Get kamagra

A General Motors cheap kamagra pills scientist who conducted pioneering research on climate change in get kamagra the 1960s says she faced sexism that made it difficult to do her job. Ruth Reck's allegations raise questions about whether GM executives dismissed or downplayed her findings on global warming because of her gender. Reck joined get kamagra GM Research Laboratories in Warren, Mich., in 1965 and soon began studying the effects of car emissions on the climate, E&E News reported as part of a monthslong investigation (Climatewire, Oct.

26). As the first female scientist in the lab, she encountered an environment in which male co-workers evaluated her body rather than her brains. "I had a get kamagra very difficult time working at GM in general.

They told me I was a distraction because I was a shapely woman. I don't want to go into detail, but it was really hard. Really, unbelievably embarrassing," get kamagra Reck recalled in one of several phone interviews with E&E News.

The lab was located inside the GM Technical Center, which had been designed by the noted Finnish-American architect Eero Saarinen. Its walls were get kamagra made almost entirely of glass. "There was glass everywhere.

You could see everyone everywhere," Reck said. "And the men, I was told get kamagra I distracted them. You could just tell that their eyes were on you all the time." In response, GM constructed a makeshift wall around Reck's workspace so passing colleagues couldn't peer inside.

"They built something so that people couldn't see me — some kind of a wall or something — when people walked down the hallway," she said. "They put get kamagra me in a position where I wouldn't be seen by the men." It was inside this cocoon that Reck conducted groundbreaking research on aerosols, or particles that can come from cars and factories. She found that aerosols caused "heating of the atmosphere near the poles," and her work was published in several peer-reviewed scientific journals, including Science and Atmospheric Environment.

During this time, a male vice president took several women at GM out to lunch. Reck was get kamagra the only woman in the group with a Ph.D. The rest were secretaries.

That experience get kamagra preceded meetings with three high-level executives at GM — all men — who doubted Reck's conclusions on global warming. In response to questions about Reck's allegations, GM spokesman Jim Cain said the automaker today is committed to diversity and inclusion. "As you can imagine, there is no practical way to respond to Ruth Reck's experiences other than to take her at her word and underscore that what she describes is antithetical to the company's values today," Cain said.

"General Motors is acutely aware of its responsibility and opportunity to use our scale and resources to drive a better, more inclusive future for all," he get kamagra added. CO2 and the CEOs Throughout the 1970s, Reck researched the effects of greenhouse gases such as carbon dioxide. Her work offered strong evidence that CO2 heated the planet and could trigger dire consequences on Earth, such as melting ice sheets and sea-level rise.

Despite her expertise, Reck was passed over for the get kamagra opportunity to lead GM's task force on global warming in 1989. That distinction went to Joseph "Joe" Colucci, an engineer who specialized in automotive fuels and lubricants — and who had not published any papers on climate change in peer-reviewed journals. Led by Colucci, the task force drafted and released a report on the technologies needed to get kamagra address global warming.

Reck was never asked to review the document. "What really bothered me was ... Things were written down and reports published, and I get kamagra never saw them before they were published," she said.

In a 2017 memoir titled "Special Memories of My Career at General Motors," Colucci recounted how the automaker convened the task force to investigate the "science of global warming." He also described how he was reprimanded for making a sexist comment about the Western States Petroleum Association (WSPA) by Betsy Ancker-Johnson, GM's vice president of environmental activities staff and the first female vice president in the U.S. Auto industry. "I sent a note to the GM get kamagra management.

It said, 'We went through the mating dance with WSPA, but were unable to consummate the relationship.' The note was easily understood, and received praise from all but one GM Exec. Dr. Betsy Ancker-Johnson, VP, Environmental Activities, chastised me for my 'sexist' comments," Colucci get kamagra wrote.

Despite being excluded from the task force, Reck was asked to present her findings on climate change to three top executives at GM's corporate headquarters in Detroit. James "Jimmy" Johnston, a vice president of government relations get kamagra. Roger Bonham Smith, who became chairman and CEO of GM in 1981.

And Robert "Bob" Stempel, who succeeded Smith in 1990. The two CEOs reacted with skepticism get kamagra. "I know in my heart of hearts what some of those people at GM were thinking.

And they were questioning climate change. No doubt about that," get kamagra Reck said. "I was not.

And I knew because I was using equations and I was doing get kamagra the calculations correctly. And I always found it frustrating when you'd look at their faces after what you'd said ... And you could see they were not responding the way you'd hope they would," she added.

After learning from Reck get kamagra that CO2 emissions from car tailpipes warmed the planet, the CEOs largely declined to alter GM's business model and lobbying practices in response. Both Smith and Stempel presided over periods in which the automaker invested in gas-guzzling trucks and SUVs while fighting fuel economy regulations that would have made those vehicles cleaner. At first, Johnston appeared to take a keen interest in Reck's research, and the two forged an unusual friendship.

But in 1989, he orchestrated GM's involvement get kamagra in the Global Climate Coalition, a lobbying group that opposed actions to reduce greenhouse gas emissions during the George H.W. Bush administration, said Marina von Neumann Whitman, who was GM's vice president and group executive for public affairs at the time. Johnston "felt his major obligation was to 'protect the product plan.' And he was the one that got General Motors into the Global Climate Coalition," said Whitman, who is now a professor at the University of Michigan's Gerald R.

Ford School of Public get kamagra Policy. After leaving GM, Johnston joined the American Enterprise Institute, a conservative think tank whose scholars have said concern about climate change is overblown. While at AEI, he get kamagra published a book titled "Driving America.

Your Car, Your Government, Your Choice" that argued the science was not settled on "whether the climate is warming and, if so, whether the warming is the result of human activity." 'Voices just haven't been heard' It's unclear whether sexism played a role in the CEOs' decisions to doubt Reck's conclusions on climate change. Sexist attitudes and intentions are difficult to prove, and her conclusions posed an inconvenient truth about their profit-making strategy. What is clear is that their reactions were part of a broader pattern of women in the auto industry feeling underrepresented and dismissed by get kamagra their male counterparts — a pattern that persists today.

In 1988, the Associated Press reported that women constituted less than 2% of executives in the U.S. Auto industry. "It's certainly been a man's domain for many years," Jeanne Beyer, then the vice president for get kamagra market research and planning at GM, told the AP at the time, noting that women had only started choosing careers in the auto industry in the prior 10 to 15 years.

Almost three decades later, an Automotive News survey of nearly 900 women found that misogyny was pervasive in the U.S. Auto industry get kamagra. Forty-three percent of respondents said they believed they had been passed over for promotions because of their gender.

More than half — 55% — reported receiving unwelcome comments on their appearance. Many respondents pointed to Mary Barra's appointment in 2014 as CEO of GM — and the first female CEO of a major automaker — get kamagra as a breakthrough moment for women in the industry. But they said it didn't diminish the discrimination they faced on a daily basis.

"Everything I've heard from women in the industry is that it is really bad. It is still not your most woke get kamagra industry. And it's still very common to be the only woman in a room," Sharon Silke Carty, who helped conduct the survey, said in an interview with E&E News.

"I think the industry get kamagra has lost a lot of talented women who opt to go other places because it's too hard. And I think women's voices just haven't been heard the way that male voices have been heard," said Carty, who is now editor-in-chief of Car and Driver, an automotive magazine whose pages have oozed with masculine imagery since its creation in 1955. Mary Beth Vander Schaaf, a managing editor at Automotive News who also helped administer the survey, said she thinks the industry has made some strides toward gender equality.

Vander Schaaf noted that Automotive News has conducted a poll every five years of 100 leading women in the North American auto industry get kamagra. This year's results — which are set to be published next month — will reveal that respondents believe the industry has made progress on pay equity. On a personal note, Vander Schaaf said she felt inspired by Barra's ascendence to the top of GM.

"The appointment of Mary Barra as CEO was historic get kamagra. For me, it was like when John Lennon was killed or the Challenger exploded. I remember where I was when I heard the news.

It was that big a deal," she said get kamagra. 'Enraging and heartbreaking' Women have been overlooked in the field of climate science, as well. Eunice Newton Foote, the first woman in climate get kamagra science, posited in 1856 that CO2 affected the Earth's temperature.

But the Irish physicist John Tyndall widely gets credit for the theory, which he suggested three years later, wrote Ayana Elizabeth Johnson and Katharine Wilkinson in their recent book "All We Can Save. Truth, Courage and Solutions for the Climate Crisis." "We have to wonder if Eunice Newton Foote ever found herself remarking, as so many women have. 'I literally just said that, dude,'" Johnson and get kamagra Wilkinson wrote in the book, which serves as a call to action for women to become leaders in the climate activism movement.

In an interview with E&E News, Wilkinson said many female climate scientists who are active today have had experiences similar to the one endured by Foote. Wilkinson — who serves as vice president at Project Drawdown, a nonprofit organization that seeks to help the world reduce greenhouse gas emissions — pointed to a 2018 study in the Proceedings of the National Academy of Sciences on female scientists who authored U.N. Intergovernmental Panel get kamagra on Climate Change assessments.

The study found that while some female authors had a positive experience, others felt they were "poorly represented and heard" on the powerful scientific body. "This would be get kamagra frustrating in any field," Wilkinson said. "But it is especially enraging and heartbreaking when it is a field that has such a critical role to play in a livable future." Wilkinson said she asks herself "What if?.

" in relation to Foote, Reck and other climate scientists whose work could have been used to exert a greater influence on reining in heat-trapping emissions. "The 'what ifs' are gutting," she said get kamagra. "What if Foote had had the resources and the platform that John Tyndall had?.

What might she have accomplished?. What get kamagra might Ruth Reck have been able to influence?. And the truth is we don't know." Cain, the GM spokesman, noted that the automaker recently announced it would aspire "to be the most inclusive company in the world" following the death of George Floyd, a Black man, in the custody of Minneapolis police officers.

As part of that goal, Barra committed to establishing an Inclusion Advisory Board that would consult with GM's senior leadership about racism and other forms of discrimination. After 27 years at GM, Reck left the automaker in get kamagra 1992 to become head of the global climate change program at Argonne National Laboratory. She was the first female senior scientist at Argonne who hadn't been recommended by her husband.

Now 88 years old and retired, Reck identifies as a feminist and believes gender equality — in addition to climate change — represents a defining issue of the get kamagra century. "I'm a feminist, and that changes how I think about things. There were women who were not feminists and disagreed with me, thinking men deserved higher pay because they brought more to the scene.

I did get kamagra not think that," Reck said in a follow-up text message to E&E News. "I believe God intended us to be how we are," she added. "There's no reason we should be criticized for how we are.

I am proud to be get kamagra female. The men should be professional enough to act in a grown-up way." Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news at www.eenews.net..

