What changes will the political shift bring to Medicare?

May 15, 2021

Things are always changing in Washington, D.C. Aside from which individual is taking the reins, the congressional majority has shifted. This means that changes in strategy will take place in multiple areas, including your healthcare. 

Although it is unlikely that we will see any big structural changes to our healthcare system, small tweaks and new policies will probably hit the floor once the dust settles and everyone newly elected gets their feet wet. 

Medicare for All

The new administration has propped up its platform on a ‘Medicare for All’ stance. This is a massive initiative and will be very hard to bring to full fruition. 

Medicare for All would give all Americans access to a government-run health plan. Those on Medicare already would see a massive influx in other members of all ages taking advantage of the plan. It could impact how the plan is fundamentally structured. Whether that would benefit or harm the senior population would not be known until something happened.

Even though we will not see this complete rewrite of Medicare, we may see a simpler expansion to Medicare eligibility. This change may lower the age qualification to 60, bringing more people into the eligibility range.

The complications of changing healthcare

Unfortunately, any change to Medicare or healthcare in general does not come directly from the office of the President. They are capable of making plans, and having ideas, but it is up to Congress to put these ideas into action that then get voted on. This is because healthcare is considered an entitlement. Executive orders even from a President cannot get used for these.

Making this type of change centers around the Byrd Rule. It specifically deals with reconciliation bills, which are often used for passing health policy. They were used in 2010 to make final tweaks to the Affordable Care Act by Democrats, and Republicans attempted to use them in 2017 to repeal the health law altogether.

Smaller policy reforms have a better chance of succeeding, so it may be in any administration’s best interest to begin small and work up to larger changes. This would keep Medicare relatively the same as it is now, although beneficiaries may see a(n):

  • Reduction in the cost of health coverage
  • Lowered prices for certain, expensive prescription medications
  • Increase Medicare coverage to include dental, vision, and hearing

The underlying issue of Medicare

While the focus of healthcare as a whole these past few months has waffled between the Affordable Care Act and Medicare for All, another more pressing issue has crept up. It revolves around Medicare funding. 

With reduced revenue coming in as a result of the pandemic, the fund supporting Medicare Part A might not last as long as initially projected. This puts pressure on Congress to properly fund Part A to meet its future obligations for coverage. Aside from all the broad strokes, or small changes, taking care of this looming problem may really be the highest priority for any incoming administration.

Here is what is already happening in 2021

While these projected changes have time to marinate, there are changes to Medicare in 2021. Here is what was approved last year that have taken effect. It is good to note what they are, because they are happening now, and you might be able to take advantage of them.

Expanded Telehealth options for Medicare Advantage

Medicare Advantage plans now cover a wider range of Telehealth services. This change came as a response to COVID-19, and the large number of Medicare beneficiaries using Telehealth to receive virtual care safely from the comfort of their home.

Additional coverage options for beneficiaries with end stage renal disease

The addition of access to Medicare Advantage plans for eligible beneficiaries with ESRD also kicked in for 2021. That means individuals will have more coverage options to select a plan that really meets their needs.

Streamlined pricing for Medicare Part D

Part D has chronically suffered from the “donut hole” in pricing. After you pay the initial coverage limit for your prescription meds, you get stuck paying a percentage of out-of-pocket, until you reach the next threshold. Getting to that point has led some to pay more for prescription drugs.

For 2021, the initial Part D coverage limit is $4,130. The out-of-pocket threshold is $6,550. When you reach the in-between stage, which is referred to as the coverage gap or the donut hole, a firm discount for medication is now set at 75 percent. You will only be responsible for 25 percent. 
It will be interesting to see what the next four years bring, but whatever the modifications, the qualified experts at Healthcare Solutions Direct will remain available to guide you through Medicare’s options. We stay on top of all Medicare updates, so you do not have to. We will ensure that you fully understand what your policy contains while making certain that you have the right coverage. Contact us today to learn more.

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