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2021 Changes to Medicare Coverage: A Medicare Customer Question

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Some Medicare enrollment questions come from current and future beneficiaries unclear about how new rules might impact their coverage.

(Related: Health Care Options During Unemployment: A Medicare Customer Question)

Here’s one that’s probably on the minds of many Medicare-eligible employees going into the new year.

The Question

What changes have been made to Medicare for 2021 and how will they affect my coverage?

The Answer

There are two recent changes to be aware of that should have positive implications for all Medicare beneficiaries.

To speed the availability of new treatments, the Centers for Medicare and Medicaid Services (CMS) recently issued a new rule that accelerates Medicare coverage for technological innovations. This rule, called Medicare Coverage of Innovative Technology (MCIT), will provide national Medicare coverage as early as the same day as the Food and Drug Administration (FDA) authorizes breakthrough devices to be released into the market. The coverage would last for four years and provide Medicare beneficiaries with predictable access to new, breakthrough devices that may help improve their overall health outcomes.

The same rule also clarifies and codifies the agency’s definition of “reasonable and necessary” coverage for services that fall under Medicare Parts A and B. This part of the rule applies to more than just technological innovations and will be used to make coverage determinations for a wide variety of services. According to the text of the rule, an item or service must be safe and effective, not experimental or investigational, and appropriate for Medicare patients.

Overall, the changes made by this rule are a win-win: they will give Medicare beneficiaries immediate access to innovative technologies that address their health needs, while at the same time keeping them safe from experimental procedures or untested devices that could put their health at risk.

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Bethany CissellBethany Cissell is a health care insurance services specialist at Allsup.