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Q1Group 2019 Medicare Plan Analysis: Over 1.5 million members in non-renewing 2018 Medicare Advantage and Prescription Drug plans may lose their 2019 Medicare plan coverage


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Q1Group 2019 Medicare Plan Analysis: Over 1.5 million members in non-renewing 2018 Medicare Advantage and Prescription Drug plans may lose their 2019 Medicare plan coverage
Published on 2018-10-18 18:18:39
Category: Annual Medicare Plan Changes


Is your 2018 Medicare Part D prescription drug plan or Medicare Advantage plan still being offered in 2019?

Each year, Medicare plans have the option of not renewing their Medicare contract.  When this happens, the Medicare plan can be discontinued across the country or in a specific service area (state or ZIP code).  If a Medicare beneficiary is enrolled in a non-renewing Medicare plan, they may be without Medicare plan coverage for the entire year (all of 2019) unless they enroll in a different Medicare plan during the Annual Open Enrollment Period (starting October 15th and continuing through December 7th) or have access to a Special Enrollment Period.

Your discontinued (non-renewing) 2018 Medicare plan may be due to a:
  • Plan Consolidation: When multiple plans from one company are brought together into one plan, or a Medicare Part D plan from one company may be merged together with a Medicare Part D plan from another company.  Members will be automatically crosswalked to a new 2019 Medicare plan.

  • Service Area Reduction: Members in some areas will remain in the Medicare plan and the plan will be discontinued in other areas.  The service area may be an entire state, specific counties, or ZIP codes.

    In some cases, members are crosswalked to a new plan, but, in other cases, the members will be without coverage if they do not select a new 2019 Medicare Part D or Medicare Advantage plan.  Remember there is a Service Area Reduction Special Enrollment Period (SAR SEP) starting on December 8 and continuing through the end of February allowing you the possibility of enrolling in a 2019 Medicare plan after the December 7th close of the annual Open Enrollment Period.

  • Terminated Plan: All members will need to choose a new Medicare plan or be without coverage in 2019.

How many 2018 plan members will be affected?
  • One Million members being crosswalked to a new Medicare plan: Approximately 800,000 members in non-renewing 2018 stand-alone Medicare prescription drug plans and an additional 200,000 members in non-renewing Medicare Advantage plans will be automatically "crosswalked" to new 2019 Medicare plans.

  • Over 1.5 Million members loosing their coverage if they do not select a new Medicare plan: Approximately 1.44 million members are currently enrolled in 2018 Medicare Advantage plans that will be terminated in 2019. These members will NOT be crosswalked and will be without 2019 coverage if they do not actively enroll in a new Medicare Advantage plan. An additional 87,000 stand-alone Medicare prescription drug plan members also need to actively select a new 2019 Medicare plans.
In these situations, members of a Medicare Part D plan will be notified in their Annual Notice of Change (ANOC) letter about the termination or consolidation and be given the option to join another plan during the Annual Open Enrollment Period.

If members do not join another Medicare plan, they may find themselves automatically moved (or crosswalked) into another Medicare plan at the start of the next plan year, or they will be without coverage.

We will first look at stand-alone Medicare Part D plans (PDPs) and further down in this article, we will discuss Medicare Advantage plans (MAs and MAPDs).

Stand-alone Medicare Part D plans (PDP) Important Points:
  • 21 Medicare Part D Prescription Drug plans will be discontinued in 2019 without crosswalking members to other plans. These people will need to select another 2019 Medicare plan or possibly be without Medicare plan coverage through 2019.

  • How many people are affected?
    87,874 members in the 21
    PDPs terminating in 2019, will find that their 2018 plan will not be offered in 2019. You can review 2019 Medicare Prescription Drug only plan changes using our PDP-Compare tool found here: PDP-Compare.com/2019.

  • In addition, 836,614 plan members in 57 Medicare Advantage plans will be crosswalked to a new PDP in 2019. Below is a chart highlighting some of the stand-alone Medicare Prescription Drug plan "crosswalks" for 2019.
Examples of 2018 stand-alone Prescription Drug plans that are being either crosswalked into other plans in 2018.

