ANOC Reminder: How is your 2015 Medicare Part D prescription drug plan or Medicare Advantage plan changing in 2016?

Studies show that most people do not change their Medicare Part D or Medicare Advantage plan each year, even if they can save money on their prescription and medical costs. We can appreciate that, for some people, the value of consistency outweighs the potential for savings.

However, we want to remind you that, if you decide to stay with your current 2015 Medicare plan into 2016, your Medicare plan coverage and costs can change, so please take time to know how your current Medicare plan is changing in 2016.

What changes can you expect in 2016?

Your 2015 Medicare plan may be discontinued in 2016. Although the 2016 Medicare plan landscape is more stable than past years, some 2015 Medicare Part D and Medicare Advantage plans will not be offered in 2016. If your Medicare plan is not being offered in 2016, and you are not being reassigned to another Medicare plan, you may be without Medicare plan coverage on January 1^st. You can click here to read more in our article about plans affected by Service Area Reductions.
Your 2015 Medicare Part D plan may be changing names in 2016. Over 600,000 Medicare Part D beneficiaries will find that their 2015 Medicare plan’s name will change in 2016. For example, the 450,000 members of the 2015 Cigna-HealthSpring Rx Secure-Xtra (PDP) may notice that their plan will become the 2016 Cigna-HealthSpring Rx Secure Extra (PDP) and, aside from the slight name change, will include some noteworthy changes in coverage. You can click here to see a few other example of 2016 Medicare Part D name changes.
You may be automatically reassigned to another 2016 Medicare Part D plan. Approximately 260,000 current members of stand-alone 2015 Medicare Part plans will be automatically “crosswalked” or merged into another Medicare Part D plan in 2016. For example, members of the 2015 SmartD Rx Saver (PDP) will be automatically reassigned to the 2016 Express Scripts Medicare - Value (PDP). You can click here to read more about 2016 Medicare Part D plan mergers or consolidations.
2015 Medicare Advantage plan members will also notice plan mergers and consolidations. In addition to the statewide stand-alone Medicare Part D plan consolidations, many 2015 Medicare Advantage plans will also be terminated in 2016 or merged into other 2016 Medicare Advantage plans - with some counties seeing significant changes in their Medicare Advantage plan landscape. The counties seeing the largest number of terminated 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 Medicare Advantage plans.
Your monthly 2016 Medicare Part D premium might be increasing. Without changing 2015 Medicare Part D plans, almost 6,000,000 Medicare beneficiaries will see a monthly 2016 Medicare Part D premium increase of over 20%. You can click here to see examples of 2015 Medicare Part D plans that are increasing their 2016 premiums.
Your plan’s Initial Deductible (the amount you pay before coverage) may increase. The standard 2016 Medicare Part D deductible will increase $40 to $360, up from the standard 2015 deductible of $320. About 573,000 Medicare beneficiaries are enrolled in 2015 plan that will see an even larger initial deductible increase of up to $310. You can click here to see an example list of Medicare Part D plan’s increasing their 2016 initial deductibles. The good news is that many Medicare Part D plans are now exempting lower-costing drug tiers from the initial deductible. Also, on a positive note, the 600,000 members of the 2015 First Health Part D Value Plus plan will notice that they now have a $0 deductible for 2016.
Your 2016 Medicare drug plan’s formulary or drug list might cover fewer medications. Although some 2016 Medicare prescription drug plans will be adding more medications, based on our analysis, over 10 million Medicare beneficiaries currently enrolled in a stand-alone Medicare Part D plan will see at least 100 medications removed from their 2016 formulary. Please remember that a larger Medicare Part D plan formulary does not necessarily mean you will get more of your medications covered. Be sure to check to make sure your medications are affordably covered by your chosen 2016 Medicare Part D plan.
Your 2016 Medicare plan’s prescription drug cost-sharing (co-payments) might increase. In other words, if you are currently paying $1.00 for a generic prescription in 2015, you may be paying $4.00 in 2016 for the same medication. You can click here to see an example of how the 2016 SilverScript Choice Medicare Part D plan will add a new drug tier to the 2016 plan formulary and change the cost-sharing design.
Your Medicare prescription drug plan may be using preferred pharmacies. For example, the First Health Part D Value Plus PDP in Washington State uses preferred network pharmacy pricing and the co-payment for a Tier 1 medication is $1.00 at a preferred network pharmacy and, for the same Tier 1 drug, a $10.00 co-pay when purchased at a non-preferred network pharmacy. You can contact your plan’s Member Service department to find preferred pharmacies in your area.
Some 2016 Medicare Advantage plans will offer a variation on the standard drug plan Initial Coverage Limit of $3,310, with 2016 Initial Coverage Limits ranging from $2,550 to $8,000. You can click here to read more about 2016 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.
Your 2016 Medicare Part D plan Donut Hole or Coverage Gap benefits can change. Some good news: the standard 2016 Initial Coverage Limit has increased to $3,310 (meaning the you can purchase medications with a retail value up to $3,310 before entering the 2016 Donut Hole) and, if you do exceed your drug plan’s Initial Coverage Limit, 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%.
Your 2016 Medicare Part D plan may no longer qualify for your State’s Low-Income Subsidy (LIS) $0 premium. In 2016, most states will have fewer Medicare Part D plans qualifying for the state’s Low-Income Subsidy (LIS) $0 premium. The state offering the smallest selection of $0 premium LIS plans is Hawaii, with only two (2) 2016 $0 premium LIS plans (down from nine (9) qualifying 2015 Part D plans). For more about the decline in the number of LIS $0 premium plans, you can click here for our article “this site analysis of the 2014 to 2016 decline of Medicare Part D plans qualifying for the Low-Income Subsidy (LIS) $0 premium”.
Your Medicare Advantage plan’s provider network may change. During the past several years some Medicare Advantage plan members have found that their healthcare providers were dropped from the plan’s network. Remember, even though you have checked to ensure that your healthcare providers are included in your Medicare Advantage plan's provider network, it is possible that your plan’s network will change during the plan year. Although Medicare has established a Special Enrollment Period (SEP) allowing you to change Medicare plans if your plan makes significant mid-year network changes, it is not yet clear when this SEP will be applied.
Your 2016 Medicare Advantage plan’s Medicare Part A and Part B maximum out-of-pocket (MOOP) limit may be reduced below the $6,700 maximum. In 2016, more Medicare Advantage plans will offer a lower Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit down 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.

