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Q1Group 2016 MA/MAPD Analysis Summary: Overall more 2016 Medicare Advantage plan choices - Medicare Advantage landscape changes 2013 to 2016

Category: Annual Medicare plan changes
Published: Oct, 10 2015 01:10:39


The total number of 2016 Medicare Advantage plans will increase slightly across the country with 4% more Medicare Advantage plans offered in 2016.   Overall, there will be 2,618 Medicare Advantage plans (MAs and MAPDs) available in 2016, as compared to 2,526 Medicare Advantage plans offered in 2015.

Most (90%) of 2016 Medicare Advantage plans will include prescription drug coverage (MAPDs).  In fact, more 2016 Medicare Advantage plans available will include prescription drug coverage (MAPD) as compared to 2015.   However, slightly fewer 2016 Medicare Advantage plans without prescription coverage (MA) will be offered in 2016, as compared to in 2015.

The majority (around 71%) of 2016 Medicare Advantage plans will be HMOs (Health Maintenance Organizations), 20% of 2016 Medicare Advantage plans will be Local PPOs (Preferred Provider Organizations).  Medicare Advantage HMOs also show the greatest increase in the total number of 2016 plans (with the addition of 80 HMO plans).  

The number of Private Fee for Service (PFFS) Medicare Advantage plans continues to decline in 2016 (a 17% decrease in PFFS plans).  In 2015, the number of PFFS Medicare Advantage plans decreased by 43% (with PFFS Medicare Advantage plans offering prescription drug coverage decreasing by 66% or losing 33 PFFS MAPD plans in 2015).

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Jump to Health Plan Type definitions

Change in the Number of All Medicare Advantage Plans
(MA & MA-PD)
  Number of Medicare Advantage Plans (MA & MA-PD)
Health Plan Type 2016 2015 Change ’15 to ‘16 2014
Cost 81 86 -5 -6% 87
Local HMO 1,865 1,785 80 4% 1,763
Local PPO 487 493 -6 -1% 540
Regional PPO 58 54 4 7% 58
All PPOs 545 547 -2 0% 598
PFFS 57 69 -12 -17% 120
MSA 4 7 -3 -43% 6
MMP 66 32 34 106% 4*
Total MA & MAPD plans 2,618 2,526 92 4% 2,578

    *Note: this is number of MMP plans in the September, 2013 landscape file

151009_MA_Type_total.jpg

 



Reminder: Types of Medicare Advantage Plans

As you browse through the 2016 Medicare Advantage plans, you will see in our Medicare Advantage search tools that there are seven common types of Medicare Advantage plans offered.
  • HMO - Health Maintenance Organizations: HMOs are wellness based Medicare Advantage plans and usually have the most-restrictive healthcare provider network, meaning that your healthcare costs may be considerably higher if you go outside of your plan’s established network.  Also, depending on your HMO plan, you may only be allowed outside of your plan network with a referral from your doctor.  Local HMOs are often very affordable compared to other Medicare Advantage plans because the restrictive network and focus on wellness helps to control healthcare costs.  The majority of 2016 Medicare Advantage plans will be HMOs (Health Maintenance Organizations).
     
  • HMO POS - Health Maintenance Organizations Point-of-Service:  These Medicare Advantage HMO’s have a more flexible healthcare network allowing you to seek care outside of your plan’s network by paying a higher cost-sharing rate.  This type of HMO is chosen often for people who travel part of the year, but still return home for the majority of their healthcare needs.  For instance, you may have a $30 co-payment when you visit a healthcare provider in-network (at home) and pay $60 when you visit a provider outside of the plan’s network (while traveling).  Important: Some 2015 HMO POS plans will convert to HMOs (without the POS option) in 2016.  Please note, depending on your HMO POS, you may find that out-of-network costs do not apply to your plan's that your Maximum Out of Pocket (MOOP) limit - check with your plan's Member Services for more details.
     
  • PPO - Preferred Provider Organization:  Medicare Advantage PPOs have a less-restrictive provider network, but again, you probably will pay a higher cost-sharing rate when you visit a healthcare provider outside of your plan’s network.
     
  • PFFS - Private Fee for Service plans:  Although popular several years ago, fewer Medicare Advantage PFFS plans are now available (only 57 PFFS plans are available in 2016).  PFFS plans have the most flexible network, meaning that you can go to any health care provider as long as they accept Medicare and the terms and conditions of your PFFS plan.  As noted, in 2016, PFFS plans will become rare, but some people still find PFFS plans as a flexible and economic alternative to other Medicare Advantage plans.
     
  • SNPs - Special Needs Plans:  SNPs are Medicare Advantage plans designed for a people with specific conditions or financial needs.  Certain SNPs are available only to diabetics, people with chronic cardiac conditions, nursing home residents, or people eligible for both Medicare and Medicaid (D-SNPs).  If you do not have the plan’s “special need”, you will not be allowed to join one of these plans.
     
  • MSAs - Medical Savings Accounts:  MSAs are like Health Savings Accounts (or HSAs) or a high-deductible health plan combined with a spending account that you can use to pay for your health care costs.  MSAs do not provide prescription drug coverage and you would need to join a separate Medicare Part D plan for your prescription needs.  Unfortunately, few MSAs are available.
     
  • MMPs - Medicare-Medicaid Plans: MMP plans were introduced in 2014 and are only offered in a few locations across the country.  As noted by CMS: "A Medicare-Medicaid Plan (MMP) [like a D-SNP] is a private health plan that has been competitively selected and approved to provide integrated care to eligible full-benefit Medicare-Medicaid enrollees under the CMS Financial Alignment Demonstration." (CMS, “Financial Alignment Initiative,”
    (www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html.)

    MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply.

Change in the Number of MA-PD Plans
  Number of Medicare Advantage Plans With Drug Coverage
Health Plan Type 2016 2015 Change
’15 to ‘16
2014 Change
’14 to ‘15
Cost 34 39 -5 39 0
Local HMO 1,732 1,649 83 1,609 40
Local PPO 441 441 0 470 -29
PFFS 38 50 -12 83 -33
Regional PPO 41 37 4 18 -1
MMP 66 32 34 34 -2
Total MAPD Plans 2,286 2,216 70 2,219 -3


151008_MA_Type_MAPD.jpg


As compared to the 2,286 MAPDs or Medicare Advantage plans that provide prescription drug coverage in 2016, there are only 266 different 2016 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).  And across the country, there will be 12 fewer MA plans in 2016.

Change in the Number of
Medicare Advantage Plans Without Drug Coverage

Number of Plans
Health Plan Type 2016 2015 Change
’15 to ‘16
2014 Change
’14 to ‘15
Cost 47 47 0 48 -1
Local HMO 133 136 -3 154 -18
Local PPO 46 52 -6 70 -18
MSA 4 7 -3 6 1
PFFS 19 19 0 37 -1
Regional PPO 17 17 0 18 -1
Total MA Plans w/o Rx Cov. 266 278 -12 333 -55


151008_MA_Type_MA.jpg

Other resources
2016 Medicare Advantage plan information is available in our 2016 Medicare Advantage plan finder (or MA-Finder) that can be found at: MA-Finder.com/2016

You can also see how each 2015 Medicare Advantage plan is changing in 2016 using our Medicare Advantage comparison tool found at: MA-Compare.com/2016.







Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.