What to Expect in 2021: Medicare Overview

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Today, please welcome Medicare expert Danielle Kunkle Roberts as she updates us on Medicare changes for 2021.

Woman in a yellow shirt with glasses sitting on a couch reading a book.

Medicare is the healthcare coverage provided by the U.S. government. Seniors age 65 and over and those with certain disabilities qualify for coverage. As with private insurance, Medicare often changes its costs and coverage each year. Here is a Medicare overview and what to expect in 2021.

Medicare covers COVID-19

COVID-19 is especially dangerous for seniors. Because of this, Medicare made several changes to its coverage to meet beneficiaries’ healthcare needs and avoid unnecessary risk of exposure.

If you begin to feel any of the COVID-19 symptoms – dry cough, high fever, loss of taste/smell – you can get the COVID-19 nasal swab test to detect if you currently have COVID-19. There is another COVID-19 test, the serology test, which detects COVID-19 antibodies. If you have antibodies, it means you had the virus in the past. If you have either of these tests at a hospital, doctor’s office, or a select drive-thru location, Medicare Part B will cover the test at 100%.

Medicare waived the deductible and coinsurance requirements to ensure senior citizens can get tested for COVID-19 whenever they need to with no out-of-pocket costs.

The FDA authorized two COVID-19 vaccines for emergency use: The Pfizer-BioNTech vaccine and the Moderna vaccine. If you are administered either of these, Medicare Part B covers 100% of the costs. There are no out-of-pocket costs for either the COVID-19 test or vaccine.

No health questions on Medicare Advantage applications

Many Medicare beneficiaries enroll in a Medicare Advantage as a Medicare alternative. In the past, when you applied for a Medicare Advantage plan, you would be asked if you had end-stage renal disease (ESRD). Those who answered yes were denied coverage unless there was a Special Needs Medicare Advantage plan available.

In 2021, all Medicare beneficiaries, regardless of ESRD status, can purchase a Medicare Advantage plan. As of January 1, insurance companies can no longer ask about your ESRD status when you apply for a Medicare Advantage plan.

Medicare beneficiaries can save on insulin

According to the Center for Disease Control and Prevention (CDC), in 2015, about 12 million senior citizens had some form of diabetes. The cost of insulin has steadily increased over the years; the current average cost for a vial of insulin is $250. Some seniors may need more than one vial of insulin each month.

The Part D Senior Savings Model is new for 2021. Seniors who buy one of these plans pay a maximum of $35 out-of- pocket for covered insulin prescriptions. This new low copayment applies at every stage of coverage; you don’t have to meet your plan deductible to take advantage of low insulin copays.

The Part D Senior Savings Model will help ensure that seniors can buy the insulin they need without any financial roadblocks.


It’s always a good idea to check the Medicare website prior to the new year to see how your coverage will change. If you need help understanding your coverage or exploring your Medicare options, get in touch with a licensed Medicare broker for personalized guidance.

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