclusion of ESRD Patients in Medicare Advantage Plans

Presently, patients with End-Stage Renal Disease (ESRD) are permitted only to enroll in Part C plans under specific circumstances. Starting in 2021, all ESRD patients will be able to enroll in an Part C plan.

This change implements the 21st Century Cures Act and gives ESRD patients access to coverage that may include transportation and meals delivered to their homes. As per the Executive Order on Advancing American Kidney Health, this step aims to improve ESRD patients' lives. Further, the rule puts into practice payment changes for kidney acquisition of Medicare Advantage patients.

Hospice Benefit

In 2021, there will be changes considering Advantage enrollees who choose hospice. In further efforts to improve care, payment rates to hospice providers will increase by 2.4% for the fiscal year, for a total of $540 million. Additionally, hospices deemed to be low in quality will have their payment rate decreased by 2%.

More Supplemental Benefits for the Chronically Ill

Special Supplemental Benefits for the Chronically Ill (SSBCI) refers to guidelines that took effect in the Advantage program on the first of this year. These guidelines allow Advantage plans to provide non-health care-related services and benefits to chronically ill individuals, with the goal of improving their health. These include food delivery, non-medical transportation, and service dogs.

The new rules that CMS is implementing will expand SSBCI. CMS will be lifting its limits on chronic conditions to be more inclusive than those listed in the Medicare Managed Care Manual. The Manual outlines the conditions that are currently covered.

Improving the Star Ratings System

Another change in Advantage plans in 2021 for discussion is the Star Ratings System. This system is in place for the rating of Advantage and Part D plans.

CMS is changing the way that ratings are weighted. Weighting for customer complaints and experiences will be more significant. This change exhibits CMS's promise to put patients first and empowers them to make the best health care decisions.

New Special Election Periods

The last change for discussion results from the Star Ratings System improvements. In further efforts to put patients first, CMS is introducing two new Special Election Periods for Part C and Part D plans.

Special Election Periods (SEPs) serve as times when beneficiaries can change their coverage, outside of the initial or annual enrollment periods. CMS is establishing Special Election Periods for those currently enrolled in a plan:

  • Identified by CMS as a Consistent Poor Performer
  • Experiencing financial difficulties that have placed the plan in receivership

The SEP for either begins on the date when the incident starts. If your plan is a Consistent Poor Performer, you'll receive a notice from Medicare.

What These Changes Mean for You

If you have a Medicare Advantage plan, 2021 will bring changes that will improve and expand your health care options. CMS is working hard to ensure that Medicare Advantage plans are more inclusive and focused on keeping patients safe and empowered to work with their providers to make the best decisions. Additionally, CMS will see that those with ESRD, chronic conditions, and in hospice will receive comprehensive care from Advantage plans.


Lindsay Malzone is the Medicare Consultant for MedicareFAQ. She has worked in the Medicare industry since 2017 and is featured in many publications as well as writing Medicare focused columns for other publications.

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