More 2021 Medicare Advantage plan choices, with increases in HMO and local PPO options

"[Medicare b]eneficiaries will have more plan choices, with about 2,100 more Medicare Advantage plans operating in 2021 than in 2017, a 76.6 percent increase. Overall, beneficiaries can choose from more than 4,800 Medicare Advantage plans during 2021 open enrollment."

A brief review of Medicare Advantage plans

Medicare Advantage plans come in two general forms (with or without drug coverage),

--  MAs or Medicare Advantage plans that do not include prescription drug coverage and
--  MAPDs or Medicare Advantage plan that includes prescription drug coverage (MAPD).

What is included in a Medicare Advantage plan?  A Medicare Advantage plan (MA or MAPD) includes your Medicare Part A (in-patient and hospitalization coverage), Medicare Part B (out-patient and physician coverage), may include additional or supplemental healthcare benefits (basic dental, optical, hearing, and/or fitness coverage) - and supplemental non-health related benefits (food delivery and general transportation).  A MAPD also includes your Medicare Part D drug coverage.  If you enroll in some types of Medicare Advantage (MAs) that do not include drug coverage, you may not be permitted to also join a stand-alone Medicare Part D plan (PDP) (so be sure to check before you join).

You can join a Medicare Advantage plan even with pre-existing health issues.  Starting in 2021, you can join a Medicare Advantage plan without any pre-existing health questions - even if you are a Medicare beneficiary suffering from End-Stage Renal Disease (ESRD), you can join a 2021 Medicare Advantage plan.  This new "guaranteed issue" rule also applies to employer/union Medicare plans (EGHP), but, depending on your state, may not include Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs).  You can click here for more details about joining a Medicare Advantage plan with ESRD.

• Most 2021 Medicare Advantage plans provide Part D prescription drug coverage (MAPDs)
  
  There are 451 more Medicare Advantage MAPD options available in 2021 as compared to 2020.  As was true in 2020, 92% of all 2021 Medicare Advantage plans include prescription drug coverage (MAPDs).  Note the increases in Local Health Maintenance Organizations (HMO) and Local Preferred Provider Organization (PPO) MAPD options for 2021 - with a further decline in Medicare Advantage Medicare-Medicaid plan MMP, Cost, and PFFS Medicare Advantage plans.
  
  
  
  
  

  Change in the Number of MAPD plans
  Number of Medicare Advantage plans with Drug Coverage
  Health Plan Type	2021	Change '20 to '21	2020	Change '19 to '20	2019	Change '18 to '19	2018
  Cost	14	-2	16	-2	18	-12	30
  Local HMO	2,893	261	2,632	364	2,268	265	2,003
  Local PPO	1,170	199	971	154	817	240	577
  Regional PPO	45	-1	46	0	46	1	45
  PFFS	21	-5	26	-3	29	-1	30
  MMP	43	-1	44	-6	50	-4	54
  Total MAPD Plans	4,186	451	3,735	507	3,228	489	2,739

  
  
  
• A few more 2021 Medicare Advantage plan options do not include drug coverage (MAs)
  
  There is a slight increase of 70 additional 2021 Medicare Advantage plans without prescription coverage (MA) as compared to 2020. In fact, as compared to the 4,186 Medicare Advantage plans that provide prescription drug coverage (MAPDs) in 2021, there are only 382 different 2021 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).
  
  
  
  
  
  

  Change in the Number of Medicare Advantage plans without Drug Coverage (MAs)
  	Number of MA Plans
  Health Plan Type	2021	Change '20 to '21	2020	Change '19 to '20	2019	Change '18 to '19	2018
  Cost	56	-8	64	10	54	0	54
  Local HMO	179	34	145	13	132	5	127
  Local PPO	111	47	64	8	56	11	45
  Regional PPO	19	1	18	1	17	0	17
  MSA	5	-1	6	0	6	3	3
  PFFS	12	-3	15	0	15	-1	16
  Total MA Plans w/o Rx Cov.	382	70	312	32	280	18	262

  
  
  
• More Medicare Advantage Health Maintenance Organization (HMO) options are offered in 2021
  
  The majority (around 67%) of 2021 Medicare Advantage plans will be HMOs (Health Maintenance Organizations) with a 11% increase in the number of 2021 HMO plans over 2020.
  
  Members of a Medicare Advantage HMOs (MA-only) are not permitted to enroll in a stand-alone Medicare Part D plan (PDP) and will need another source for their drug coverage (such as employer/union drug coverage or VA drug coverage).
  