Kamagra 50mg

WEDNESDAY, Dec kamagra 50mg https://therambarranlawfirm.com/how-to-buy-propecia/. 30, 2020 (HealthDay News) -- The erectile dysfunction treatment kamagra may be taking a bigger toll on women's mental health than on men's, new research suggests. For the study, researchers examined the results of an kamagra 50mg online survey of 112 men and 459 women in Canada.

The survey took place between March 23 and June 7, 2020. During that time, schools and many businesses were closed, and people were told to stay home as much as possible to reduce erectile dysfunction transmission. More than 66% of the survey participants reported poor sleep kamagra 50mg quality and more than 39% reported worsening insomnia.

All said they had increased anxiety and distress. Sleep problems, depression and anxiety symptoms were more common in women than in men, according to the report published online recently in the journal Frontiers in Global Women's Health. "Generally, the study found women reporting more anxiety and depression," said study author Veronica kamagra 50mg Guadagni, a postdoctoral scholar in the University of Calgary School of Medicine.

"Their symptoms worsened over time and with greater length of the isolation period." Guadagni noted that there was a progressive rise in anxiety, depression, poor sleep quality and trauma for both men and women, but it was greater for women over time. Women also reported higher scores on a scale measuring empathy, the ability to understand the emotions of others and care for them. But greater empathy was associated with greater anxiety, depression and trauma, the study authors noted in a university news kamagra 50mg release.

"I was not surprised by the findings. Women are the ones who carry the additional load," said senior investigator Giuseppe Iaria, a professor of psychology. "Taking care of family and critical situations has always been a huge load on women and females." Guadagni pointed out that greater empathy among women may mean they're more likely to follow public health guidelines, such as washing hands, social distancing and kamagra 50mg wearing a mask.

"If we see that higher empathy is connected to prosocial behavior we could expect that the people who actually care more for others would be more respectful of the rules. Future studies should test this specific hypothesis," she said. More kamagra 50mg information The U.S.

National Institute of Mental Health has more on erectile dysfunction treatment and mental health. SOURCE. University of Calgary, kamagra 50mg news release, Dec.

22, 2020Business Insider. €œCyc Fitness and YogaWorks just filed for bankruptcy -- here are the 7 fitness and sporting goods companies that have folded in 2020 as the kamagra upends how Americans exercise.” Karen Juul, Stamford, CT. Haylin Alpert, owner, Core Principles kamagra 50mg Personal Training, Stamford, CT.

Amy Williams, public relations manager, Life Time Fitness. 24 Hour Fitness. Josh Leve, founder and kamagra 50mg CEO, Association of Fitness Studios.

Rick Mayo, owner, Alloy Personal Training, Roswell, GA. Bryan O’Rourke, board of directors, International Health, Racquet &. Sportsclub Association kamagra 50mg.

Jeff O’Mara, franchise owner, Anytime Fitness. Adam Stewart, Atlanta..

WEDNESDAY, Dec get kamagra. 30, 2020 (HealthDay News) -- The erectile dysfunction treatment kamagra may be taking a bigger toll on women's mental health than on men's, new research suggests. For the study, researchers examined the results of get kamagra an online survey of 112 men and 459 women in Canada. The survey took place between March 23 and June 7, 2020.

During that time, schools and many businesses were closed, and people were told to stay home as much as possible to reduce erectile dysfunction transmission. More than 66% of the survey participants reported poor sleep quality and more than 39% reported worsening insomnia get kamagra. All said they had increased anxiety and distress. Sleep problems, depression and anxiety symptoms were more common in women than in men, according to the report published online recently in the journal Frontiers in Global Women's Health.

"Generally, the study found women get kamagra reporting more anxiety and depression," said study author Veronica Guadagni, a postdoctoral scholar in the University of Calgary School of Medicine. "Their symptoms worsened over time and with greater length of the isolation period." Guadagni noted that there was a progressive rise in anxiety, depression, poor sleep quality and trauma for both men and women, but it was greater for women over time. Women also reported higher scores on a scale measuring empathy, the ability to understand the emotions of others and care for them. But greater empathy was associated with greater anxiety, depression get kamagra and trauma, the study authors noted in a university news release.

"I was not surprised by the findings. Women are the ones who carry the additional load," said senior investigator Giuseppe Iaria, a professor of psychology. "Taking care of family and critical situations has always been a huge load on women and females." Guadagni pointed out that greater empathy among women may mean they're more likely to follow public health guidelines, such as washing hands, social distancing and wearing get kamagra a mask. "If we see that higher empathy is connected to prosocial behavior we could expect that the people who actually care more for others would be more respectful of the rules.

Future studies should test this specific hypothesis," she said. More information get kamagra The U.S. National Institute of Mental Health has more on erectile dysfunction treatment and mental health. SOURCE.

University of Calgary, news release, Dec get kamagra. 22, 2020Business Insider. €œCyc Fitness and YogaWorks just filed for bankruptcy -- here are the 7 fitness and sporting goods companies that have folded in 2020 as the kamagra upends how Americans exercise.” Karen Juul, Stamford, CT. Haylin Alpert, owner, Core Principles get kamagra Personal Training, Stamford, CT.

Amy Williams, public relations manager, Life Time Fitness. 24 Hour Fitness. Josh Leve, founder and CEO, Association of Fitness get kamagra Studios. Rick Mayo, owner, Alloy Personal Training, Roswell, GA.

Bryan O’Rourke, board of directors, International Health, Racquet &. Sportsclub Association get kamagra. Jeff O’Mara, franchise owner, Anytime Fitness. Adam Stewart, Atlanta..

Where can I keep Kamagra?

Keep out of reach of children. Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Can u buy kamagra over the counter

Location http://dpfcleaningkent.co.uk/where-is-better-to-buy-levitra/ can u buy kamagra over the counter. 89-91 Academy can u buy kamagra over the counter Street, Belfast, BT1 2LSSalary. £32,000 (depending on experience) plus personal development budget of £5000Contract Type. Fixed Term (30 can u buy kamagra over the counter months)Closing Date.

23.59 hours BST on Friday 04 June 2021Interview Date. To be confirmedThis is an exciting opportunity for a professionally qualified Optometrist to develop a Digital Decision Support System to aid the diagnoses of eye diseases and improve can u buy kamagra over the counter patients’ quality of care. You will lead a project team, managing the expectations of various stakeholders, under the guidance of an Academic and Company Supervisor with additional support from a mentor from Innovate UK.This position is 30 months fixed term contract, with up to £5000 dedicated training budget tailored towards your personal development and future career.Candidate Profile. You will can u buy kamagra over the counter have a BSc/ BOptom/ MOptom degree (min 2:1) in Optometry or related discipline (e.g.

Medicine/Ophthalmology) and will be registered with the General Optical Council/ General Medical Council or similar.Key skills/ experience required include:Ability to initiate can u buy kamagra over the counter &. Conduct evidence based studies gathering clinical data Sound IT skills, particularly in Microsoft Excel to support development of an AI based solution (additional training will be provided as required).Ability to work with complex concepts and explore creative problem solving approaches.Personal attributes:Work collaboratively with a range of stakeholders in a multidisciplinary project teamExcellent written and verbal communication skills. Strong organisational skills to take project ownership, co-ordinate work-streams and achieve agreed can u buy kamagra over the counter objectives.Self-motivated &. Confident with good persuasion &.

Negotiation skills can u buy kamagra over the counter. Fit in with the organisational culture and present a positive image of the company to clients.This is a Knowledge Transfer Partnership (KTP) funded by Cathedral Eye Clinic and Innovate UK. It is essential you can u buy kamagra over the counter understand how KTP works and the vital role you will play if you secure this position. To learn more please visit www.aston.ac.uk/ktpThe Company.

Cathedral Eye Clinic can u buy kamagra over the counter is a world-class eye healthcare facility with a team of ophthalmologists with specialist expertise in laser and lens replacement surgery, management/ treatment of cataract, retinal conditions, glaucoma and oculoplastics. It recently can u buy kamagra over the counter launched a specialised clinic for the diagnosis and treatment of Ocular Surface Conditions such as Dry Eye Disease. For more information see https://cathedraleye.com/Aston University. You will work alongside an academic team led by Dr Shehzad Naroo with support from Dr Mark Dunne, Dr Raquel Gil Cazorla and Professor Sunil Shah from Aston’s can u buy kamagra over the counter Vision Sciences Department within the School of Life and Health Sciences, which undertakes cutting-edge research with real impact.Location.

You will be based predominantly at Cathedral Eye Clinic in Belfast but will also have access to facilities at Aston University in central Birmingham. Some travel to key clients may also be required.For informal enquiries call Dr Shehzad Naroo on 0121 204 4132 or s.a.naroo@aston.ac.uk or ktp@aston.ac.uk.Aston University is committed to can u buy kamagra over the counter the principles of the Athena SWAN Charter http://www.ecu.ac.uk/equality-charter-marks/athena-swan/, recognised by a bronze award. We pride ourselves on our vibrant, friendly, supportive working environment and collaborative atmosphere.Please visit our website https://jobs.aston.ac.uk/vacancies.aspx?. Cat= for further information and to apply online.

As users of the disability confident scheme, we guarantee to interview all disabled applicants who meet the minimum criteria for the vacancy.

Location. 89-91 Academy Street, Belfast, BT1 2LSSalary. £32,000 (depending on experience) plus personal development budget of £5000Contract Type. Fixed Term (30 months)Closing Date.

23.59 hours BST on Friday 04 June 2021Interview Date. To be confirmedThis is an exciting opportunity for a professionally qualified Optometrist to develop a Digital Decision Support System to aid the diagnoses of eye diseases and improve patients’ quality of care. You will lead a project team, managing the expectations of various stakeholders, under the guidance of an Academic and Company Supervisor with additional support from a mentor from Innovate UK.This position is 30 months fixed term contract, with up to £5000 dedicated training budget tailored towards your personal development and future career.Candidate Profile. You will have a BSc/ BOptom/ MOptom degree (min 2:1) in Optometry or related discipline (e.g.

Medicine/Ophthalmology) and will be registered with the General Optical Council/ General Medical Council or similar.Key skills/ experience required include:Ability to initiate &. Conduct evidence based studies gathering clinical data Sound IT skills, particularly in Microsoft Excel to support development of an AI based solution (additional training will be provided as required).Ability to work with complex concepts and explore creative problem solving approaches.Personal attributes:Work collaboratively with a range of stakeholders in a multidisciplinary project teamExcellent written and verbal communication skills. Strong organisational skills to take project ownership, co-ordinate work-streams and achieve agreed objectives.Self-motivated &. Confident with good persuasion &.

Negotiation skills. Fit in with the organisational culture and present a positive image of the company to clients.This is a Knowledge Transfer Partnership (KTP) funded by Cathedral Eye Clinic and Innovate UK. It is essential you understand how KTP works and the vital role you will play if you secure this position. To learn more please visit www.aston.ac.uk/ktpThe Company.

