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More 2020 Medicare Advantage plan choices, with increases in HMO and local PPO options

Category: Annual Medicare Plan Changes
Published on 2019-09-27 08:59:01


As noted in a recent press release from the Centers for Medicare and Medicaid Services (CMS), "Medicare Advantage continues to be popular, with enrollment projected to increase to an all-time high of 24.4 million beneficiaries from the current enrollment of 22.2 million, out of approximately 60 million people currently enrolled in Medicare".
  • 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), may include additional healthcare benefits (basic dental, optical, hearing, and/or fitness coverage) - and 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).

  • More 2020 Medicare Advantage plans than ever before

    Overall, there will be 15% more Medicare Advantage plans available in 2020.  Across the country, the number of 2020 Medicare Advantage plans (combined MAs and MAPDs) will increase to 4,047**, as compared to 3,508 Medicare Advantage plans offered nationwide in 2019.

  • Like 2019, Most 2020 Medicare Advantage plans provide Part D drug coverage (MAPDs)

    92% of 2020 Medicare Advantage plans include prescription drug coverage (MAPDs) -- the same percentage as in 2019.   

  • A few more 2020 Medicare Advantage plan options that do not include drug coverage (MAs)

    There is a slight increase in the number of 2020 Medicare Advantage plans without prescription coverage (MA) as compared to 2019.

  • More Medicare Advantage HMOs options offered in 2020

    The majority (around 68.6%) of 2020 Medicare Advantage plans will be HMOs (Health Maintenance Organizations) with a 15% increase in the number of 2020 HMO plans over 2019.

    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.

  • More Local PPOs

    There will be a 18.6% increase in 2020 Medicare Advantage Local PPOs (Preferred Provider Organizations) plans as compared to 2019.

    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 PFFS plan offering

    The number of Medicare Advantage Private Fee for Service (PFFS) plans continues to decline in 2020 (a 7% decrease in PFFS plans).  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%.  In particular, 2015 Medicare Advantage PFFS plans offering prescription drug coverage (MAPDs) decreasing by 66% or losing 33 PFFS plans.

    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 2020 MSAs offered, but Medical Savings Accounts (MSAs) are now available to more beneficiaries in 2020.

    In the chart below, we see that there are only six Medicare Medical Savings Accounts (MSAs) being offered in 2020.  However, these MSAs will be available in 29 states (1,883 counties) across the country and available to millions of Medicare beneficiaries.  In comparison, 2019 MSAs were offered in 19 states (1,262 counties) - and 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 2017 - 2020 MAPD Plan chart
Jump to 2017 - 2020 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 2020 2019 Change '19 to '20 2018 2017
Cost 80 72 8 11% 84 77
Local HMO 2,777 2,400 377 16% 2,130 1,920
Local PPO 1,035 873 162 19% 622 515
Regional PPO 64 63 1 2% 62 61
All PPOs 1,099 936 163 17% 684 576
PFFS 41 44 -3 -7% 46 48
MSA 6 6 0 0% 3 4
MMP 44 50 -6 -12% 54 62
Total MA & MAPD plans 4,047 3,508 539 15% 3,001 2,687

**Why our numbers vary slightly from the number of Medicare Advantage plans reported by Medicare

Medicare Advantage plans can be defined by three numbers: (Contract_ID, Plan_ID, Segment_ID) and may appear on your plan documents as "H1234-001-001".  In the analysis of the total number of Medicare Advantage plans, we look only to a Plan_ID level.  Therefore, the number of Medicare Advantage plans that we report is slightly different than the number of Medicare Advantage plans reported by the Centers for Medicare and Medicaid Services (CMS).

As the recent 2019 CMS press release stated: "Beneficiaries will have more [Medicare Advantage] plan choices, with about 1,200 more Medicare Advantage plans operating in 2020 than in 2018".

