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Medicare Advantage Changes Effective January 1, 2021

Audience: All Providers and Facilities

We would like you to be aware of the following benefit and administrative changes effective January 1, 2021 for our members who have Medicare Advantage coverage. Members will be notified of these changes in September.

The Annual Enrollment Period (AEP) extends from October 15 to December 7, 2020. Medicare beneficiaries can enroll or switch plans during this time.   

If members have questions, encourage them to visit or call a Customer Care Advocate at 1-877-883-9577 (TTY users call 1-800-662-1220) Monday to Friday from 8 a.m. to 8 p.m. From October 1 to March 31 we are available seven days a week from 8 a.m. to 8 p.m. 

Most members will not receive new ID cards this year. Please encourage members to continue to use their current ID card. Be sure to verify eligibility prior to providing service.

  • Applicable to Medicare Advantage plans for individuals (does not apply to members who receive a Medicare Advantage plan through a former employer): 
    • NEW Over-the-Counter (OTC) Benefit – Receive $30 per quarter for over-the-counter pre-approved medication and supplies. (Available only in the Syracuse and East Regions, not available in Rochester)
    • NEW Medicare Insulin Savings Program – Available on select plans. Members pay one low price for insulin throughout the entire year without a deductible or higher cost in the coverage gap
  • Applicable to all Medicare Advantage members: 
    • More coverage options for people with end-stage renal disease (ESRD) – People with ESRD can enroll in 2021 Medicare Advantage plans. Previously, they could only enroll in Medicare Advantage plans under limited circumstances. Additionally, organ acquisition costs of kidney transplants will be covered under Original Medicare rather than Medicare Advantage plans.  
    • Acupuncture coverage – Members pay 50 percent of the cost. Plans cover up to 20 visits per calendar year for chronic low back pain and an additional 10 visits per calendar year for all other diagnoses. 
    • Continuous Glucose Monitoring (CGM) – Supplies can be purchased at a participating retail pharmacy, participating mail-order pharmacy, or a participating durable medical equipment provider. CGM supplies require a $5 copayment per item for each 30-day supply. We cover FreeStyle Libre and Dexcom G-6 products. Prior authorization is required; quantity limits may apply.
    • Enhanced TruHearing Benefit – For an additional $50 per aid, members can get a rechargeable hearing aid. 
    • Enhanced Silver&Fit fitness benefit – Members can choose to participate in both the Home Fitness Program and by joining a participating fitness center. 

We hope that you find this information helpful. If you have questions, please contact your Provider Relations representative.

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