Cathedral Eye Clinic is a world-class eye healthcare facility with a team of ophthalmologists with specialist expertise in laser and lens replacement surgery, management/ treatment of cataract, retinal conditions, glaucoma and oculoplastics. It recently launched a specialised clinic for the diagnosis and treatment of Ocular Surface Conditions such as Dry Eye Disease. For more information see https://cathedraleye.com/Aston University. You will work alongside an academic team led by Dr Shehzad Naroo with support from Dr Mark Dunne, Dr Raquel Gil Cazorla and Professor Sunil Shah from Aston’s Vision Sciences Department within the School of Life and Health Sciences, which undertakes cutting-edge research with real impact.Location.

You will be based predominantly at Cathedral Eye Clinic in Belfast but will also have access to facilities at Aston University in central Birmingham. Some travel to key clients may also be required.For informal enquiries call Dr Shehzad Naroo on 0121 204 4132 or s.a.naroo@aston.ac.uk or ktp@aston.ac.uk.Aston University is committed to the principles of the Athena SWAN Charter http://www.ecu.ac.uk/equality-charter-marks/athena-swan/, recognised by a bronze award. We pride ourselves on our vibrant, friendly, supportive working environment and collaborative atmosphere.Please visit our website https://jobs.aston.ac.uk/vacancies.aspx?. Cat= for further information and to apply online.

As users of the disability confident scheme, we guarantee to interview all disabled applicants who meet the minimum criteria for the vacancy.

Kamagra chewable tablets uk

Over the last kamagra chewable tablets uk decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a larger role in the Medicare program http://mpa.ms/order-propecia-online/. In 2020, more than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2021 and key trends over time.Plan Offerings in 2021Number of PlansNumber of Plans Available to kamagra chewable tablets uk Beneficiaries.

For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade (Figure 1).Figure 1. The average Medicare beneficiary has access to 33 Medicare Advantage plans in 2021, an increase from prior yearsAmong the 33 Medicare Advantage plans generally available for individual enrollment to the average Medicare beneficiary, kamagra chewable tablets uk 27 of the plans include prescription drug coverage (MA-PDs). These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs) and PACE plans, which are only available to select populations.Total Number of Plans.

In total, 3,550 Medicare Advantage plans are available nationwide for individual enrollment in 2021 – a 13 percent increase (402 more plans) kamagra chewable tablets uk from 2020 and the largest number of plans ever available (Figure 2. Appendix Table 1). The vast majority (89 percent) of all kamagra chewable tablets uk Medicare Advantage plans offered include prescription drug coverage in 2021.

.As in prior years, HMOs continue to account for about two-thirds (62%) of all plans offered in 2021. The availability of local kamagra chewable tablets uk PPOs has increased rapidly over recent years. In 2021, one-third of plans offered are local PPOs, compared to a quarter in 2018.

Between 2020 and 2021, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.The growth in number of plans varies across states and counties, with the preponderance of the growth occurring in Florida and California (41 more kamagra chewable tablets uk and 30 more plans, respectively. Data not shown). Virginia has 6 fewer plans available for 2021 than in 2020, while South Carolina has 3 fewer plans, and Maryland and Nebraska each have one fewer plan available kamagra chewable tablets uk in 2021 than in 2020.While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2021 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these plans are not available to the general Medicare population.One notable change for 2021 is that people with end-stage renal disease (ESRD) are eligible to enroll in Medicare Advantage plans.

Prior to this change, people with ESRD were not able to enroll in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPS for people with ESRD.Special Needs Plans (SNPs). More SNPs are available for 2021 than in any year since they were authorized, increasing from 855 plans in 2020 to 975 plans in 2021, a 14 percent increase (Figure 3). .The rise in SNPs for people who require an institutional-level of care (I-SNPs) has been particularly notable, more than doubling from 83 plans in 2017 to 174 plans in 2021 kamagra chewable tablets uk.

I-SNPs may be attractive to insurers because they tend to have much lower marketing costs than other plan types since they are often the only available option for people to receive their Medicare benefits in certain retirement communities and nursing homes. The number of SNPs for people dually eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the past five years, rising from 373 dual SNPs in 2017 to 598 dual SNPs in 2021, a 60% increase, suggesting insurers’ continue to be interested in managing the care of this high-need population.The number of SNPs offered for people with chronic conditions (C-SNPs) kamagra chewable tablets uk is also increasing in 2021, most of which focus on people with diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs. For 2021, three firms are offering C-SNPs for people with dementia (the same as 2020), two firms are offering a C-SNP for people with mental health conditions (up one from 2020), three firms are offering C-SNPs for people with end-stage renal disease (one fewer than 2020) and two firms are offering C-SNPs for people with HIV/AIDS (similar to 2020).Variation in the Number of Plans, by Geographic Area.

On average, beneficiaries in metropolitan areas can choose from about twice as many Medicare Advantage plans as beneficiaries in non-metropolitan areas (36 plans versus 20 plans, respectively).In 11 percent of counties (accounting for 41% of beneficiaries), beneficiaries can choose from more kamagra chewable tablets uk than 35 plans in 2021, including eleven counties in Ohio and five counties in Pennsylvania where more than 60 Medicare Advantage plans are available (Figure 4). In contrast, in 4 percent of counties (accounting for 1% of beneficiaries), beneficiaries can choose from two or fewer Medicare Advantage plans. The number of counties with no Medicare Advantage plans for 2021 is 82, similar to 2020 kamagra chewable tablets uk.

As in prior years, there are no Medicare Advantage plans offered in Alaska. Additionally, no Medicare kamagra chewable tablets uk Advantage plans are available in territories other than Puerto Rico. .Access to Medicare Advantage Plans, by Plan TypeAs in recent years, virtually all Medicare beneficiaries (99%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas (99.9%) and the vast majority of beneficiaries in non-metropolitan areas (97.7%).

In non-metropolitan counties, a smaller share of beneficiaries have access to HMOs (87% in non-metropolitan versus 99% kamagra chewable tablets uk in metropolitan counties) or local PPOs (89% in non-metropolitan versus 96% in metropolitan counties), and a slightly larger share of beneficiaries have access to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan counties). Number of FirmsThe average Medicare beneficiary is able to choose from plans offered by 8 firms in 2021, one more than in 2020 (Figure 5). Despite most beneficiaries having access to plans operated kamagra chewable tablets uk by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare, Humana, and Blue Cross Blue Shield affiliates.Figure 5.

More than one-quarter of beneficiaries can choose among Medicare Advantage plans offered by 10 or more firmsMore than one-quarter of beneficiaries (27%) are able to choose from plans offered by 10 or more firms. Fifteen or more firms are offering Medicare Advantage plans in three counties. Orange County, California and Summit and Medina Counties kamagra chewable tablets uk in Ohio.

In contrast, in 109 counties, most of which are rural counties with relatively few Medicare beneficiaries (1% of total), only one firm will offer Medicare Advantage plans in 2021. Over the past several years, the number kamagra chewable tablets uk of counties with a single firm offering Medicare Advantage plans has fallen substantially. As recently as 2019, there was a single firm offering plans in nearly 200 counties.UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2020, have large footprints across the country, offering plans in most counties.

Humana is offering plans in 84 percent of counties and UnitedHealthcare is offering plans in 66 kamagra chewable tablets uk percent of counties in 2021 (Figure 6). More than 8 in 10 (87%) Medicare beneficiaries have access to at least one Humana plan and 86 percent have access to at least one UnitedHealthcare plans. .Most major kamagra chewable tablets uk Medicare Advantage firms have also expanded the number of counties where they are offering plans.

UnitedHealthcare is offering plans in 2,117 counties in 2021, an increase of 245 from 2021, while Humana is offering plans in 2,703 counties in 2021, an increase of 33 from 2020. Centene is offering plans kamagra chewable tablets uk in 1,129 counties in 2021, an increase of 261 plans from 2020. Blue Cross Blue Shield Affiliates are offering plans in 1,181 counties, an increase of 152 plans.

CVS Health is kamagra chewable tablets uk offering plans in 1,759 counties, an increase of 119 plans. And Cigna is offering plans in 369 counties, an increase of 67 plans. Kaiser Permanente kamagra chewable tablets uk had the smallest growth and is offering plans in 109 counties, an increase of 4 plans.New Market Entrants and ExitsMedicare Advantage continues to be an attractive market for insurers, with 14 firms entering the market for the first time in 2021, collectively accounting for about 6 percent of the growth in the number of plans available for general enrollment and about 10 percent of the growth in SNPs (Appendix Table 2).

Nine new entrants are offering HMOs available for individual enrollment. Five of the new entrants are kamagra chewable tablets uk offering SNPs. Three firms are offering D-SNPs for people dually eligible for Medicaid, three firms are offering C-SNPs for people with select chronic conditions, and one firm is offering an I-SNPs Four of the new firm entrants are offering plans in California, two are offering plans in Indiana, and the remainder are offering plans in at least one of ten other states (Colorado, Georgia, Illinois, Mississippi, Missouri, Ohio, Texas, Utah, and Wisconsin).Six firms that previously participated in the Medicare Advantage market are not offering plans in 2021.

Two of the firms (ApexHealth, Inc. And Clarion Health) offered plans for the first time in 2020, but did not appear to enroll any kamagra chewable tablets uk participants. The other four firms had very low enrollment in 2020.

Three of the six exiting firms offered plans in New York.PremiumsThe kamagra chewable tablets uk vast majority of Medicare Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and 54 percent of these plans will charge no premium, other than the Part B premium, similar to 2020. More than nine out of ten beneficiaries (96%) have access to a MA-PD with no monthly premium in 2021. However, in Wyoming, beneficiaries do not have access to a zero-premium MA-PD, and in Idaho, less than half of beneficiaries have access to a zero-premium MA-PD.In 2020, 60 percent of enrollees in MA-PD plans pay no premium other than the Medicare kamagra chewable tablets uk Part B premium of $144.60 per month.

Based on enrollment in March 2020, nearly one in five enrollees (18%) pay at least $50 a month, and 6 percent pay $100 or more. CMS announced that the average monthly plan premium among all Medicare Advantage enrollees in 2021, including those who pay no premium for their Medicare kamagra chewable tablets uk Advantage plan, is expected to decrease 11 percent from 2020 to $21 a month. CMS does not disclose the methods or assumptions used in deriving their calculations, but since most Medicare Advantage enrollees pay no additional premium, the average they report is heavily influenced by zero-premium plans, and does not reflect the average premium paid by those who are in plans with an additional premium.Extra BenefitsMedicare Advantage plans may provide extra benefits that are not available in traditional Medicare, are considered “primarily health related,” and can use rebate dollars (including bonus payments) to help cover the cost of these extra benefits.

