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Q1Group 2020 MA/MAPD Analysis: Medicare beneficiaries can expect more Medicare plan options, continued low monthly premiums, more D-SNPs, and slightly more Medicare Advantage plans offering some Donut Hole coverage

Category: Annual Medicare Plan Changes
Published on 2019-09-29 14:49:04


A preliminary analysis of the 2020 Medicare Advantage plan (MA and MAPD) landscape data recently released by the Centers for Medicare and Medicaid Services (CMS) shows that Medicare beneficiaries can expect a few more Medicare plans in most areas; continued low monthly premiums; slightly more Medicare Advantage plans offering some Donut Hole coverage; and stable out-of-pocket spending limits ( MOOP).

First, here are four important points about Medicare Advantage plans:

(1)  A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization coverage), Medicare Part B (out-patient and physician coverage), and may include prescription drug coverage (MAPD) or can be offered without drug coverage (MA).

(2)  A Medicare Advantage plan may include supplemental healthcare benefits such as vision, dental, or fitness coverage. A Medicare Advantage plan may also include non-health related benefits such as meal delivery and non-health related transportation.

(3)  You cannot add a stand-alone Medicare Part D plan (PDP) if you are enrolled in a Medicare Advantage (MA) plan -- unless your Medicare Advantage plan is a PFFS or MSA plan. 

(4)  A Medicare Advantage plan is not a Medicare Supplement (Medigap plan) and cannot be used with a Medicare Supplement.


Highlights of the 2020 Medicare Advantage plan landscape
  • The total number of 2020 Medicare Advantage plans will increase.

    Across the country, there will be 15% more Medicare Advantage plans offered in 2020 – with 4,047 Medicare Advantage plans (MAs and MAPDs) available, as compared to 3,431 Medicare Advantage plans offered in 2019.  You can click here to read more about the number (and type) of 2020 Medicare Advantage plans.

  • Most 2020 Medicare Advantage plans will offer prescription drug coverage (MAPDs).

    As in past years, around 92% of 2020 Medicare Advantage plans will include prescription drug coverage. You can click here to read more about the annual changes in the number of Medicare Advantage plans offering prescription drug coverage.

  • Most Medicare Advantage plans are HMOs.

    The majority (around 69%) of 2020 Medicare Advantage plans will be Local HMOs (Health Maintenance Organizations). However, there will be a 19% increase in 2020 Local PPO (Preferred Provider Organization) Medicare Advantage plans. You can click here to read more about the different types of 2020 Medicare Advantage plans.

  • Even with more Medicare Advantage plans offered in 2020, many counties will see significant changes in their Medicare Advantage plan landscape.

    When viewed in detail, many 2019 Medicare Advantage plans will be terminated in 2020 or merged into other 2020 plans. As an example, Miami-Dade County, FL will lose 17 of the 82 Medicare Advantage plans that are currently offered in 2019, however 14 new 2020 Medicare Advantage plans will be introduced. You can see more 2020 Medicare plan changes using our 2019/2020 Medicare Advantage plan compare tool: MA-Compare.com/2020. You can click here to read more about changes in Medicare Advantage plan availability across the country.

  • 2020 Medicare Medical Savings Accounts (MSAs) will be more widely available.

    In 2020, Medicare Medical Savings Accounts (MSAs) will be available in 29 states (1,883 counties) across the country. In 2019, MSAs were available to Medicare beneficiaries in only 1,262 counties across 19 states. Unlike other Medicare Advantage 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.

  • Monthly 2020 Medicare Advantage plan premiums will remain low.

    As in past years, close to 79% of all 2020 Medicare Advantage plans will have a monthly premium under $50, with around 43% of the 2020 Medicare Advantage plans having a $0 premium. You can click here to read more about changes in Medicare Advantage plan premiums and see a chart of how plan premiums have changed since 2014.

  • More 2020 Medicare Advantage Special Needs Plans (SNPs).

    Although about 13% of the 2019 Medicare Advantage Special Needs Plans (SNPs) will be discontinued in 2020, plan losses will be offset by the introduction of new SNPs, resulting in a 19% increase in the total number of 2020 SNPs. The vast majority of SNPs remains Dual-Eligible (D-SNPs) (63%). You can click here to learn more about 2020 Medicare Advantage Special Needs Plans and how the SNP landscape has changed since 2014.

  • More 2020 MAPDs have a $0 premium and $0 drug deductible ($0/$0).

    Twenty-six percent (26%) of all 2020 Medicare Advantage plans will include prescription drug coverage with a $0 premium and $0 drug coverage deductible (up from 21% in 2019). You can click here to read more about the 2020 $0/$0 Medicare Advantage plans with prescription drug coverage (MAPDs).

  • The Donut Hole will close in 2020.

    All MAPD plans will honor the 2020 Donut Hole discount that will increase to 75% for all formulary medications purchased while in the Donut Hole. You pay 25% of your plan’s retail drug price for both brand-name and generic formulary medications.

  • Slightly more 2020 MAPDs will offer additional Donut Hole coverage.

    Forty percent (40%) of MAPD plans will offer some level of additional drug coverage should you reach the 2020 Donut Hole -- as compared to 38% of MAPDs in 2019. For brand-name drug purchases, this gap coverage is in addition to the brand-name drug manufacturers Donut Hole discount.

  • Slightly more 2020 Medicare Advantage plans will offer a lower Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit.

    The number of Medicare Advantage plans having the statutory maximum MOOP of $6,700 will decrease to 31% of all 2020 Medicare Advantage plans (down from 34% in 2019). The number of MAs with a MOOP under $3,400 will increase to 24% of all 2020 Medicare Advantage plans as compared to 23% in 2019. You can click here to learn more about the Maximum Out-of-Pocket Limits for 2020 Medicare Advantage plans and how MOOPs have changed since 2014.



Need an overview of Medicare Advantage plan options in your area?

To get you started with your review of 2020 Medicare Advantage plans available in your area, just click on your state and then click on your county name: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY.

You can also use our 2020 Medicare Advantage plan finder (MA-Finder) to review plans in your area -- found directly at: MA-Finder.com/2020 .  The MA-Finder currently displays the plan premium, prescription deductible, Gap or Donut Hole coverage availability, and Medicare Part A and Part B Maximum Out-of-Pocket limit (MOOP). The 2020 Medicare plan drug tier cost-sharing, heath coverage information, formulary information, and star ratings are coming soon.

You can use our 2019/2020 MA-Compare tool to see how your 2019 Medicare Advantage plan is changing in 2020. Our Medicare Advantage comparison tool can be found directly at: MA-Compare.com/2020.


. . . and a few reminders . . .

Reminder #1:  No need to rush.

The annual Open Enrollment 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. For more information, Medicare beneficiaries can telephone Medicare at 1-800-633-4227 to speak with a Medicare representative.

Reminder #2: Some Extra Help recipients may need to act to keep their 2020 Extra Help status.

The 2019 / 2020 CMS, SSA, and Medicare plan mailings schedule is online and includes notices for people who need to submit information to keep their 2020 Extra Help status. So be sure to review anything you receive from Medicare or the Social Security Administration as some Medicare Part D Extra Help recipients will need to act or risk losing their Medicare Part D Extra Help or Low-income Subsidy (LIS) in 2020. Please click here to read more about the LIS mailings. When in doubt, contact your local Medicaid office for more information or call Medicare at 1-800-633-4227.








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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.