- Medicare Plan Consolidation or Merger
Sometimes a Medicare plan will offer several different variations of a Medicare plan in a single Service Area (state or ZIP Code area) - and although all of these plans may offer slightly different drug or healthcare coverage, the company may decide to merge or consolidate these different plans into one single plan, or a Medicare Part D plan from one company may be merged together with a Medicare Part D plan from another company that was acquired during the year. In either case, existing Medicare plan members will be automatically "crosswalked" to (merged into) the new Medicare plan that starts January 1st of next year.
The good news is that the members who are "crosswalked" do not lose Medicare plan coverage, but are moved to another plan. And the new Medicare plan may have new cost and coverage features. As an example, 5.28 million people are currently enrolled in a 2024 Medicare plan that will "crosswalk" plan members to a different 2025 Medicare plan.
- A Medicare plan's Service Area Reductions (SAR)
Each year, Medicare plans have the option to discontinue their plan in specific service areas of the country. The Medicare plan's affected service area may be an entire state, specific counties, or ZIP codes. It is possible that plan members in some areas of the country will remain in the Medicare plan, but the plan will be discontinued in other areas.
As noted above, in some cases, a discontinued plan will "crosswalk" plan members to a new Medicare plan, but, in other cases, the members of a discontinued plan will be without coverage next year if they do not select a new Medicare Part D or Medicare Advantage plan. For example, in 2024, over 7 million people are enrolled in Medicare Part D or Medicare Advantage plans that will be not continued in 2025 - and these people will lose their 2025 Medicare plan coverage - unless they enrolled into a different 2025 Medicare plan.
Remember, there is a Service Area Reduction Special Enrollment Period (SAR SEP) starting on December 8th and continuing through the end of February allowing people who who were in a terminated plan the possibility of enrolling in a new Medicare plan for the new plan year - after the December 7th close of the annual Open Enrollment Period (AEP).
- Terminated Medicare Plans
As just noted, sometimes an insurance company will choose to terminate a specific Medicare plan - however, it is also possible that the Centers for Medicare and Medicaid Services (CMS) will terminate an insurance company's contract and the Medicare plan will no longer be offered. All members of a terminated Medicare plan will also need to actively join a new Medicare plan or be without coverage in the next year.
When a plan is no longer being offered, existing Medicare plan members of a Medicare Advantage plan or Medicare Part D plan will be notified in their Annual Notice of Change (ANOC) letter about the plan termination or consolidation - and plan members are given the option to join another plan during the annual Open Enrollment Period (AEP).
Need a faster way to see if your Medicare Part D or Medicare Advantage plan is changing next year?
Our PDP-Compare and MA-Compare tools allow you to compare annual changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MAs or MAPDs) across the country showing changes in monthly premiums and plan design changes, as well as changes in co-payments or co-insurance rates for different drug tiers along with the most recent Medicare quality star ratings.
Both the PDP-Compare and MA-Compare also show the Medicare Part D plans or Medicare Advantage plans that will be merged, discontinued, or added each year.