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Q1Group 2016 MA/MAPD Analysis Summary: Stable Medicare Advantage plan premiums, but beneficiaries in many counties will find significant changes in plan availability

Annual Medicare plan changes · published Oct 18, 2015

A preliminary analysis of the 2016 Medicare Advantage plan (MA and MAPD) landscape data recently released by the Centers for Medicare and Medicaid Services (CMS) shows changes in Medicare Advantage plan availability, with stable plans premiums, and lower maximum out-of-pocket limits.

Reminder:  You can receive Medicare prescription drug coverage from either a stand-alone Medicare Part D plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage (MAPD).  A Medicare Part D plan only offers prescription drug coverage.  A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization), Medicare Part B (out-patient and physician), and may include additional healthcare benefits.  Some Medicare Advantage plans do not include prescription drug coverage (MAs).  If you enroll in a Medicare Advantage (MA) that does not include drug coverage, you may not be permitted to join a stand-alone Medicare Part D plan (PDP).  Please telephone a Medicare representative at 1-800-633-4227 for more details.

Here are a few highlights of the 2016 Medicare Advantage plans:
  • As noted by CMS, Medicare Advantage plan premiums have remained stable over the past few years.  Overall, almost 70% of the 2016 Medicare Advantage plans will have premiums under $50, with 35% of the 2016 Medicare Advantage plan having a $0 premium.  You can click here to read more about changes in Medicare Advantage plan premiums and see a chart of how Medicare Advantage plan premiums have changed since 2014. Please note: The overall stability of Medicare Advantage plan premiums does not indicate that your 2015 Medicare Advantage plan premium will remain the same 2016.  Please review your Annual Notice of Change letter to see how your 2015 Medicare Advantage plan is changing in 2016 or use our Medicare Advantage plan 2015/2016 comparison tool (MA-Compare.com/2016).

  • 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.  You can click here to read more about annual changes in Medicare Advantage plan availability by health plan type.

  • However, when viewed in detail, many 2015 Medicare Advantage plans will be terminated in 2016 or merged into other 2016 plans and many counties will see significant changes in their Medicare Advantage plan landscape.  The counties seeing the largest decrease of 2016 Medicare Advantage plans are found in: Florida, New York, and Puerto Rico.  For example, Twenty (20) of the 81 Medicare Advantage plans currently available Richmond County, New York are no longer offered in 2016.  You can click here to read more about county-level changes in the available Medicare Advantage plans.  You can also see more 2016 Medicare Advantage plan changes using our MA-Compare tool found here: MA-Compare.com/2016.

  • 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).  You can click here to read more about the different types of Medicare Advantage plans and plan availability changes.

  • Over 24% of the 2015 Medicare Advantage Special Needs Plans (SNPs) will be discontinued in 2016 as compared to 16% of the 2014 Special Needs Plans that were discontinued in 2015.  The good news is that such a large number of new SNPs are being introduced in 2016, that overall, there is actually an increase of one (1) SNP for 2016.  You can click here to learn more about the 2016 Medicare Advantage Special Needs Plans and how the SNP landscape has changed since 2014.

  • Most (90%) of 2016 Medicare Advantage plans will include prescription drug coverage (MAPDs), with 2,286 MAPD plans available in 2016 as compared to the 2,216 MAPDs available in 2015.  However, slightly fewer Medicare Advantage plans without prescription coverage (MA) will be offered in 2016, with 266 plans available as compared to 278 MAs available in 2015.  You can click here to read more about the changes in Medicare Advantage plans that offer prescription drug coverage over the past few years.

  • A large number of 2016 Medicare Advantage plans will include prescription drug coverage and have a $0 premium and $0 drug deductible.  You can click here to read more about the 2016 Medicare Advantage plans that have a $0 premium and a $0 initial deductible for prescription drug coverage.

  • Some 2016 Medicare Advantage plans will offer a variation in the standard drug plan Initial Coverage Limit of $3,310.  You can click here to read more about 2016 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.

  • Slightly more 2016 Medicare Advantage plans (MAPDs) will offer Donut Hole coverage for prescriptions purchased while in the Coverage Gap.  The 2016 Donut Hole discount will continue to provide a 55% discount for brand-name drugs and the generic drug discount will increase to 42%.

  • More 2016 Medicare Advantage plans will lower their Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit from the $6,700 maximum.  The number of 2016 Medicare Advantage plans having the statutory maximum MOOP will decrease to 33% -- down from 48% in 2015.  You can click here to learn more about the Maximum Out-of-Pocket Limits for 2016 Medicare Advantage plans and how MOOPs have changed since 2014.

  • As in prior years, no Medicare Advantage plans are offered in Alaska.

Need an example?
To get you started with an overview of the 2016 Medicare Advantage plans in your area, just click on your state and then click on your county name: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY.

You can also use our 2016 Medicare Advantage plan finder (or MA-Finder) that can be found directly at: MA-Finder.com/2016.  The MA-Finder displays the plan premium, prescription deductible, Gap or Donut Hole coverage availability, and Medicare Part A and Part B Maximum Out-of-Pocket limit (or MOOP), drug tier

You can also use our 2015/2016 MA-Compare tool to see how your 2015 Medicare Advantage plan is changing in 2016.  Our Medicare Advantage comparison tool can be found directly at: MA-Compare.com/2016.