Beginning in 2019, CMS expanded the kamagra chewable tablets uk definition of “primarily health related” to allow Medicare Advantage plans to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Information on the availability of SSBCI for 2021 has not yet been published by CMS, but may include services such as pest control, food kamagra chewable tablets uk and produce (beyond a limited basis), and non-medical transportation.

Since plans are permitted to offer these benefits non-uniformly to enrollees, it will be important to examine how these benefits are distributed across subgroups of enrollees.Availability of Extra Benefits in Plans for General Enrollment. Historically, the kamagra chewable tablets uk most offered extra benefits were fitness, dental, vision, and hearing. Nearly two-thirds of plans (68%) provide all four of these benefits for 2021.

Though these benefits are widely available, the scope of specific services varies. For example, a dental benefit may include cleanings only or more kamagra chewable tablets uk comprehensive coverage. As of 2020, Medicare Advantage plans have also been allowed to offer more telehealth benefits than traditional Medicare (though Medicare has temporarily expanded these benefits during the kamagra).

The vast majority (98%) of Medicare kamagra chewable tablets uk Advantage plans are offering telehealth in 2021 (up from 91% in 2020) (Figure 7).Figure 7. Most Medicare Advantage plans provide fitness and dental benefits but much fewer provide in-home or caregiver supportOther extra benefits that are frequently offered for 2021 include over the counter items (75%), meal benefits, such as a cooking class, nutrition education, or meal delivery (55%), and transportation benefits (36%).Less than 10 percent of plans provide bathroom safety devices (6%) or in-home support (6%).Availability of Extra Benefits in Special Needs Plans. SNPs are designed to kamagra chewable tablets uk serve a disproportionately high-need population, and a somewhat larger percentage of SNPs than plans for other Medicare beneficiaries provide their enrollees with over the counter items (91%), transportation benefits (85%) and meal benefits (63%).

Similar to plans available for general enrollment, a relatively small share of SNPs provide bathroom safety devices (11%) or in-home support (18%).Access to Extra Benefits. Virtually all Medicare beneficiaries live in kamagra chewable tablets uk a county where at least one Medicare Advantage plan available for general enrollment has some extra benefits not covered by traditional Medicare, with 98% having access to some dental, fitness, vision, and hearing benefits for 2021. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), transportation assistance (95%) and a meal benefit (98%), but far fewer have access to bathroom safety (55%) or in-home support (62%).DiscussionMore Medicare Advantage plans are being offered for 2021 than in any other year.

Fourteen insurers are entering the Medicare Advantage kamagra chewable tablets uk market for the first time, and six insurers are exiting the market, suggesting thatMedicare Advantage remains an attractive, profitable market for insurers. As in prior years, some (mostly non-metropolitan) counties are less attractive to insurers, with fewer firms and plans available, though the number of areas where this is the case has declined over time. Overall, more than 99 percent of beneficiaries will have access to one kamagra chewable tablets uk or more Medicare Advantage plans in 2021, similar to prior years.

With more firms offering SNPs and the number of SNPs rapidly growing, there may be greater focus on how well high-need, vulnerable beneficiaries are being served by Medicare Advantage plans, including SNPs as well as plans for general enrollment. As Medicare Advantage enrollment continues to grow, insurers seem to be responding by offering more plans and choices to kamagra chewable tablets uk the people on Medicare. This analysis focuses on the Medicare Advantage marketplace in 2021 and trends over time.

The analysis includes more than 24 million enrollees in Medicare Advantage plans in 2020.Data on Medicare Advantage plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):Medicare Advantage plan landscape files, released each fall prior to the annual enrollment periodMedicare Advantage plan and premium files, released each fallMedicare Advantage plan crosswalk files, released each fallMedicare Advantage contract/plan/state/county level enrollment files, released on a monthly basisMedicare Advantage plan kamagra chewable tablets uk benefit package files, released each fallMedicare Enrollment Dashboard files, released on a monthly basisIn previous years, KFF has used the Medicare Advantage Penetration Files to calculate the number of Medicare beneficiaries eligible for Medicare. The Medicare Advantage Penetration Files includes people who were previously, but no longer covered by Medicare (e.g., people who obtained employer-sponsored health insurance coverage after initially enrolling in Medicare).

It also includes people kamagra chewable tablets uk within 5 months of their 65th birthday, but not yet age 65. In addition, CMS has identified an issue where beneficiaries with multiple addresses were double counted in the Penetration File. KFF has refined its approach this year and is using the Medicare Enrollment Dashboard to calculate the number of Medicare beneficiaries because it only includes Medicare beneficiaries with either Part A or Part B coverage, which is a more kamagra chewable tablets uk accurate estimate of the Medicare population.

The numbers published here supersede all prior estimates by KFF of the number of Medicare beneficiaries.Jeannie Fuglesten Biniek, Meredith Freed, and Tricia Neuman are with KFF.Anthony Damico is an independent consultant.During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits, including drugs. Among the 46 million Part D enrollees in 2020, 20.2 million (44%) are in PDPs and 19.3 million (41%) are in MA-PDs (excluding the 7.0 million kamagra chewable tablets uk (15%) in employer-only group PDPs and MA-PDs). This issue brief provides an overview of Medicare Part D drug plans that will be available in 2021 and key trends over time.Part D Plan AvailabilityThe Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans with Part D Drug Coverage in 2021, Including 30 Medicare Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansFigure 1.

The Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans kamagra chewable tablets uk Offering Drug Coverage in 2021, Including 30 Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansA larger number of Part D plans will be offered in 2021 than in recent years. The average Medicare beneficiary will have a choice of 30 stand-alone PDPs in 2021, two more PDP options than in 2020, and eight more than in 2017, a 36% increase (Figure 1). Although the number of PDP options in 2021 is half of what it was at the peak in 2007 (when there were 56 PDP options, on average), this is the fourth year in a row with an increase in the average number of stand-alone drug plan options.In 2021, beneficiaries will also have access to 27 MA-PDs, on average, a 71% increase kamagra chewable tablets uk in MA-PD options since 2017 (excluding Medicare Advantage plans that do not offer the drug benefit and plans not available to all beneficiaries.

Overall, an average of 33 Medicare Advantage plan options will be available in 2021).Based on September 2020 enrollment, 8 out of 10 PDP enrollees (80%) in 2021 are projected to be in PDPs operated by just four firms. UnitedHealth, Centene (which acquired WellCare in 2020), Humana, and CVS Health (based on PDP enrollment as of September 2020) kamagra chewable tablets uk. All four firms offer PDPs in all 34 PDP regions in 2021.A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017 Figure 2.

A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017​A total of 996 PDPs will be offered in the 34 PDP regions in 2021 (plus another 11 PDPs in the territories), an increase of 48 PDPs (5%) over 2020, and 250 more PDPs (a 34% increase) since 2017 (Figure 2). This increase is primarily due to the Trump Administration’s kamagra chewable tablets uk elimination of the “meaningful difference” requirement for enhanced benefit PDPs offered by the same organization in the same region. Eliminating this requirement means that PDP sponsors no longer have to demonstrate that their enhanced PDPs offered in the same region are meaningfully different in terms of enrollee out-of-pocket costs.

In 2021, 62% of PDPs (618 plans) will offer kamagra chewable tablets uk enhanced Part D benefits—a 60% increase in the availability of enhanced-benefit PDPs since 2017, when just over half of PDPs (387 plans) offered enhanced benefits.The number of PDPs per region in 2021 will range from 25 PDPs in Alaska to 35 PDPs in Texas and will be the same or higher in 32 of the 34 PDP regions compared to 2020 (see map, Table 1). Part D PremiumsThe Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current EnrollmentFigure 3. The Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current Enrollment​The estimated national average monthly PDP kamagra chewable tablets uk premium for 2021 is projected to increase by 9% to $41, from $38 in 2020, weighted by September 2020 enrollment (Figure 3).

It is likely that the actual average weighted premium for 2021, after taking into account enrollment choices by new enrollees and plan changes by current enrollees, will be somewhat lower than the estimated average. CMS reported that the average premium for basic Part D coverage offered by PDPs and MA-PDs will be an estimated $30 in 2021 kamagra chewable tablets uk. Our premium estimate is higher because it is based on PDPs only (excluding MA-PDs) and includes PDPs offering both basic and enhanced coverage (enhanced plans, which account for 62% of all PDPs in 2021, have higher premiums than basic plans, on average).Average Monthly Premiums for the 21 National Part D Stand-alone PDPs Are Projected to Range from $7 to $89 in 2021, with Higher Average Premiums for Enhanced Benefits and Zero-Deductible PDPsFigure 4.

Average Monthly kamagra chewable tablets uk Premiums for the 21 National Part D Stand-alone Drug Plans Are Projected to Range from $7 to $89 in 2021​PDP premiums will vary widely across plans in 2021, as in previous years (Figure 4, Table 2). Among the 21 PDPs available nationwide, average premiums will range from a low of $7 per month for SilverScript SmartRx to a high of $89 per month for AARP MedicareRx Preferred.Changes to premiums from 2020 to 2021, averaged across regions and weighted by 2020 enrollment, also vary widely across PDPs, as do the absolute amounts of monthly premiums for 2021.The 1.9 million non-LIS enrollees in the largest PDP, CVS Health’s SilverScript Choice (which had a total of 3.9 million enrollees in 2020, including those receiving low-income subsidies) will face a modest $1 (2%) decrease in their average monthly premium, from $29 in 2020 to $28 in 2021.In contrast, the 1.8 million non-LIS enrollees in the second largest PDP, AARP MedicareRx Preferred, will face a $10 (12%) increase in their average monthly premium between 2020 and 2021, from $79 to $89. This is the highest monthly premium among the national PDPs in 2021.The 1.3 million non-LIS enrollees in the fourth largest PDP, Humana Premier Rx, will see a $7 (13%) increase in their monthly premium, from $58 in kamagra chewable tablets uk 2020 to $65 in 2021.Most Part D stand-alone drug plans in 2021 (62% of PDPs) will offer enhanced benefits for a higher monthly premium.

Enhanced benefits can include a lower (or no) deductible, reduced cost sharing, or a higher initial coverage limit than under the standard benefit design. The average premium in 2021 for enhanced benefit PDPs is $51, which is 55% higher than the kamagra chewable tablets uk monthly premium for PDPs offering the basic benefit ($33) (weighted by September 2020 enrollment).In 2021, a large majority of PDPs (86%) will charge a deductible, with most PDPs (67%) charging the standard amount of $445 in 2021. Across all PDPs, the average deductible in 2021 will be $345 (weighted by September 2020 enrollment).