  
  
• More Local Medicare Advantage Preferred Provider Organizations (PPOs) in 2021
  
  There will be a 24% increase in 2021 Medicare Advantage Local PPOs (Preferred Provider Organizations) plans as compared to 2020.
  
  Members of a Medicare Advantage PPOs (MA-only) are not permitted to enroll in a stand-alone Medicare Part D plan (PDP) and will need another source for their drug coverage.
  
  
  
• The declining Medicare Advantage Private Fee-for-Service (PFFS) plan offering
  
  The number of Medicare Advantage Private Fee-for-Service (PFFS) plans continues to decline in 2021 - with only 33 PFFS plans available in 2021).  As a note, PFFS plans have continued to decrease since 2015 when the number of Medicare Advantage PFFS (MA and MAPD) plans decreased by 43%. 
  
  Members of a Medicare Advantage PFFS (MA-only) can enroll in any available stand-alone Medicare Part D plan (PDP) for their drug coverage.
  
  
  
• Only a few different 2021 Medical Savings Accounts (MSAs) offered, but 2021 MSAs are now more-widely available to beneficiaries across the country.
  
  In the chart below, we see that there are only five Medicare Medical Savings Accounts (MSAs) being offered in 2021. 
  
  However, these MSAs will be available in 38 states (2,337 counties) across the country and available to millions of Medicare beneficiaries.  In comparison, 2020 MSAs were offered in 29 states (1,883 counties) -- and back in 2018, MSAs were available to Medicare beneficiaries in only 111 counties across two states.
  
  Unlike other Medicare Advantage (MA) plans, MSAs are made up of a high-deductible health plan and a medical savings account funded by an annual tax-free deposit. MSA members can use the medical savings account to pay for healthcare costs before the health plan deductible is met.
  
  MSA members can enroll in any available stand-alone Medicare Part D plan (PDP) for their drug coverage.

• HMO - Health Maintenance Organization plans
  
  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 have access health services outside of your plan network with a referral from your doctor.  Local HMOs are often very affordable compared to other Medicare Advantage plans because of the restrictive network and their focus on wellness helps to control healthcare costs.  The majority of 2021 Medicare Advantage plans will be HMOs (Health Maintenance Organizations).
   
• HMO POS - Health Maintenance Organization with Point-of-Service option plans
  
  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.  An HMO-POS is often chosen by people who travel part of the year, but still return home for the majority of their healthcare needs.  Again, expect out-of-network healthcare costs to be more than in-network.  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: Be sure to read your Annual Notice of Change (ANOC) carefully to be sure that you still have your POS option.  In past years, some HMO-POS plans "crosswalked" or moved members to an HMO (without the POS option). 
  
  Please also note, depending on your HMO-POS plan, you may find that out-of-network costs do not count toward your Maximum Out of Pocket (MOOP) limit or you may have a much higher out-of-network MOOP — check with your plan's Member Services department for more details.
   
• PPO - Preferred Provider Organization plans
  
  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 very popular (and affordable) several years ago, few Medicare Advantage PFFS plans are now available (only 33 PFFS plans are available in 2021).  PFFS plans have the most flexible network, meaning that you can go to any health care provider as long as the provider accepts Medicare and the terms and conditions of your PFFS plan.  As noted, although 2021 PFFS plans will be offered in only isolated areas, some people may still find PFFS plans a flexible and economical alternative to other Medicare Advantage plans.  If you choose a PFFS plan that does not include prescription drug coverage, you have the option to join a separate stand-alone Medicare Part D plan (PDP).
  
  
• SNP - 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 dual eligible for both Medicare and Medicaid (D-SNPs).  If you do not meet the plan’s “special need”, you will not be permitted to join the Special Needs plan.  In a separate article, "Significant changes in the 2021 Medicare Advantage Special Needs Plan (SNP) landscape", we look closer at the 2021 SNPs ( on this site).
   
• MSA - Medical Savings Account plans
  
  MSAs are like Health Savings Accounts (HSAs) — a high-deductible health plan combined with a medical 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 stand-alone Medicare Part D plan (PDP).  More people will have access to MSA plans in 2021.  Although there are only five (5) MSA plans in 2021, MSAs are available in 2,337 counties across 38 states.
   
• MMP - Medicare-Medicaid Plans
  
  MMP plans were introduced in 2014 and are only offered in 155 counties across nine (9) states.  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,”
  (https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html.)
   
  MMPs only serve full-benefit dual-eligible (Medicare/Medicaid) beneficiaries and some additional limitations may apply.