Crosswalked Stand-Alone Medicare Prescription Drug Plans (PDPs)
(with the number of plan members impacted)
Plan Name States Members Affected
Symphonix Value Rx (PDP) members crosswalked to AARP MedicareRx Saver Plus (PDP) in all states 735,860
First Health Part D Premier Plus (PDP) members crosswalked to Aetna Medicare Rx Value Plus (PDP) in 23 states 17,220
Blue MedicareRx Premier (PDP) members crosswalked to Blue MedicareRx Standard (PDP) in 12 states 51,611
Anthem Blue Cross MedicareRx Gold (PDP) members crosswalked to Anthem Blue Cross MedicareRx Standard (PDP) CA  31,923


Discontinued Stand-Alone Medicare Prescription Drug Plans (PDPs)
Members must select a new prescription drug plan 
Plan Name States Members Affected
Magellan Rx Medicare Basic (PDP) in all states 86,940
Educators Rx Advantage (PDP) & Educators Rx Basic (PDP) ID UT 751
Senior Care Plus: Medicare Rx Standard (PDP) NV  183
TakeCare RX Plus (PDP) IS GU 183


What about 2018 Medicare Advantage plan (MA and MAPD) mergers and terminations?

Important Points:
  • 324 Medicare Advantage plans will be discontinued in 2019 without crosswalking members to other plans.   These people will need to select another 2019 Medicare plan or possibly be without Medicare plan coverage through 2019.

  • How many people are affected?
    1,440,088 Medicare Advantage plan members in the 324
    Medicare Advantage plans terminating in 2019, will find that their 2018 Medicare Advantage plan will not be offered in 2019.  And many counties across the country will see significant changes in their Medicare Advantage plan landscape.  You can review 2019 Medicare Advantage plan changes using our MA-Compare tool found here: MA-Compare.com/2019.

  • In addition, 200,230 plan members in 67 Medicare Advantage plans will be crosswalked to a new Medicare Advantage plan in 2019.  Below is a chart highlighting some of the Medicare Advantage plan "crosswalks" for 2019.
Examples of Medicare Advantage plan Reassignments
2018 Medicare Advantage Plan New 2019 Medicare Advantage Plan State(s) Members Affected
Senior Dimensions Southern Nevada (HMO)
UnitedHealthcare Medicare Focus (HMO) H0609-032 2 Counties in NV 43,297
MMM - Elite Ultra (HMO-POS) MMM Elite (HMO-POS) H4003-034 Counties in PR 24,243
AARP MedicareComplete SecureHorizons Plan 1 (HMO) AARP MedicareComplete SecureHorizons Plan 2 (HMO) H0543-144 4 Counties in CA 18,499
UCare for Seniors Value Plus (HMO-POS) UCare Classic (HMO-POS) H2459-021 Counties in MN 10,954
WellCare Choice (HMO-POS) WellCare Choice (HMO) H4868-012 5 Counties in NY 8,237
Cigna-HealthSpring Preferred SMS (HMO) Cigna-HealthSpring Preferred (HMO) H4407-026 Counties in MS 7,882
WellCare Dividend (HMO) WellCare Value (HMO-POS) H0174-005 11 Counties in TX 6,336

Need a faster way to see if your Medicare Part D or Medicare Advantage plan is changing in 2019? 
Our PDP-Compare and MA-Compare tools allow you to compare annual 2018/2019 changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MAs or MAPDs) across the country showing changes in monthly premiums and plan design changes, as well as changes in co-payments or co-insurance rates for different drug tiers along with the most recent Medicare quality Star ratings.

Both the PDP-Compare and MA-Compare also show the Medicare Part D plans or Medicare Advantage plans that will be merged, discontinued, or added in 2019.

Not sure where to begin with all this information?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare representative, and learn more about their 2019 Medicare Part D and Medicare Advantage plan options.


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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.