The average monthly premium in 2021 for PDPs that charge no deductible is $88, nearly three times kamagra chewable tablets uk the monthly premium for PDPs that charge the standard deductible ($34) or a partial deductible ($31) (weighted by September 2020 enrollment).Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current PlanFigure 5. Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current Plan​Most (78%, or 10 million) of the 13.4 million Part D PDP enrollees who are responsible for paying the entire premium (which excludes Low-Income Subsidy (LIS) recipients) will see their monthly premium increase in 2021 if they stay in their same plan, while 2.8 million (21%) will see a premium reduction if they stay in their same plan (Figure 5).Nearly 2 million non-LIS enrollees (13%) will see a premium increase of $10 or more per month, while significantly fewer (0.2 million non-LIS enrollees, or 1%) will see a premium reduction of the same magnitude. One-third (34%) of non-LIS enrollees (4.6 million) are projected to pay monthly premiums of at least $60 if they stay in their current plans, and more than 230,000 (2% of non-LIS enrollees) are projected to pay monthly premiums of at least $100.The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay Is Substantially Higher Than Premiums for Other PDPsFigure 6.

The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay is Substantially Higher than Premiums for Other Plans​New for 2021, beneficiaries in each state will have kamagra chewable tablets uk the option to enroll in a Part D plan participating in the Trump Administration’s new Innovation Center model in which enhanced drug plans cover insulin products at a monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit. Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).In 2021, a total of 1,635 enhanced Part D plans will participate in this model, which represents just over 30% of both PDPs (310 plans) and MA-PDs (1,325 plans) available in 2021, including plans in the territories. Between 8 and 10 enhanced PDPs in each region are participating in the kamagra chewable tablets uk model, in addition to multiple MA-PDs (see map).

The average premium in 2021 for the subset of enhanced PDPs participating in the insulin $35 copay model ($59) is nearly twice as high as the monthly premium for basic PDPs ($33) and 61% higher than the average premium for enhanced PDPs that are not participating in the model ($37) (weighted by September 2020 enrollment). Part D Cost SharingPart D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs Than For Drugs on a Generic Tier, and a kamagra chewable tablets uk Mix of Copays and Coinsurance for Different Formulary TiersFigure 7. In 2021, Part D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs than for Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary Tiers​In 2021, as in prior years, Part D enrollees will face much higher cost-sharing amounts for brands and non-preferred drugs (which can include both brands and generics) than for drugs on a generic tier, and a mix of copayments and coinsurance for different formulary tiers (Figure 7).

The typical kamagra chewable tablets uk five-tier formulary design in Part D includes tiers for preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs. Among all PDPs, median standard cost sharing in 2021 is $0 for preferred generics and $5 for generics (an increase from $4 in 2020), $40 for preferred brands (a decrease from $42 in 2020), 40% coinsurance for non-preferred drugs (an increase from 38% in 2020. The maximum allowed is 50%), and 25% coinsurance for specialty drugs (the same as kamagra chewable tablets uk in 2020.

The maximum allowed is 33%).Among the 21 national PDPs, 13 PDPs, covering 9.3 million enrollees as of September 2020, are increasing cost-sharing amounts for drugs on at least one formulary tier between 2020 and 2021 (Table 3). Five PDPs are increasing copayments for generics, kamagra chewable tablets uk with increases ranging from $1 to $4. Six PDPs are increasing copayments for preferred brands, with increases ranging from $3 to $10.

And 10 PDPs are increasing coinsurance for non-preferred drugs, kamagra chewable tablets uk with increases ranging from 2 percentage points (e.g., from a 38% coinsurance rate to 40%) to 14 percentage points (e.g., from a 35% coinsurance rate to 49%).Low-Income Subsidy Plan AvailabilityIn 2021, 259 Part D Stand-Alone Drug Plans Will Be Premium-Free to Enrollees Receiving the Low-Income Subsidy (Benchmark Plans)Figure 8. In 2021, 259 Part D Stand-Alone Drug Plans Will Be Available Without a Premium to Enrollees Receiving the Low-Income Subsidy (“Benchmark” Plans)​In 2021, a larger number of PDPs will be premium-free benchmark plans—that is, PDPs available for no monthly premium to Medicare Part D enrollees receiving the Low-Income Subsidy (LIS)—than in recent years, with 259 premium-free benchmark plans, or roughly a quarter of all PDPs in 2021 (Figure 8). Through the Part D LIS program, enrollees with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing.

As of 2020, approximately 13 million Part D enrollees are receiving LIS, including 6.7 million (52%) in PDPs and 6.1 million (48%) in MA-PDs.On average (weighted by Medicare enrollment), kamagra chewable tablets uk LIS beneficiaries have eight benchmark plans available to them for 2021, or about one-fourth the average number of PDP choices available overall. All LIS enrollees can select any plan offered in their area, but if they enroll in a non-benchmark plan, they must pay some portion of their chosen plan’s monthly premium. In 2021, 10% of all LIS PDP enrollees who are eligible for premium-free Part D coverage (0.6 million LIS enrollees) will pay Part D premiums averaging $33 per month kamagra chewable tablets uk unless they switch or are reassigned by CMS to premium-free plans.The number of benchmark plans available in 2021 will vary by region, from five to 10 (see map).

In 2020, 89% of the 6.6 million LIS PDP enrollees are projected to be in PDPs operated by five firms. CVS Health, Centene, Humana, UnitedHealth, and Cigna (based on 2020 enrollment) kamagra chewable tablets uk. DiscussionOur analysis of the Medicare Part D stand-alone drug plan landscape for 2021 shows that millions of Part D enrollees without low-income subsidies will face premium and other cost increases in 2021 if they stay in their current stand-alone drug plan.

There are more plans available nationwide in 2021, with Medicare beneficiaries having 30 PDP choices during this year’s open enrollment period, plus 27 kamagra chewable tablets uk Medicare Advantage drug plan options. Most Part D PDP enrollees who remain in the same plan in 2021 will be in a plan with the standard $445 deductible and will face much higher cost sharing for brands than for generic drugs, including as much as 50% coinsurance for non-preferred drugs.Some Part D enrollees who choose to stay in their current plans may see lower premiums and other costs for their drug coverage, but nearly 8 in 10 non-LIS enrollees will face higher premiums if they remain in their current plan, and many will also face higher deductibles and cost sharing for covered drugs. Some beneficiaries might find the best coverage and costs for their specific medications in a plan with a relatively low kamagra chewable tablets uk premium, while for other beneficiaries, a higher-premium plan might be more suitable.

Because Part D plans vary in a number of ways that can have a significant effect on an enrollee’s out-of-pocket spending, beyond the monthly premium, all Part D enrollees could benefit from the opportunity to compare plans during open enrollment.Juliette Cubanski is with KFF.Anthony Damico is an independent consultant. This kamagra chewable tablets uk analysis focuses on the Medicare Part D stand-alone prescription drug plan marketplace in 2021 and trends over time. The analysis includes 20.2 million enrollees in stand-alone PDPs, as of March 2020.

The analysis kamagra chewable tablets uk excludes 17.4 million MA-PD enrollees (non-employer), and another 4.6 million enrollees in employer-group only PDPs and 2.3 million in employer-group only MA-PDs for whom plan premium and benefits data are unavailable.Data on Part D plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):– Part D plan landscape files, released each fall prior to the annual enrollment period– Part D plan and premium files, released each fall– Part D plan crosswalk files, released each fall– Part D contract/plan/state/county level enrollment files, released on a monthly basis– Part D Low-Income Subsidy enrollment files, released each spring– Medicare plan benefit package files, released each fallIn this analysis, premium estimates are weighted by September 2020 enrollment unless otherwise noted. Percentage increases are calculated based on non-rounded estimates and in some cases differ from percentage calculations calculated based on rounded estimates presented in the text..

Over the last decade, Medicare Advantage, the private plan alternative get kamagra to traditional click here for info Medicare, has taken on a larger role in the Medicare program. In 2020, more than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2021 and key trends over time.Plan Offerings get kamagra in 2021Number of PlansNumber of Plans Available to Beneficiaries. For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade (Figure 1).Figure 1. The average Medicare beneficiary has access to 33 Medicare Advantage plans in 2021, an increase from prior yearsAmong the 33 Medicare Advantage plans generally available for individual enrollment get kamagra to the average Medicare beneficiary, 27 of the plans include prescription drug coverage (MA-PDs).

These numbers exclude employer or union-sponsored group plans, Special Needs Plans (SNPs) and PACE plans, which are only available to select populations.Total Number of Plans. In total, 3,550 Medicare Advantage get kamagra plans are available nationwide for individual enrollment in 2021 – a 13 percent increase (402 more plans) from 2020 and the largest number of plans ever available (Figure 2. Appendix Table 1). The vast majority (89 percent) get kamagra of all Medicare Advantage plans offered include prescription drug coverage in 2021. .As in prior years, HMOs continue to account for about two-thirds (62%) of all plans offered in 2021.

The availability of get kamagra local PPOs has increased rapidly over recent years. In 2021, one-third of plans offered are local PPOs, compared to a quarter in 2018. Between 2020 and 2021, the number of regional PPOs has remained constant, while the number of private fee-for-service plans has continued to decline.The growth in number of plans varies across states and counties, with the preponderance of the growth occurring in Florida and California (41 more and 30 get kamagra more plans, respectively. Data not shown). Virginia has 6 fewer plans available for 2021 than in 2020, while South Carolina has 3 fewer plans, and Maryland and Nebraska each have one fewer plan available in 2021 than in 2020.While many employers and unions also offer Medicare Advantage plans to their retirees, no information about these 2021 plan offerings is made available by CMS to the public during the Medicare open enrollment period because these plans are not available to the general Medicare population.One notable change for 2021 is that people with end-stage renal disease (ESRD) are eligible to enroll in Medicare Advantage plans get kamagra.

Prior to this change, people with ESRD were not able to enroll in most Medicare Advantage plans, subject to limited exceptions, such as C-SNPS for people with ESRD.Special Needs Plans (SNPs). More SNPs are available for 2021 than in any year since they were authorized, increasing from 855 plans in 2020 to 975 plans in 2021, a 14 percent increase (Figure 3). .The rise in SNPs get kamagra for people who require an institutional-level of care (I-SNPs) has been particularly notable, more than doubling from 83 plans in 2017 to 174 plans in 2021. I-SNPs may be attractive to insurers because they tend to have much lower marketing costs than other plan types since they are often the only available option for people to receive their Medicare benefits in certain retirement communities and nursing homes. The number of SNPs for people dually eligible for Medicare and Medicaid (D-SNPs) has also increased sharply over the past five years, rising from 373 dual SNPs in 2017 to 598 dual SNPs in 2021, a 60% increase, suggesting insurers’ continue to be interested in managing the care of this high-need population.The number of SNPs offered for people with chronic conditions (C-SNPs) is also increasing in 2021, most of which focus on people with get kamagra diabetes, heart disease, or lung conditions, as has been the case since the inception of C-SNPs.

