Medicare is again seeing profound affects in 2021 due to COVID-19 – particularly concerning how to be tested, treated and, especially, vaccinated.
COVID-19 care and the disease itself are likely to evolve, so it’s vital to check with health care providers and trusted information sources before making decisions. The information and guidance here are current as of April 2021 and will be updated to reflect new developments.
COVID-19
Medicare covers all medically necessary COVID-19 care, and there are no out-of-pocket costs for testing and vaccinations.
Because the COVID-19 vaccine supply is limited, the Centers for Disease Control and Prevention (CDC) recommends a phased approach, with those at highest risk receiving the vaccine first. Vaccinations have ramped up significantly in recent weeks with President Joe Biden asking states to make all American adults eligible for the vaccine by April 19.
Contact your caregivers, health insurers or state and local health authorities to find out when you can get vaccinated and where they recommend you receive injections. You can also check out the COVID-19 Vaccine Resource Locator, provided by UnitedHealthcare, to find local resources and information in one spot, based on your zip code.
Longer-term shifts in care
Telehealth services have exploded as an alternative to in-person care for many Medicare beneficiaries. Telehealth often is as simple as a phone or video call but may include sophisticated at-home monitoring and diagnostic services for people with chronic health conditions.
“Before the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service,” the Centers for Medicare & Medicaid Services (CMS) stated in early December. “CMS has added 144 telehealth services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services … preliminary data show that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service.”
Medicare is making many of these covered services permanent. The list of covered treatments and care is extensive. People with private Medicare Advantage plans should check with their insurer to make sure a service is covered, and also find in-network telehealth providers in addition to their own primary care doctor and specialists. People with Original Medicare should check with their doctors about which services are covered and, if needed, contact the federal Medicare contractor who administers Medicare in their state.
With few exceptions, nursing homes have been overwhelmed by COVID-19 cases and effectively quarantined. Demand for slots from new patients largely has disappeared, accelerating a shift to home-based care that many see as permanent.
Some Medicare plans cover home-based health services, including a growing array of non-medical services that can provide important improvements to health. These include home safety devices such as bathroom grab bars, delivery of prepared meals and other services that help address social determinants of health. Medicare Advantage plans are authorized to provide these services, so check with your insurance plan. These benefits are not yet available to Original Medicare beneficiaries but are expected to be added in the future.
Lastly, President Joe Biden issued an executive order in late January that created an enrollment period for the Affordable Care Act (ACA) from Feb. 15 to May 15, which could lead to expanded access to Medicaid and greater financial supports for ACA policyholders.
Important 2021 financial updates
With that, here are the 2021 numbers that you need to know about Medicare and Social Security rules that may affect you.
Medicare
Standard monthly Part B premium – $148.50 (up $3.90 from $144.60 in 2020).
Annual Part B deductible – $203 (up $5 from $198).
Full monthly Part A premium for hospital insurance (for those who haven’t worked enough to qualify for premium-free Part A) – $471 (up $13 from $458).
Part A hospital deductibles and coinsurance per 60-day episode of care:
| 2021 | 2020 |
Inpatient hospital deductible | $1,484 | $1,408 |
Daily coinsurance for 61st-90th days | $371 | $352 |
Daily coinsurance for lifetime reserve days | $742 | $704 |
Skilled Nursing Facility coinsurance | $185.50 | $176 |
High-income premiums (technically called income-related monthly adjustment amount, or IRMAA):
Part B
Individual tax returns | Joint tax returns | IRMAA | Total |
$88,000 or less | $176,000 or less | $ 0 | $ 148.50 |
Above $88,000; up to $111,000 | Above $176,000; up to $222,000 | $ 59.40 | $ 207.90 |
Above $111,000; up to $138,000 | Above $222,000; up to $276,000 | $ 148.50 | $ 297.00 |
Above $138,000; up to $165,000 | Above $276,000; up to $330,000 | $ 237.60 | $ 386.10 |
Above $165,000; up to $500,000 | Above $330,000; up to $750,000 | $ 326.70 | $ 475.20 |
$500,000 or more | $750,000 or more | $ 356.40 | $ 504.90 |
Married, separate tax returns | IRMAA | Total |
$88,000 or less | $ 0 | $ 148.50 |
Above $88,000; up to $412,000 | $ 326.70 | $ 475.20 |
$412,000 or more | $ 356.40 | $ 504.90 |
Part D (IRMAA charges added to your monthly Part D premium)
Individual tax returns | Joint tax returns | Married, separate tax returns | IRMAA |
$88,000 or less | $176,000 or less | $88,000 or less | $ 0 |
Above $88,000; up to $111,000 | Above $176,000; up to $222,000 | n/a | $ 12.30 |
Above $111,000; up to $138,000 | Above $222,000; up to $276,000 | n/a | $ 31.80 |
Above $138,000; up to $165,000 | Above $276,000; up to $330,000 | n/a | $ 51.20 |
Above $165,000; up to $500,000 | Above $330,000; up to $750,000 | Above $88,000; up to $412,000 | $ 70.70 |
$500,000 or more | $750,000 or more | $412,000 or more | $ 77.10 |
Social Security
Annual COLA (cost-of-living adjustment) – 1.3% increase (down from 1.6% for 2020)
Wage ceiling (contribution and benefit base) subject to payroll taxes – $142,800 (up $5,100, or 3.7%, from $137,700 in 2020)
Monthly earnings limits for disability benefits:
Non-Blind – $1,310 (up $50 from $1,260 in 2020)
Blind – $2,190 (up $80 from $2,110 in 2020)
Trial work period – $940 (up $30 from $910 in 2020)
Earnings Test (benefit reductions for Social Security recipients younger than full retirement age (FRA) who continue to earn wage income):
Under FRA: Earnings exemption ends at $18,960 (up $720 from $18,140 in 2020)
Note: $1 in benefits will be withheld for every $2 earned above the exemption amount.
The year in which you reach your FRA: Earnings exemption ends at $50,520 (up $1,920 from $48,600 in 2020)
Note: $1 in benefits will be withheld for every $3 earned above the exemption amount.
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Journalist Phil Moeller is an expert on retirement and health. He is the principal author of the Get What’s Yours series of consumer guides, published by Simon & Schuster: “Get What’s Yours for Health Care: How to Get the Best Care at the Right Price” (2021); “Get What’s Yours for Medicare: Maximizing Your Coverage; Minimizing Your Costs” (2016); and, as co-author, The New York Times bestseller, “Get What’s Yours: The Secrets to Maxing Out Your Social Security” (2015, 2016). You can follow him on Twitter (@PhilMoeller) or reach him via e-mail: AskPhilByUHC@gmail.com.