Q1Group 2018 MA/MAPD Analysis: More 2018 Medicare Advantage plan choices, with increases in HMO and local PPO options

• A brief review of Medicare Advantage plans:  Medicare Advantage plans come in two general forms, MAs (Medicare Advantage plans that do not include prescription drug coverage) and MAPDs or Medicare Advantage plan that includes prescription drug coverage (MAPD).  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), and may include additional healthcare benefits (basic dental, optical, hearing, and/or fitness coverage) - an MAPD also includes 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).
  
  
• More 2018 Medicare Advantage plans then ever before:  Overall, there will be 3,001 Medicare Advantage plans (MAs and MAPDs) available across the country in 2018, as compared to 2,687 Medicare Advantage plans offered in 2017.
  
  
• Most 2018 Medicare Advantage plans are MAPDs:  91% of 2018 Medicare Advantage plans include prescription drug coverage (MAPDs).  In fact, a few more 2018 Medicare Advantage plans will include prescription drug coverage (MAPD) as compared to 2017. 
  
  
• Just slightly more 2018 MAs.  Breaking with a trend over the past few years, there was a slight increase in the number of 2018 Medicare Advantage plans without prescription coverage (MA).
  
  
• More HMOs.  The majority (around 71.5%) of 2018 Medicare Advantage plans will be HMOs (Health Maintenance Organizations) with a 11% increase in the number of 2018 HMO plans over 2017.  In fact, Medicare Advantage Local HMOs show the greatest increase in the total number of 2018 plans (with the addition of 210 Local HMO plans).
  
  
• More Local PPOs.  There will be a 21% increase in 2018 Medicare Advantage Local PPOs (Preferred Provider Organizations) plans as compared to 2017.
  
  
• The declining PFFS plan offering.  The number of Private Fee for Service (PFFS) Medicare Advantage plans continues to decline in 2018 (a 4% decrease in PFFS plans).  As a note, 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) and have continued to decrease since that time.

Jump to 2015 - 2018 MAPD Plan chart
Jump to 2015 - 2018 MA Plan chart
Jump to Health Plan Type definitions

• 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 2018 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: A few 2017 HMO POS plans will convert to HMOs (without the POS option) in 2018.  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 46 PFFS plans are available in 2018).  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 2018, PFFS plans will continue to be 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,” (https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html.)
  
  MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply.
  

Note the increases in Local HMO and Local PPO MAPD options for 2018 with a decline in MMP, Cost, and PFFS plans.