For 2021, three firms are offering C-SNPs for people with dementia (the same as 2020), two firms are offering a C-SNP for people with mental health conditions (up one from 2020), three firms are offering C-SNPs for people with end-stage renal disease (one fewer than 2020) and two firms are offering C-SNPs for people with HIV/AIDS (similar to 2020).Variation in the Number of Plans, by Geographic Area. On average, beneficiaries in metropolitan areas can choose from about twice as many Medicare Advantage plans as beneficiaries in non-metropolitan areas get kamagra (36 plans versus 20 plans, respectively).In 11 percent of counties (accounting for 41% of beneficiaries), beneficiaries can choose from more than 35 plans in 2021, including eleven counties in Ohio and five counties in Pennsylvania where more than 60 Medicare Advantage plans are available (Figure 4). In contrast, in 4 percent of counties (accounting for 1% of beneficiaries), beneficiaries can choose from two or fewer Medicare Advantage plans. The number of counties with no Medicare Advantage plans get kamagra for 2021 is 82, similar to 2020. As in prior years, there are no Medicare Advantage plans offered in Alaska.

Additionally, no Medicare Advantage plans are available get kamagra in territories other than Puerto Rico. .Access to Medicare Advantage Plans, by Plan TypeAs in recent years, virtually all Medicare beneficiaries (99%) have access to a Medicare Advantage plan as an alternative to traditional Medicare, including almost all beneficiaries in metropolitan areas (99.9%) and the vast majority of beneficiaries in non-metropolitan areas (97.7%). In non-metropolitan counties, a smaller share of beneficiaries have access to HMOs (87% in non-metropolitan versus 99% in metropolitan counties) or local PPOs (89% in non-metropolitan versus 96% in metropolitan counties), and a slightly larger share of beneficiaries have access to regional PPOs (77% in non-metropolitan counties versus 72% in metropolitan counties) get kamagra. Number of FirmsThe average Medicare beneficiary is able to choose from plans offered by 8 firms in 2021, one more than in 2020 (Figure 5). Despite most beneficiaries having access to plans operated by several different firms, enrollment is concentrated in plans operated by UnitedHealthcare, Humana, and Blue Cross Blue Shield get kamagra affiliates.Figure 5.

More than one-quarter of beneficiaries can choose among Medicare Advantage plans offered by 10 or more firmsMore than one-quarter of beneficiaries (27%) are able to choose from plans offered by 10 or more firms. Fifteen or more firms are offering Medicare Advantage plans in three counties. Orange County, California and Summit and get kamagra Medina Counties in Ohio. In contrast, in 109 counties, most of which are rural counties with relatively few Medicare beneficiaries (1% of total), only one firm will offer Medicare Advantage plans in 2021. Over the past several years, the get kamagra number of counties with a single firm offering Medicare Advantage plans has fallen substantially.

As recently as 2019, there was a single firm offering plans in nearly 200 counties.UnitedHealthcare and Humana, the two firms with the most Medicare Advantage enrollees in 2020, have large footprints across the country, offering plans in most counties. Humana is offering plans in 84 percent of counties and UnitedHealthcare is offering plans get kamagra in 66 percent of counties in 2021 (Figure 6). More than 8 in 10 (87%) Medicare beneficiaries have access to at least one Humana plan and 86 percent have access to at least one UnitedHealthcare plans. .Most major Medicare Advantage firms get kamagra have also expanded the number of counties where they are offering plans. UnitedHealthcare is offering plans in 2,117 counties in 2021, an increase of 245 from 2021, while Humana is offering plans in 2,703 counties in 2021, an increase of 33 from 2020.

Centene is offering plans in 1,129 counties in 2021, an increase of 261 plans from get kamagra 2020. Blue Cross Blue Shield Affiliates are offering plans in 1,181 counties, an increase of 152 plans. CVS Health is offering plans in 1,759 counties, an increase of 119 get kamagra plans. And Cigna is offering plans in 369 counties, an increase of 67 plans. Kaiser Permanente had the smallest growth and is offering plans in 109 counties, an increase of 4 plans.New Market Entrants and ExitsMedicare Advantage continues to be an attractive market for insurers, with 14 get kamagra firms entering the market for the first time in 2021, collectively accounting for about 6 percent of the growth in the number of plans available for general enrollment and about 10 percent of the growth in SNPs (Appendix Table 2).

Nine new entrants are offering HMOs available for individual enrollment. Five of get kamagra the new entrants are offering SNPs. Three firms are offering D-SNPs for people dually eligible for Medicaid, three firms are offering C-SNPs for people with select chronic conditions, and one firm is offering an I-SNPs Four of the new firm entrants are offering plans in California, two are offering plans in Indiana, and the remainder are offering plans in at least one of ten other states (Colorado, Georgia, Illinois, Mississippi, Missouri, Ohio, Texas, Utah, and Wisconsin).Six firms that previously participated in the Medicare Advantage market are not offering plans in 2021. Two of the firms (ApexHealth, Inc. And Clarion Health) offered get kamagra plans for the first time in 2020, but did not appear to enroll any participants.

The other four firms had very low enrollment in 2020. Three of the six exiting firms offered plans in New York.PremiumsThe vast majority of Medicare get kamagra Advantage plans for individual enrollment (89%) will include prescription drug coverage (MA-PDs), and 54 percent of these plans will charge no premium, other than the Part B premium, similar to 2020. More than nine out of ten beneficiaries (96%) have access to a MA-PD with no monthly premium in 2021. However, in Wyoming, beneficiaries do not have access to a zero-premium MA-PD, and in Idaho, less than half of beneficiaries have access to a zero-premium MA-PD.In 2020, 60 percent of enrollees in MA-PD plans get kamagra pay no premium other than the Medicare Part B premium of $144.60 per month. Based on enrollment in March 2020, nearly one in five enrollees (18%) pay at least $50 a month, and 6 percent pay $100 or more.

CMS announced that the average monthly plan premium among all Medicare Advantage enrollees in 2021, including those get kamagra who pay no premium for their Medicare Advantage plan, is expected to decrease 11 percent from 2020 to $21 a month. CMS does not disclose the methods or assumptions used in deriving their calculations, but since most Medicare Advantage enrollees pay no additional premium, the average they report is heavily influenced by zero-premium plans, and does not reflect the average premium paid by those who are in plans with an additional premium.Extra BenefitsMedicare Advantage plans may provide extra benefits that are not available in traditional Medicare, are considered “primarily health related,” and can use rebate dollars (including bonus payments) to help cover the cost of these extra benefits. Beginning in 2019, CMS expanded the definition of “primarily health related” to allow Medicare Advantage plans get kamagra to offer additional supplemental benefits. Medicare Advantage plans may also restrict the availability of these extra benefits to certain subgroups of beneficiaries, such as those with diabetes or congestive heart failure, making different benefits available to different enrollees.Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill (SSBCI). Information on the availability of SSBCI for 2021 has not yet been published by CMS, but may get kamagra include services such as pest control, food and produce (beyond a limited basis), and non-medical transportation.

Since plans are permitted to offer these benefits non-uniformly to enrollees, it will be important to examine how these benefits are distributed across subgroups of enrollees.Availability of Extra Benefits in Plans for General Enrollment. Historically, the most offered extra get kamagra benefits were fitness, dental, vision, and hearing. Nearly two-thirds of plans (68%) provide all four of these benefits for 2021. Though these benefits are widely available, the scope of specific services varies. For example, a dental benefit may include cleanings only or get kamagra more comprehensive coverage.

As of 2020, Medicare Advantage plans have also been allowed to offer more telehealth benefits than traditional Medicare (though Medicare has temporarily expanded these benefits during the kamagra). The vast majority (98%) of Medicare Advantage plans are offering telehealth in 2021 (up get kamagra from 91% in 2020) (Figure 7).Figure 7. Most Medicare Advantage plans provide fitness and dental benefits but much fewer provide in-home or caregiver supportOther extra benefits that are frequently offered for 2021 include over the counter items (75%), meal benefits, such as a cooking class, nutrition education, or meal delivery (55%), and transportation benefits (36%).Less than 10 percent of plans provide bathroom safety devices (6%) or in-home support (6%).Availability of Extra Benefits in Special Needs Plans. SNPs are designed to serve a disproportionately high-need population, get kamagra and a somewhat larger percentage of SNPs than plans for other Medicare beneficiaries provide their enrollees with over the counter items (91%), transportation benefits (85%) and meal benefits (63%). Similar to plans available for general enrollment, a relatively small share of SNPs provide bathroom safety devices (11%) or in-home support (18%).Access to Extra Benefits.

Virtually all Medicare beneficiaries live in a county where at least one Medicare Advantage plan available for general enrollment has some extra benefits not covered by traditional Medicare, with 98% having access to some dental, fitness, get kamagra vision, and hearing benefits for 2021. The vast majority of beneficiaries also have access to telehealth benefits (99%), over the counter items (99%), transportation assistance (95%) and a meal benefit (98%), but far fewer have access to bathroom safety (55%) or in-home support (62%).DiscussionMore Medicare Advantage plans are being offered for 2021 than in any other year. Fourteen insurers are entering the Medicare Advantage market for the first time, and six get kamagra insurers are exiting the market, suggesting thatMedicare Advantage remains an attractive, profitable market for insurers. As in prior years, some (mostly non-metropolitan) counties are less attractive to insurers, with fewer firms and plans available, though the number of areas where this is the case has declined over time. Overall, more than 99 percent of beneficiaries will have access to one or more Medicare Advantage plans in get kamagra 2021, similar to prior years.

With more firms offering SNPs and the number of SNPs rapidly growing, there may be greater focus on how well high-need, vulnerable beneficiaries are being served by Medicare Advantage plans, including SNPs as well as plans for general enrollment. As Medicare Advantage enrollment continues to grow, insurers seem to be responding by offering more plans and choices to the people get kamagra on Medicare. This analysis focuses on the Medicare Advantage marketplace in 2021 and trends over time. The analysis includes more than 24 million enrollees in Medicare Advantage plans in 2020.Data on Medicare Advantage plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):Medicare Advantage plan landscape files, released each fall prior to the annual enrollment periodMedicare Advantage plan and premium files, released each fallMedicare Advantage plan crosswalk files, released each fallMedicare Advantage contract/plan/state/county level enrollment files, released on a monthly basisMedicare Advantage plan benefit package files, released each fallMedicare Enrollment Dashboard files, released on a monthly basisIn previous years, get kamagra KFF has used the Medicare Advantage Penetration Files to calculate the number of Medicare beneficiaries eligible for Medicare.

