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More 2019 Medicare Advantage plan choices, with increases in HMO and local PPO options

Category: Annual Medicare Plan Changes
Published on 2018-10-06 08:30:36


Updated October 14, 2019 with CMS revised landscape data.
As noted in a recent press release from the Centers for Medicare and Medicaid Services (CMS), the total number of 2019 Medicare Advantage plans will increase across the country with about 99 percent of Medicare beneficiaries having access to a Medicare Advantage plan.
  • 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 2019 Medicare Advantage plans than ever before:  Overall, there will be 3,508 Medicare Advantage plans (MAs and MAPDs) available across the country in 2019, as compared to 3,001 Medicare Advantage plans offered in 2018.

  • Most 2019 Medicare Advantage plans are MAPDs:  92% of 2019 Medicare Advantage plans include prescription drug coverage (MAPDs).  In fact, a few more 2019 Medicare Advantage plans will include prescription drug coverage (MAPD) as compared to 2018 (91% MAPD). 

  • A few more 2019 MAs.  There is a slight increase in the number of 2019 Medicare Advantage plans without prescription coverage (MA) as compared to 2018.

  • More HMOs.  The majority (around 68%) of 2019 Medicare Advantage plans will be HMOs (Health Maintenance Organizations) with a 13% increase in the number of 2019 HMO plans over 2018.

  • More Local PPOs.  There will be a 40% increase in 2019 Medicare Advantage Local PPOs (Preferred Provider Organizations) plans as compared to 2018.

  • The declining PFFS plan offering.  The number of Private Fee for Service (PFFS) Medicare Advantage plans continues to decline in 2019 (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.

  • The Return of MSAs: Looking beyond just the numbers, 2019 Medical Savings Accounts (MSAs) will now be available to a much larger population.  In the chart below, we see that there are only 3 new Medicare Medical Savings Accounts (MSAs) being offered in 2019.  However, these six 2019 MSAs will now be available in 19 states (1,262 counties) across the country and available to millions of Medicare beneficiaries. As a comparison, 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.

Jump to 2016 - 2019 MAPD Plan chart
Jump to 2016 - 2019 MA Plan chart
Jump to Health Plan Type definitions

Change in the Number of All Medicare Advantage plans
(both MA & MAPD)
  Number of Medicare Advantage plans (MA & MAPD)
Health Plan Type 2019 2018 Change '18 to '19 2017 2016
Cost 72 84 -12 -14% 77 81
Local HMO 2,400 2,130 270 13% 1,920 1,865
Local PPO 873 622 251 40% 515 487
Regional PPO 63 62 1 2% 61 58
All PPOs 936 684 252 37% 576 545
PFFS 44 46 -2 -4% 48 57
MSA 6 3 3 100% 4 4
MMP 50 54 -4 -7% 62 68
Total MA & MAPD plans 3,508 3,001 507 17% 2,687 2,620

[Editorial Note, October 4, 2018] The number of Medicare Advantage plans that we report is calculated from the 2019 Medicare plan landscape data files and is slightly different than the number of Medicare Advantage plans reported by the Centers for Medicare and Medicaid Services (CMS).  As the recent CMS press release stated: "Medicare Advantage will be offering approximately 600 more plans in 2019. The number of plans available to individuals to choose from across the country is increasing from about 3,100 to about 3,700 — and more than 91 percent of people with Medicare will have access to 10 or more Medicare Advantage plans, compared to nearly 86 percent in 2018."

Total number of all Medicare Advantage plans available
 
Reminder: Types of Medicare Advantage Plans
As you browse through the 2019 Medicare Advantage plans, you will see in our Medicare Advantage search tools that there are seven common types of Medicare Advantage plans offered.
  • 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 the restrictive network and focus on wellness helps to control healthcare costs.  The majority of 2019 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.  This type of HMO is often chosen by 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:  Members of a few 2018 HMO-POS plans will be "crosswalked" to HMOs (without the POS option) in 2019.  Be sure to read your Annual Notice of Change (ANOC) carefully to be sure that you still have your POS option.

    Please 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 — 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 popular several years ago, fewer Medicare Advantage PFFS plans are now available (only 44 PFFS plans are available in 2019).  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, although PFFS plans will continue to be rare in 2019, some people still find PFFS plans to be 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 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.
     
  • 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) for your prescription needs.  More people will have access to MSA plans in 2019.  Although there are only six (6) MSA plans in 2019, MSAs are available in 1,262 counties across 19 states.
     
  • MMP - Medicare-Medicaid Plans:  MMP plans were introduced in 2014 and are only offered in 151 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.
Change in the Number of MAPD plans
  Number of Medicare Advantage plans with Drug Coverage
Health Plan Type 2019 Change
'18 to '19
2018 Change
'17 to '18
2017 Change
'16 to '17
2016
Cost 18 -12 30 -3 33 -1 34
Local HMO 2,268 265 2,003 218 1,785 53 1,732
Local PPO 817 240 577 98 479 38 441
PFFS 29 -1 30 -2 32 -6 38
Regional PPO 46 1 45 1 44 3 41
MMP 50 -4 54 -8 62 -6 68
Total MAPD Plans 3,228 489 2,739 304 2,435 81 2,354

Note the increases in Local HMO and Local PPO MAPD options for 2019 with a decline in MMP, Cost, and PFFS plans.

Total number of Medicare Advantage plans with drug coverage (MAPD)

As compared to the 3,228 Medicare Advantage plans that provide prescription drug coverage (MAPDs) in 2019, there are only 280 different 2019 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).  And across the country, there will be 13 additional MA plans in 2019.

Change in the Number of
Medicare Advantage plans without Drug Coverage (MAs)

Number of MA Plans
Health Plan Type 2019 Change
'18 to '19
2018 Change
'17 to '18
2017 Change
'16 to '17
2016
Cost 54 0 54 10 44 -3 47
Local HMO 132 5 127 -8 135 2 133
Local PPO 56 11 45 9 36 -10 46
MSA 6 3 3 -1 4 0 4
PFFS 15 -1 16 0 16 -3 19
Regional PPO 17 0 17 0 17 0 17
Total MA Plans w/o Rx Cov. 280 18 262 10 252 -14 266

Total number of Medicare Advantage plans without drug coverage (MA)

 

Other resources
The 2019 Medicare Advantage plan information is available in our 2019 Medicare Advantage plan finder (MA-Finder) that can be found at: MA-Finder.com/2019

You can also see how each 2018 Medicare Advantage plan is changing in 2019 using our Medicare Advantage comparison tool found at: MA-Compare.com/2019.

Reminder: October 15th starts the annual Open Enrollment Period
The annual Medicare Open Enrollment Period (or Annual Coordinated Election Period) for 2019 Medicare Part D plans and Medicare Advantage plans begins on October 15th and continues through , December 7th, with 2019 Medicare plan coverage beginning on January 1, 2019.

For more information, you 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.