However, in our article, "2020 Medicare Advantage plan (MA and MAPD) premiums remain low", we evaluate Medicare Advantage plan premiums at a Segment_ID level, thus increasing our sample.  In this article, you can see that (using the Segment_ID), the increase in the number of plans from 2018 to 2020 is 1,146 - much closer to the 1,200 value stated in the 2019 CMS press release.

Total number of all Medicare Advantage plans available


Reminder: Types of Medicare Advantage Plans

As you browse through the 2020 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 2020 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: In past yeasts, some Members of a HMO-POS plans were "crosswalked" or moved into HMOs (without the POS option).  Be sure to read your Annual Notice of Change (ANOC) carefully to be sure that you still have your 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, fewer Medicare Advantage PFFS plans are now available (only 41 PFFS plans are available in 2020).  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 PFFS plans will continue to be rare in 2020, some people still find PFFS plans as 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 2020 Medicare Advantage Special Needs Plan (SNP) landscape", we look closer at the 2020 SNPs (https://Q1News.com/785.html).
     
  • 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 2020.  Although there are only six (6) MSA plans in 2020, MSAs are available in 1,883 counties across 29 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.
Change in the Number of MAPD plans
  Number of Medicare Advantage plans with Drug Coverage
Health Plan Type 2020 Change
'19 to '20
2019 Change
'18 to '19
2018 Change
'17 to '18
2017
Cost 16 -2 18 -12 30 -3 33
Local HMO 2,632 364 2,268 265 2,003 218 1,785
Local PPO 971 154 817 240 577 98 479
PFFS 26 -3 29 -1 30 -2 32
Regional PPO 46 0 46 1 45 1 44
MMP 44 -6 50 -4 54 -8 62
Total MAPD Plans 3,735 507 3,228 489 2,739 304 2,435

Note the increases in Local HMO and Local PPO MAPD options for 2020 - with a further decline in MMP, Cost, and PFFS Medicare Advantage plans.

Total number of Medicare Advantage plans with drug coverage (MAPD)
As compared to the 3,735 Medicare Advantage plans that provide prescription drug coverage (MAPDs) in 2020, there are only 312 different 2020 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).  However, in 2020 there will be 32 additional MA plans offered.

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

Number of MA Plans
Health Plan Type 2020 Change
'19 to '20
2019 Change
'18 to '19
2018 Change
'17 to '18
2017
Cost 64 10 54 0 54 10 44
Local HMO 145 13 132 5 127 -8 135
Local PPO 64 8 56 11 45 9 36
MSA 6 0 6 3 3 -1 4
PFFS 15 0 15 -1 16 0 16
Regional PPO 18 1 17 0 17 0 17
Total MA Plans w/o Rx Cov. 312 32 280 18 262 10 252


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

Reviewing local Medicare plan options and comparing changes from 2019

The 2020 Medicare Advantage plan information within in each county (or Zip Code region) is available in our 2020 Medicare Advantage plan finder (MA-Finder) that can be found at: MA-Finder.com/2020

You can also see how each 2019 Medicare Advantage plan is changing in 2020 using our Medicare Advantage comparison tool found at: MA-Compare.com/2020.

Reminder: October 15th starts the annual Open Enrollment Period

The annual Medicare Open Enrollment Period (or Annual Coordinated Election Period - AEP) for 2020 Medicare Part D plans and Medicare Advantage plans begins on October 15th and continues through December 7th, with 2020 Medicare plan coverage beginning on January 1, 2020.

In addition, member of Medicare Advantage plans are given a second annual enrollment period once the new plan years begins.  The annual Medicare Advantage Open Enrollment Period (MA OEP) begins on January 1st and continues through March 31st.  During the MA-OEP,  current members of 2020 Medicare Advantage plans can change to a different 2020 Medicare Advantage plan or return to Original Medicare and enroll in a stand-alone Medicare Part D plan (PDP), with their new 2020 Medicare plan coverage beginning on the first day of the month following their enrollment.

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.
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  • 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.