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More 2021 Medicare Advantage plan choices, with increases in HMO and local PPO options

Category: Annual Medicare Plan Changes
Published on 2020-09-28 16:31:49


An analysis of 2021 Medicare Advantage plan data shows that there will be more Medicare Advantage plans available in 2021 as compared to 2020.  As the Centers for Medicare and Medicaid Services (CMS) noted in their press release:
"[Medicare b]eneficiaries will have more plan choices, with about 2,100 more Medicare Advantage plans operating in 2021 than in 2017, a 76.6 percent increase. Overall, beneficiaries can choose from more than 4,800 Medicare Advantage plans during 2021 open enrollment."
Our findings support the CMS press release and estimate a 13% increase in 2021 Medicare Advantage plans as compared to 2020.  Across the country, the number of 2021 Medicare Advantage plans (combined MAs and MAPDs) will increase to 4,568**, as compared to 4,047 Medicare Advantage plans offered nationwide in 2020.

Total number of all Medicare Advantage plans available


Change in the Number of All Medicare Advantage plans
(both MA & MAPD)
  Number of Medicare Advantage plans (MA & MAPD)
Health Plan Type 2021 2020 Change '20 to '21 2019 2018
Cost 70 80 -10 -13% 72 84
Local HMO 3,072 2,777 295 11% 2,400 2,130
Local PPO 1,281 1,035 246 24% 873 622
Regional PPO 64 64 0 0% 63 62
All PPOs 1,345 1,099 246 22% 936 684
PFFS 33 41 -8 -20% 44 46
MSA 5 6 -1 -17% 6 3
MMP 43 44 -1 -2% 50 54
Total MA & MAPD plans 4,568 4,047 521 13% 3,508 3,001

**Why our numbers can 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 can be slightly different than the number of Medicare Advantage plans reported by the Centers for Medicare and Medicaid Services (CMS).

Jump to 2018 - 2021 MAPD Plan chart
Jump to 2018 - 2021 MA Plan chart
Jump to Health Plan Type definitions


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).

Joining a Medicare Advantage plan without regard to your pre-existing health issues. 
Starting in 2021, you can join a Medicare Advantage plan without any pre-existing health questions - even if you are a Medicare beneficiary suffering from End-Stage Renal Disease (ESRD), you can join a 2021 Medicare Advantage plan.  This new "guaranteed issue" rule also applies to employer/union Medicare plans (EGHP), but, depending on your state, may not include Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicare-Medicaid Plans (MMPs).  You can click here for more details about joining a Medicare Advantage plan with ESRD.



Here are a few additional facts about the 2021 Medicare Advantage plan landscape:
  • Most 2021 Medicare Advantage plans provide Part D prescription drug coverage (MAPDs)

    There are 451 more Medicare Advantage MAPD options available in 2021 as compared to 2020.  As was true in 2020, 92% of all 2021 Medicare Advantage plans include prescription drug coverage (MAPDs).  Note the increases in Local HMO and Local PPO MAPD options for 2021 - with a further decline in MMP, Cost, and PFFS Medicare Advantage plans.

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

    Change in the Number of MAPD plans
      Number of Medicare Advantage plans with Drug Coverage
    Health Plan Type 2021 Change
    '20 to '21
    2020 Change
    '19 to '20
    2019 Change
    '18 to '19
    2018
    Cost 14 -2 16 -2 18 -12 30
    Local HMO 2,893 261 2,632 364 2,268 265 2,003
    Local PPO 1,170 199 971 154 817 240 577
    Regional PPO 45 -1 46 0 46 1 45
    PFFS 21 -5 26 -3 29 -1 30
    MMP 43 -1 44 -6 50 -4 54
    Total MAPD Plans 4,186 451 3,735 507 3,228 489 2,739


  • A few more 2021 Medicare Advantage plan options that do not include drug coverage (MAs)

    There is a slight increase of 70 additional 2021 Medicare Advantage plans without prescription coverage (MA) as compared to 2020. In fact, as compared to the 4,186 Medicare Advantage plans that provide prescription drug coverage (MAPDs) in 2021, there are only 382 different 2021 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).

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


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

    Number of MA Plans
    Health Plan Type 2021 Change
    '20 to '21
    2020 Change
    '19 to '20
    2019 Change
    '18 to '19
    2018
    Cost 56 -8 64 10 54 0 54
    Local HMO 179 34 145 13 132 5 127
    Local PPO 111 47 64 8 56 11 45
    Regional PPO 19 1 18 1 17 0 17
    MSA 5 -1 6 0 6 3 3
    PFFS 12 -3 15 0 15 -1 16
    Total MA Plans w/o Rx Cov. 382 70 312 32 280 18 262


  • More Medicare Advantage Health Maintenance Organization (HMO) options are offered in 2021

    The majority (around 67%) of 2021 Medicare Advantage plans will be HMOs (Health Maintenance Organizations) with a 11% increase in the number of 2021 HMO plans over 2020.

    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 (such as employer/union drug coverage or VA drug coverage).


  • More Local Medicare Advantage Preferred Provider Organizations (PPOs) in 2021

    There will be a 24% increase in 2021 Medicare Advantage Local PPOs (Preferred Provider Organizations) plans as compared to 2020.

    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  Private Fee-for-Service (PFFS) plan offering

    The number of Medicare Advantage Private Fee-for-Service (PFFS) plans continues to decline in 2021 - with only 33 PFFS plans available in 2021).  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%. 

    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 2021 Medical Savings Accounts (MSAs) offered, but MSAs are now available to more beneficiaries in 2021.

    In the chart below, we see that there are only five Medicare Medical Savings Accounts (MSAs) being offered in 2021. 

    However, these MSAs will be available in 38 states (2,337 counties) across the country and available to millions of Medicare beneficiaries.  In comparison, 2020 MSAs were offered in 29 states (1,883 counties) -- and back 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.


Reminder: Different Types of Medicare Advantage Plans

As you browse through the 2021 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 2021 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: Be sure to read your Annual Notice of Change (ANOC) carefully to be sure that you still have your POS option.  In past years, some Members of a HMO-POS plan were "crosswalked" or moved into an HMO (without the 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 33 PFFS plans are available in 2021).  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 2021 PFFS plans will be offered in only isolated areas, some people may still find PFFS plans 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 2021 Medicare Advantage Special Needs Plan (SNP) landscape", we look closer at the 2021 SNPs (https://Q1News.com/861.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 2021.  Although there are only five (5) MSA plans in 2021, MSAs are available in 2,337 counties across 38 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.

Reviewing local Medicare plan options and comparing plan feature changes from 2020 to 2021

The 2021 Medicare Advantage plan information within in each county (or Zip Code region) is available in our 2021 Medicare Advantage plan finder (MA-Finder) that can be found at: MA-Finder.com/2021

Q1Medicare Medicare Advantage Plan Finder showing plan details

You can also see how each 2020 Medicare Advantage plan is changing in 2021 using our Medicare Advantage comparison tool found at: MA-Compare.com/2021.


Reminder: October 15th starts the annual Open Enrollment Period

The annual Medicare Open Enrollment Period (or Annual Coordinated Election Period - AEP) for 2021 Medicare Part D plans and Medicare Advantage plans begins on October 15th and continues through December 7th, with 2021 Medicare plan coverage beginning on January 1, 2021.

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 2021 Medicare Advantage plans can change to a different 2021 Medicare Advantage plan or return to Original Medicare and enroll in a stand-alone Medicare Part D plan (PDP), with their new 2021 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.

See:  https://www.cms.gov/newsroom/press-releases/trump-administration-announces-historically-low-medicare-advantage-premiums-and-new-payment-model






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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.