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Q1Group 2016 PDP Analysis Summary: Many Medicare beneficiaries will see higher plan premiums and find fewer plan choices.

Category: Annual Medicare Plan Changes
Published on 2015-10-05 13:53:41


A preliminary analysis of the 2016 stand-alone Medicare Part D prescription drug plan (PDP) landscape data recently released by the Centers for Medicare and Medicaid Services (CMS) shows that, in general, Medicare beneficiaries will have fewer 2016 Medicare Part D plan choices in most states and may pay higher monthly PDP premiums.  More specifically:
  • As was true last year, there will be fewer 2016 stand-alone Medicare Part D prescription drug plan (PDP) choices.  The average number of stand-alone 2016 Medicare Part D plans offered in each state dropped to 26 stand-alone PDPs from an average of 29 stand-alone Part D plans available in 2015.  Alaska, Illinois, and Florida saw the largest decrease of stand-alone Medicare Part D plans in 2016.  You can click here to read more about plan availability and see a chart of how the average number of Medicare Part D plans has changed since 2007.

  • As in past years, some Medicare Part D plans in your area may be changing their names or are discontinued in 2016.  You can see more 2016 Medicare Part D plan changes using our PDP-Compare tool found here: PDP-Compare.com/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 two (2) 2016 $0-premium LIS plans (down from nine (9) qualifying 2015 Part D plans).   You can click here to read more about $0 premium LIS plan availability and see a chart of how the average number of $0 LIS qualifying Medicare Part D plans has changed since 2007.  For more about the decline in the number of LIS $0 premium plans, you can click here for our article “Q1Group analysis of the 2014 to 2016 decline of Medicare Part D plans qualifying for the $0 premium Low-Income Subsidy (LIS)”.

  • The national average 2016 stand-alone Medicare Part D premium will increase by only 1%.   However, when premiums are weighted by plan enrollment, the average weighted Medicare Part D plan premium will increase 13% to $41.34.   Based on premium increases and plan enrollment, around 77% of all Medicare beneficiaries currently enrolled in a stand-alone 2015 Medicare Part D plan (PDP) will see an increase in their 2016 monthly premium, unless they change coverage to a more affordable 2016 Medicare Part D or Medicare Advantage plan that includes prescription drug coverage.  The average 2016 PDP premium increase is $7.40. You can click here to read more about how the average and average-weighted Medicare Part D plan premiums have changed since 2007.

  • The lowest-costing 2016 Medicare Part D plan will be the SilverScript Choice (PDP) offered in Arkansas ($11.40).  In many other states, the Humana Walmart Rx plan will continue to have the lowest monthly premium ($18.40).  Overall, fewer 2016 Medicare Part D plans will be available with monthly premiums under $25. The 2016 Medicare Part D plan with the most expensive premium will be the Florida BlueMedicare Rx-Option 2 (PDP) ($174.70).  You can click here to read more about the Medicare Part D plans with the lowest and highest premiums and how the range of premiums has changed since 2007.

  • Most 2016 Medicare Part D plans will have an Initial Deductible that can range from $200 to the 2016 standard Initial Deductible of $360.  As an example, of the 27 plans available in Ohio, only 9 stand-alone Medicare Part D plans will have a $0 initial deductible in 2016.  Click here to see a graph of the changes in the total number of Medicare Part D plans offering a $0 deductible.

  • All 2016 Medicare Part D plans will have the standard 2016 Initial Coverage Limit of $3,310.  However, some Medicare Advantage plans that offer prescription drug coverage may offer a higher Initial Coverage Limit, meaning plan Members will be able to buy more formulary medications before reaching the 2016 Donut Hole.

  • Fewer 2016 Medicare Part D plans will offer any Donut Hole coverage for purchases made while in the Coverage Gap.   However, the good news is that the 2016 Donut Hole discount will remain at 55% for brand-name drugs and increase to a 42% discount for generic medications.  You can click here to read more on the 2016 Donut Hole.

If you would like to see a specific state’s PDP landscape summary, please use the following links to our interactive 2016 PDP-Facts: 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 National Statistics.

Please note: The above information is from our Medicare Part D plan landscape summaries and based on stand-alone Medicare Part D prescription drug plans (or PDPs). The 2016 Medicare Advantage plan landscape summary will be presented in our next Newsletter. A number of the 2016 Medicare Advantage plans may be available in your area and may include comprehensive prescription drug coverage, along with Medicare Part A (hospitalization), Medicare Part B (out-patient and physician), and additional healthcare benefits (these Medicare plans are also called MAPD plans).

Reminder:
No need to rush.
The annual Medicare Open Enrollment Period for 2016 Medicare Part D plans and Medicare Advantage plans begins on Thursday, October 15th and continues through Monday, December 7th, with 2016 Medicare plan coverage beginning on Friday, January 1, 2016.   For more information, Medicare beneficiaries can telephone Medicare at 1-800-633-4227 to speak with a Medicare representative.






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Tips & Disclaimers
  • 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 PDP-Compare.com and MA-Compare.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.
  • 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.