The Medicare Advantage Penetration Files includes people who were previously, but no longer covered by Medicare (e.g., people who obtained employer-sponsored health insurance coverage after initially enrolling in Medicare). It also includes people get kamagra within 5 months of their 65th birthday, but not yet age 65. In addition, CMS has identified an issue where beneficiaries with multiple addresses were double counted in the Penetration File. KFF has refined its approach this year get kamagra and is using the Medicare Enrollment Dashboard to calculate the number of Medicare beneficiaries because it only includes Medicare beneficiaries with either Part A or Part B coverage, which is a more accurate estimate of the Medicare population. The numbers published here supersede all prior estimates by KFF of the number of Medicare beneficiaries.Jeannie Fuglesten Biniek, Meredith Freed, and Tricia Neuman are with KFF.Anthony Damico is an independent consultant.During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which covers all Medicare benefits, including drugs.

Among the 46 million Part D enrollees in 2020, 20.2 get kamagra million (44%) are in PDPs and 19.3 million (41%) are in MA-PDs (excluding the 7.0 million (15%) in employer-only group PDPs and MA-PDs). This issue brief provides an overview of Medicare Part D drug plans that will be available in 2021 and key trends over time.Part D Plan AvailabilityThe Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans with Part D Drug Coverage in 2021, Including 30 Medicare Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansFigure 1. The Average Medicare Beneficiary Has a Choice of Nearly 60 Medicare Plans Offering Drug Coverage in 2021, Including 30 Stand-alone Drug Plans and 27 Medicare Advantage Drug PlansA larger number of get kamagra Part D plans will be offered in 2021 than in recent years. The average Medicare beneficiary will have a choice of 30 stand-alone PDPs in 2021, two more PDP options than in 2020, and eight more than in 2017, a 36% increase (Figure 1). Although the number of PDP options in get kamagra 2021 is half of what it was at the peak in 2007 (when there were 56 PDP options, on average), this is the fourth year in a row with an increase in the average number of stand-alone drug plan options.In 2021, beneficiaries will also have access to 27 MA-PDs, on average, a 71% increase in MA-PD options since 2017 (excluding Medicare Advantage plans that do not offer the drug benefit and plans not available to all beneficiaries.

Overall, an average of 33 Medicare Advantage plan options will be available in 2021).Based on September 2020 enrollment, 8 out of 10 PDP enrollees (80%) in 2021 are projected to be in PDPs operated by just four firms. UnitedHealth, Centene (which acquired WellCare in 2020), Humana, and CVS get kamagra Health (based on PDP enrollment as of September 2020). All four firms offer PDPs in all 34 PDP regions in 2021.A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017 Figure 2. A Total of 996 Medicare Part D Stand-Alone Prescription Drug Plans Will Be Offered in 2021, a 5% Increase From 2020 and a 34% Increase Since 2017​A total of 996 PDPs will be offered in the 34 PDP regions in 2021 (plus another 11 PDPs in the territories), an increase of 48 PDPs (5%) over 2020, and 250 more PDPs (a 34% increase) since 2017 (Figure 2). This increase is primarily due to the Trump Administration’s elimination of the “meaningful difference” requirement for enhanced benefit PDPs offered get kamagra by the same organization in the same region.

Eliminating this requirement means that PDP sponsors no longer have to demonstrate that their enhanced PDPs offered in the same region are meaningfully different in terms of enrollee out-of-pocket costs. In 2021, 62% of PDPs (618 plans) will offer enhanced Part D benefits—a 60% increase in the availability of enhanced-benefit PDPs since 2017, when just over half of PDPs (387 plans) offered enhanced benefits.The number of PDPs per region in 2021 will range from 25 PDPs in Alaska to 35 PDPs in Texas and will be the same or higher in 32 of the 34 PDP regions compared to 2020 (see map, Table get kamagra 1). Part D PremiumsThe Estimated Average Monthly Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current EnrollmentFigure 3. The Estimated Average Monthly get kamagra Premium for Medicare PDPs Is Projected to Increase by 9% to $41 in 2021, Based on Current Enrollment​The estimated national average monthly PDP premium for 2021 is projected to increase by 9% to $41, from $38 in 2020, weighted by September 2020 enrollment (Figure 3). It is likely that the actual average weighted premium for 2021, after taking into account enrollment choices by new enrollees and plan changes by current enrollees, will be somewhat lower than the estimated average.

CMS reported that the average premium for basic Part D coverage offered by PDPs and MA-PDs will be an estimated $30 in 2021 get kamagra. Our premium estimate is higher because it is based on PDPs only (excluding MA-PDs) and includes PDPs offering both basic and enhanced coverage (enhanced plans, which account for 62% of all PDPs in 2021, have higher premiums than basic plans, on average).Average Monthly Premiums for the 21 National Part D Stand-alone PDPs Are Projected to Range from $7 to $89 in 2021, with Higher Average Premiums for Enhanced Benefits and Zero-Deductible PDPsFigure 4. Average Monthly Premiums for the 21 National Part D Stand-alone Drug Plans Are Projected to Range from $7 to $89 in 2021​PDP get kamagra premiums will vary widely across plans in 2021, as in previous years (Figure 4, Table 2). Among the 21 PDPs available nationwide, average premiums will range from a low of $7 per month for SilverScript SmartRx to a high of $89 per month for AARP MedicareRx Preferred.Changes to premiums from 2020 to 2021, averaged across regions and weighted by 2020 enrollment, also vary widely across PDPs, as do the absolute amounts of monthly premiums for 2021.The 1.9 million non-LIS enrollees in the largest PDP, CVS Health’s SilverScript Choice (which had a total of 3.9 million enrollees in 2020, including those receiving low-income subsidies) will face a modest $1 (2%) decrease in their average monthly premium, from $29 in 2020 to $28 in 2021.In contrast, the 1.8 million non-LIS enrollees in the second largest PDP, AARP MedicareRx Preferred, will face a $10 (12%) increase in their average monthly premium between 2020 and 2021, from $79 to $89. This is the highest monthly premium among the national PDPs in 2021.The 1.3 million non-LIS enrollees in the fourth largest PDP, get kamagra Humana Premier Rx, will see a $7 (13%) increase in their monthly premium, from $58 in 2020 to $65 in 2021.Most Part D stand-alone drug plans in 2021 (62% of PDPs) will offer enhanced benefits for a higher monthly premium.

Enhanced benefits can include a lower (or no) deductible, reduced cost sharing, or a higher initial coverage limit than under the standard benefit design. The average premium in 2021 for enhanced benefit PDPs is $51, which is 55% higher than the monthly premium for PDPs offering the basic benefit ($33) (weighted by September 2020 enrollment).In 2021, a large majority of PDPs (86%) will charge a deductible, with most PDPs (67%) charging the standard amount get kamagra of $445 in 2021. Across all PDPs, the average deductible in 2021 will be $345 (weighted by September 2020 enrollment). The average monthly premium in 2021 for PDPs that charge no deductible is $88, nearly three times the monthly premium for PDPs that charge the standard deductible ($34) or a partial get kamagra deductible ($31) (weighted by September 2020 enrollment).Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current PlanFigure 5. Nearly 8 in 10 Part D Stand-alone Drug Plan Enrollees Without Low-income Subsidies Will Pay Higher Premiums in 2021 If They Stay in Their Current Plan​Most (78%, or 10 million) of the 13.4 million Part D PDP enrollees who are responsible for paying the entire premium (which excludes Low-Income Subsidy (LIS) recipients) will see their monthly premium increase in 2021 if they stay in their same plan, while 2.8 million (21%) will see a premium reduction if they stay in their same plan (Figure 5).Nearly 2 million non-LIS enrollees (13%) will see a premium increase of $10 or more per month, while significantly fewer (0.2 million non-LIS enrollees, or 1%) will see a premium reduction of the same magnitude.

One-third (34%) of non-LIS enrollees (4.6 million) are projected to pay monthly premiums of at least $60 if they stay in their current plans, and more than 230,000 (2% of non-LIS enrollees) are projected to pay monthly premiums of at least $100.The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay Is Substantially Higher Than Premiums for Other PDPsFigure 6. The Average Monthly Part D Premium in 2021 for the Subset of Enhanced Stand-alone Drug Plans Covering Insulin at a $35 Monthly Copay is Substantially Higher than Premiums for Other Plans​New for 2021, beneficiaries in each state will have the option to enroll in a Part D plan participating in the Trump Administration’s new Innovation Center model in which enhanced drug plans cover insulin products at a get kamagra monthly copayment of $35 in the deductible, initial coverage, and coverage gap phases of the Part D benefit. Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting).In 2021, a total of 1,635 enhanced Part D plans will participate in this model, which represents just over 30% of both PDPs (310 plans) and MA-PDs (1,325 plans) available in 2021, including plans in the territories. Between 8 and 10 enhanced PDPs in each region are participating in the model, in addition to multiple MA-PDs (see map) get kamagra. The average premium in 2021 for the subset of enhanced PDPs participating in the insulin $35 copay model ($59) is nearly twice as high as the monthly premium for basic PDPs ($33) and 61% higher than the average premium for enhanced PDPs that are not participating in the model ($37) (weighted by September 2020 enrollment).

Part D Cost SharingPart D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs Than For Drugs on a Generic Tier, get kamagra and a Mix of Copays and Coinsurance for Different Formulary TiersFigure 7. In 2021, Part D Enrollees Will Pay Much Higher Cost-Sharing Amounts for Brands and Non-preferred Drugs than for Drugs on a Generic Tier, and a Mix of Copays and Coinsurance for Different Formulary Tiers​In 2021, as in prior years, Part D enrollees will face much higher cost-sharing amounts for brands and non-preferred drugs (which can include both brands and generics) than for drugs on a generic tier, and a mix of copayments and coinsurance for different formulary tiers (Figure 7). The typical get kamagra five-tier formulary design in Part D includes tiers for preferred generics, generics, preferred brands, non-preferred drugs, and specialty drugs. Among all PDPs, median standard cost sharing in 2021 is $0 for preferred generics and $5 for generics (an increase from $4 in 2020), $40 for preferred brands (a decrease from $42 in 2020), 40% coinsurance for non-preferred drugs (an increase from 38% in 2020. The maximum allowed is 50%), and 25% coinsurance for specialty drugs get kamagra (the same as in 2020.

The maximum allowed is 33%).Among the 21 national PDPs, 13 PDPs, covering 9.3 million enrollees as of September 2020, are increasing cost-sharing amounts for drugs on at least one formulary tier between 2020 and 2021 (Table 3). Five PDPs get kamagra are increasing copayments for generics, with increases ranging from $1 to $4. Six PDPs are increasing copayments for preferred brands, with increases ranging from $3 to $10. And 10 PDPs are increasing coinsurance for non-preferred drugs, with increases ranging from 2 percentage points (e.g., from a 38% coinsurance rate to 40%) to 14 percentage points (e.g., from a 35% coinsurance rate to 49%).Low-Income Subsidy Plan AvailabilityIn 2021, 259 Part D Stand-Alone Drug Plans Will Be get kamagra Premium-Free to Enrollees Receiving the Low-Income Subsidy (Benchmark Plans)Figure 8. In 2021, 259 Part D Stand-Alone Drug Plans Will Be Available Without a Premium to Enrollees Receiving the Low-Income Subsidy (“Benchmark” Plans)​In 2021, a larger number of PDPs will be premium-free benchmark plans—that is, PDPs available for no monthly premium to Medicare Part D enrollees receiving the Low-Income Subsidy (LIS)—than in recent years, with 259 premium-free benchmark plans, or roughly a quarter of all PDPs in 2021 (Figure 8).

