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How is your 2018 Medicare plan changing in 2019?


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How is your 2018 Medicare plan changing in 2019?
Published on 2018-10-15 18:09:08
Category: Annual Medicare Plan Changes


We want to remind you that, if you decide to stay with your current 2018 Medicare plan into 2019, your Medicare plan coverage and costs can (and usually do) change each year - so please take time to know how your current Medicare plan is changing in 2019.

How might your Medicare plan change in 2019?
  • Your 2018 Medicare plan may no longer be offered in 2019.  About 1.4 million people are currently enrolled in 2018 Medicare Advantage plans that will no longer be available in 2019. Although a number of areas around the country will experience significant changes in their Medicare Advantage plan landscape, the counties seeing the largest number of terminated 2019 Medicare Advantage plans are found in: Minnesota. For example, Becker, Cass, Clay, Crow Wing and Hubbard Counties will each lose thirty-two (32) Medicare Advantage plan options in 2019 (and have the introduction of nine (9) new 2019 Medicare Advantage plans). An additional 87,000 people enrolled in stand-alone Medicare Part D plans, will find their coverage discontinued in 2019. You can click here to read more in our article about Medicare plans affected by Service Area Reductions.

  • You may be automatically reassigned to a different 2019 Medicare plan.  Over 800,000 current members of stand-alone 2018 Medicare Part D plans and 200,000 Medicare Advantage plan members will be automatically “crosswalked” or merged into another Medicare plan in 2019. For example, members of the 2018 Symphonix Value Rx (PDP) will be automatically reassigned to the 2019 AARP MedicareRx Saver Plus (PDP). You can click here to read more about 2019 Medicare Part D plan mergers or consolidations.

  • Your monthly 2019 Medicare Part D premium may be increasing.  Without changing 2018 stand-alone Medicare Part D plans, over 4.5 million Medicare beneficiaries will see a monthly 2019 Medicare Part D premium increase of over 20%. The good news is about 6.2 million people will see a 2019 premium decrease of up to 74%. You can click here to see examples of 2018 Medicare Part D plans that are increasing their 2019 premiums.

  • Your plan’s Initial Deductible may increase.  The standard 2019 Medicare Part D (PDP) deductible will increase to $415, up from the standard 2018 deductible of $405. About 600,000 Medicare PDP beneficiaries are enrolled in 2018 Part D plan that will see an even larger initial deductible increase of up to $315. You can click here to see an example list of Medicare Part D plan’s increasing their 2019 initial deductibles. The good news is that about 1.2 million people will see a decrease in their current initial deductible, with some 2018 Part D plans even moving to a $0 deductible in 2019.

  • Your 2019 Medicare drug plan’s formulary or drug list may cover fewer medications.  Although some 2019 Medicare prescription drug plans will be adding more medications, based on our analysis, over 11 million Medicare beneficiaries currently enrolled in a stand-alone 2018 Medicare Part D plan will see at least 100 fewer medications on their 2019 formulary. But, please remember that a larger Medicare Part D plan formulary does not necessarily mean that the Medicare drug plan will cover all of your medications. Important: Check to make sure your medications are affordably covered by your chosen 2019 Medicare Part D plan.

  • Your 2019 Medicare plan’s prescription drug cost-sharing may increase.  Medicare plans can change their fixed copayments from year-to-year (for example, you now pay $3 for a Tier 1 drug and in 2019 you will pay $5 for the same Tier 1 drug) – or plans may increase the percentage of retail drug prices you pay for co-insurance (you now pay 27% of retail and in 2019 you will pay 37% of the retail drug price). And some Medicare drug plans change between co-insurance (percent of retail prices) to copayment as a cost-sharing model. You can click here to see an example of how the 2019 California EnvisionRxPlus plan will change from 15% co-insurance to a $29 copayment for Tier 3 Preferred Brands on their 2019 plan formulary.

  • Your Medicare prescription drug plan probably offers preferred pharmacy pricing.  About 99% of all 2019 stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard network pharmacies (as compared to 85% back in 2017). The Farm Bureau Select Rx (PDP) in AL & TN, AR Blue Cross - Medi-Pak Rx Basic (PDP) in AR, AR Blue Cross - Medi-Pak Rx Premier (PDP) in AR, Regence Medicare Script Basic (PDP) in ID & UT, and Asuris Medicare Script Basic (PDP) in OR & WA will begin using preferred network pharmacy pricing in 2019. As an example, the California SilverScript Choice (PDP) will have a co-payment of $3 for a Tier 1 medication at a preferred network pharmacy and, for the same Tier 1 drug, a $7 co-pay when purchased at a standard network pharmacy. You can contact your plan’s Member Service department to find preferred pharmacies in your area.

  • Your Medicare Advantage plan’s Initial Coverage Limit may change.  Some 2019 Medicare Advantage plans will offer a variation on the standard drug plan Initial Coverage Limit of $3,820, with 2019 Initial Coverage Limits ranging from $3,130 to $8,000.  The Initial Coverage Limit (ICL) is the boundary between your Medicare Part D plan's Initial Coverage Phase and the Donut Hole or Coverage Gap. The ICL is measured by the retail value of your prescription drug purchases. You can click here to read more about 2019 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.

  • Your 2019 Medicare Part D plan may no longer qualify for your state’s Low-Income Subsidy (LIS) $0 premium.  In 2019, most states will offer about the same number of Medicare Part D plans qualifying for the state’s LIS $0 premium as they did in 2018. Florida will continue to offer the smallest selection of only two $0 premium LIS plans. Arizona offers the largest selection of ten $0 premium LIS qualifying plans. For more about the changing landscape of LIS $0 premium plans, you can click here for our article comparing LIS plan availability since 2007.

  • Your Medicare Advantage plan’s provider network can change at any time.  Even though you have checked to ensure that your healthcare providers are included in your 2019 Medicare Advantage plan's provider network, it is possible that your plan’s network can change during the plan year. Although Medicare has established a case-by-case Special Enrollment Period (SEP) allowing you to change Medicare plans if your plan makes “significant” mid-year network changes, it is still not clear when this SEP will be applied.

  • Your 2019 Medicare Advantage plan’s Medicare Part A and Part B maximum out-of-pocket (MOOP) limit may change.  The Medicare Advantage plan MOOP threshold limits how much you will spend on co-payments and co-insurance for in-network, eligible Medicare Part A and Part B coverage. In 2019, slightly more Medicare Advantage plans will offer a Medicare Part A and Part B MOOP limit at or below the $3,400 voluntary maximum MOOP, however 77% of Medicare Advantage plans continue to have a MOOP greater than $3,400. You can click here to learn more about the maximum out-of-pocket limits for 2019 Medicare Advantage plans.
Bottom Line: If you do not enroll into a new Medicare Part D plan or Medicare Advantage plan next year, you will be automatically re-enrolled into your current Medicare Part D or Medicare Advantage plan for another year and your Medicare plan next year may cost you more money and provide different coverage than are finding this year. If your current Medicare plan is being terminated next year and you are not merged or “crosswalked” to another Medicare plan, you may be without Medicare plan coverage on January 1st.

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

How to learn more about the changes in your next year's 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 next year?

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 next year.  The MA-Compare tool includes links to the health coverage details of all Medicare Advantage plans.


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