Bottom Line: If you do not enroll into a new 2016 Medicare Part D plan or Medicare Advantage plan, you will be automatically re-enrolled into your current Medicare Part D or Medicare Advantage plan for 2016 and your 2016 Medicare plan may cost you more money and provide different coverage than in 2015. If your 2015 Medicare plan is being terminated in 2016 and you are not merged or “crosswalked” to another 2016 Medicare plan, you may be without Medicare plan coverage on January 1^st.

The Good News: You still have plenty of time to review your 2016 Medicare plan coverage options during the annual Open Enrollment Period that began on October 15^th and continues through December 7^th.

How to learn more about the changes in your 2016 Medicare plan?
Your Medicare plan provider is required to summarize any Medicare Part D or Medicare Advantage plan changes in your Annual Notice of Change letter (ANOC) that you should have received in late-September or early-October. If you have not received a copy of your plan’s ANOC letter, please call your plan’s Member Services department and ask your plan to send another copy.

Need a fast way to see how your Medicare Advantage or Medicare Part D plan is changing in 2016?
Our PDP-Compare and MA-Compare tools allow you to compare changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MAs or MAPDs) across the country. Our comparison tools show changes in monthly premiums and plan designs, as well as changes in co-payments or co-insurance rates for different drug tiers. Both the PDP-Compare and MA-Compare also show the Medicare Part D plans or Medicare Advantage plans that will be discontinued or added in 2016. The MA-Compare tool includes links to the health coverage details of all 2015 and 2016 Medicare Advantage plans.

To see the annual 2015 / 2016 changes in Medicare Part D plan details, simply click on your state: AK 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.

As a 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 stand-alone Medicare Part D plan only offers prescription drug coverage.
For an overview of the 2016 Medicare Part D prescription drug plan (PDP) landscape please see our article: “A summary of the national 2016 Medicare Part D prescription drug plan (PDP) landscape: Many Medicare beneficiaries will see higher plan premiums and find fewer plan choices”.
A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization), Medicare Part B (out-patient and doctor visits), and may include Medicare Part D coverage along with other healthcare benefits (such as limited dental, hearing, and vision coverage).
Some Medicare Advantage plans do not include prescription drug coverage and are known as “MAs” (as compared to MAPDs).
If you enroll in a Medicare Advantage (MA) plan that does not include drug coverage, you may not be allowed to also join a stand-alone Medicare Part D plan (PDP). Instead, you might wish to join a Medicare Advantage plan that includes prescription coverage (MAPD).
A Medicare Advantage plan is not the same as a Medicare Supplement or Medigap policy.
For a summary of the 2016 Medicare Advantage (MA and MAPD) plan landscape please see our article: "The 2016 Medicare Advantage plan landscape: Stable plan premiums, but beneficiaries in many counties will find significant changes in plan availability"