Through the Part D LIS program, enrollees with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. As of 2020, approximately 13 million Part D get kamagra enrollees are receiving LIS, including 6.7 million (52%) in PDPs and 6.1 million (48%) in MA-PDs.On average (weighted by Medicare enrollment), LIS beneficiaries have eight benchmark plans available to them for 2021, or about one-fourth the average number of PDP choices available overall. All LIS enrollees can select any plan offered in their area, but if they enroll in a non-benchmark plan, they must pay some portion of their chosen plan’s monthly premium. In 2021, 10% of all LIS PDP enrollees who are eligible for premium-free Part D coverage (0.6 million LIS enrollees) will pay Part D premiums averaging $33 get kamagra per month unless they switch or are reassigned by CMS to premium-free plans.The number of benchmark plans available in 2021 will vary by region, from five to 10 (see map). In 2020, 89% of the 6.6 million LIS PDP enrollees are projected to be in PDPs operated by five firms.

CVS Health, Centene, Humana, UnitedHealth, and get kamagra Cigna (based on 2020 enrollment). DiscussionOur analysis of the Medicare Part D stand-alone drug plan landscape for 2021 shows that millions of Part D enrollees without low-income subsidies will face premium and other cost increases in 2021 if they stay in their current stand-alone drug plan. There are more plans available nationwide in 2021, with Medicare beneficiaries having 30 PDP choices during this year’s open enrollment period, plus get kamagra 27 Medicare Advantage drug plan options. Most Part D PDP enrollees who remain in the same plan in 2021 will be in a plan with the standard $445 deductible and will face much higher cost sharing for brands than for generic drugs, including as much as 50% coinsurance for non-preferred drugs.Some Part D enrollees who choose to stay in their current plans may see lower premiums and other costs for their drug coverage, but nearly 8 in 10 non-LIS enrollees will face higher premiums if they remain in their current plan, and many will also face higher deductibles and cost sharing for covered drugs. Some beneficiaries might find the best coverage and costs for their specific medications in a plan with a relatively low premium, while for get kamagra other beneficiaries, a higher-premium plan might be more suitable.

Because Part D plans vary in a number of ways that can have a significant effect on an enrollee’s out-of-pocket spending, beyond the monthly premium, all Part D enrollees could benefit from the opportunity to compare plans during open enrollment.Juliette Cubanski is with KFF.Anthony Damico is an independent consultant. This analysis focuses on the Medicare Part get kamagra D stand-alone prescription drug plan marketplace in 2021 and trends over time. The analysis includes 20.2 million enrollees in stand-alone PDPs, as of March 2020. The analysis excludes 17.4 million MA-PD enrollees (non-employer), and another 4.6 million enrollees get kamagra in employer-group only PDPs and 2.3 million in employer-group only MA-PDs for whom plan premium and benefits data are unavailable.Data on Part D plan availability, enrollment, and premiums were collected from a set of data files released by the Centers for Medicare &. Medicaid Services (CMS):– Part D plan landscape files, released each fall prior to the annual enrollment period– Part D plan and premium files, released each fall– Part D plan crosswalk files, released each fall– Part D contract/plan/state/county level enrollment files, released on a monthly basis– Part D Low-Income Subsidy enrollment files, released each spring– Medicare plan benefit package files, released each fallIn this analysis, premium estimates are weighted by September 2020 enrollment unless otherwise noted.

Percentage increases are calculated based on non-rounded estimates and in some cases differ from percentage calculations calculated based on rounded estimates presented in the text..

Kamagra next day

Over the last few years, kamagra oral jelly online australia there have kamagra next day been many articles detailing how bad sitting can be for the body. You may have even seen the phrase, “Sitting is the new smoking.” But how bad is sitting down, really?. As a physical kamagra next day therapist, I see many people who come into my office and sheepishly admit that they sit all day long for their jobs. As our reliance on technology for our jobs increases, this becomes more and more of the norm for society.

Personally, I think sitting has gotten a bad rap, and what we kamagra next day really need to do is look at our lack of physical activity overall. When we sit every day for our job, it can have a negative impact on the body, but an overall lack of physical activity is much more concerning than sitting itself. When we sit, our bodies adapt to that position. There are several things that occur, kamagra next day such as a tightening of the hamstrings and a forward head and rounded shoulder posture.

We don’t use our core muscles when we sit, because our body is supported, so there can be a weakening of those muscles as well. Our body kamagra next day gets used to not having to use these muscle groups. Then, when you do try to get out and be active, or work in the yard, you might be more susceptible to injury or pain because your body isn’t used to that kind of stress. In short, you don’t kamagra next day need to quit your day job to pursue a career that involves standing all day.

What you really need to do is increase your activity level outside of work and incorporate some regular exercises that combat the negative effects of sitting. These exercises can include core strengthening, stretching of the hips and chest and exercises to reverse your forward posture. If you are experiencing pain related to sitting for long kamagra next day periods of time, a physical therapist can help you identify a more targeted exercise program. Physical Therapist Kyle Stevenson, D.P.T., sees patients at MidMichigan’s Rehabilitation Services location in Greater Midland North-End Fitness Center.

He has a special interest in sports kamagra next day medicine, and enjoys working with athletes of all ages buy cheap kamagra next day delivery. He has completed specialized coursework and training for the throwing athletes. New patients are welcome kamagra next day with a physician referral by calling (989) 832-5913. Those who would like more information about MidMichigan’s Rehabilitation Services may visit www.midmichigan.org/rehabilitation.W-sitting is a normal developmental position that babies usually discover when they sit back straight from their hands and knees.

Their legs will then form a “W.” Often, babies also transition back to a single hip, toward a side sitting position. When a baby varies his or her sitting kamagra next day position, W-sitting is rarely a problem. However, when a baby sits back straight to a W-sit consistently, they don’t get the opportunity to elongate and activate lateral trunk muscles to develop their core muscles. W-sitting is a very stable position that children find useful, however, it allows them to play without developing muscle that provide the ability for kids to reach out to kamagra next day their sides or rotate across their midline, leading to underdevelopment of lower trunk muscles, which stabilize the pelvis.

When a child uses this position as their preference without the normal variety in movements, it can affect development. They may kamagra next day demonstrate an in-toeing gait, core weakness or balance difficulties. The hips are positioned in extreme internal rotation, placing stress on the hips and the knee joints. This can lead to hip and knee orthopedic issues as the child develops.

So, what can you do kamagra next day to prevent any development issues?. Encourage your child to alternate sitting positions, such as side sitting (alternating sides), ring sitting, or, with older children, sitting in a chair or on a ball. This might be challenging initially, but once your child kamagra next day gets used to it, they may just need reminders. If it’s difficult for your child to sit in alternate positions or they begin to show other developmental concerns, a referral to a physical therapist may be helpful to facilitate trunk muscle development.

Eileen McMahon, M.S.P.T., is a physical therapist at MidMichigan Health..

Over the last where to get kamagra few years, there have been many articles detailing how bad sitting can be get kamagra for the body. You may have even seen the phrase, “Sitting is the new smoking.” But how bad is sitting down, really?. As a physical therapist, I see many people who come into get kamagra my office and sheepishly admit that they sit all day long for their jobs. As our reliance on technology for our jobs increases, this becomes more and more of the norm for society. Personally, I think get kamagra sitting has gotten a bad rap, and what we really need to do is look at our lack of physical activity overall.

When we sit every day for our job, it can have a negative impact on the body, but an overall lack of physical activity is much more concerning than sitting itself. When we sit, our bodies adapt to that position. There are several things that occur, such as a tightening of the hamstrings and a get kamagra forward head and rounded shoulder posture. We don’t use our core muscles when we sit, because our body is supported, so there can be a weakening of those muscles as well. Our body get kamagra gets used to not having to use these muscle groups.

Then, when you do try to get out and be active, or work in the yard, you might be more susceptible to injury or pain because your body isn’t used to that kind of stress. In get kamagra short, you don’t need to quit your day job to pursue a career that involves standing all day. What you really need to do is increase your activity level outside of work and incorporate some regular exercises that combat the negative effects of sitting. These exercises can include core strengthening, stretching of the hips and chest and exercises to reverse your forward posture. If you are experiencing pain related to sitting for long periods of time, a physical therapist can get kamagra help you identify a more targeted exercise program.

Physical Therapist Kyle Stevenson, D.P.T., sees patients at MidMichigan’s Rehabilitation Services location in Greater Midland North-End Fitness Center. He has a special http://kwcea.net/?p=74 interest in sports medicine, get kamagra and enjoys working with athletes of all ages. He has completed specialized coursework and training for the throwing athletes. New patients are welcome with a physician referral by calling (989) 832-5913 get kamagra. Those who would like more information about MidMichigan’s Rehabilitation Services may visit www.midmichigan.org/rehabilitation.W-sitting is a normal developmental position that babies usually discover when they sit back straight from their hands and knees.

Their legs will then form a “W.” Often, babies also transition back to a single hip, toward a side sitting position. When a baby varies get kamagra his or her sitting position, W-sitting is rarely a problem. However, when a baby sits back straight to a W-sit consistently, they don’t get the opportunity to elongate and activate lateral trunk muscles to develop their core muscles. W-sitting is a very stable position that children find useful, however, it allows them to play without developing get kamagra muscle that provide the ability for kids to reach out to their sides or rotate across their midline, leading to underdevelopment of lower trunk muscles, which stabilize the pelvis. When a child uses this position as their preference without the normal variety in movements, it can affect development.

They may demonstrate an in-toeing gait, core weakness get kamagra or balance difficulties. The hips are positioned in extreme internal rotation, placing stress on the hips and the knee joints. This can lead to hip and knee orthopedic issues as the child develops. So, what can you do to prevent any development issues? get kamagra. Encourage your child to alternate sitting positions, such as side sitting (alternating sides), ring sitting, or, with older children, sitting in a chair or on a ball.

This might be challenging initially, but once your child gets get kamagra used to it, they may just need reminders. If it’s difficult for your child to sit in alternate positions or they begin to show other developmental concerns, a referral to a physical therapist may be helpful to facilitate trunk muscle development. Eileen McMahon, M.S.P.T., is a physical therapist at MidMichigan Health..