Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


Q1Group 2016 MA/MAPD Analysis Summary: Stable Medicare Advantage plan premiums, but beneficiaries in many counties will find significant changes in plan availability

Category: Annual Medicare Plan Changes
Published on 2015-10-18 10:34:48


A preliminary analysis of the 2016 Medicare Advantage plan (MA and MAPD) landscape data recently released by the Centers for Medicare and Medicaid Services (CMS) shows changes in Medicare Advantage plan availability, with stable plans premiums, and lower maximum out-of-pocket limits.

Reminder:  You can receive Medicare prescription drug coverage from either a stand-alone Medicare Part D plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage (MAPD).  A Medicare Part D plan only offers prescription drug coverage.  A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization), Medicare Part B (out-patient and physician), and may include additional healthcare benefits.  Some Medicare Advantage plans do not include prescription drug coverage (MAs).  If you enroll in a Medicare Advantage (MA) that does not include drug coverage, you may not be permitted to join a stand-alone Medicare Part D plan (PDP).  Please telephone a Medicare representative at 1-800-633-4227 for more details.

Here are a few highlights of the 2016 Medicare Advantage plans:
  • As noted by CMS, Medicare Advantage plan premiums have remained stable over the past few years.  Overall, almost 70% of the 2016 Medicare Advantage plans will have premiums under $50, with 35% of the 2016 Medicare Advantage plan having a $0 premium.  You can click here to read more about changes in Medicare Advantage plan premiums and see a chart of how Medicare Advantage plan premiums have changed since 2014. Please note: The overall stability of Medicare Advantage plan premiums does not indicate that your 2015 Medicare Advantage plan premium will remain the same 2016.  Please review your Annual Notice of Change letter to see how your 2015 Medicare Advantage plan is changing in 2016 or use our Medicare Advantage plan 2015/2016 comparison tool (MA-Compare.com/2016).

  • The total number of 2016 Medicare Advantage plans will increase slightly across the country with 4% more Medicare Advantage plans offered in 2016.  Overall, there will be 2,618 Medicare Advantage plans (MAs and MAPDs) available in 2016, as compared to 2,526 Medicare Advantage plans offered in 2015.  You can click here to read more about annual changes in Medicare Advantage plan availability by health plan type.

  • However, when viewed in detail, many 2015 Medicare Advantage plans will be terminated in 2016 or merged into other 2016 plans and many counties will see significant changes in their Medicare Advantage plan landscape.  The counties seeing the largest decrease of 2016 Medicare Advantage plans are found in: Florida, New York, and Puerto Rico.  For example, Twenty (20) of the 81 Medicare Advantage plans currently available Richmond County, New York are no longer offered in 2016.  You can click here to read more about county-level changes in the available Medicare Advantage plans.  You can also see more 2016 Medicare Advantage plan changes using our MA-Compare tool found here: MA-Compare.com/2016.

  • The majority (around 71%) of 2016 Medicare Advantage plans will be HMOs (Health Maintenance Organizations), 20% of 2016 Medicare Advantage plans will be Local PPOs (Preferred Provider Organizations).  You can click here to read more about the different types of Medicare Advantage plans and plan availability changes.

  • Over 24% of the 2015 Medicare Advantage Special Needs Plans (SNPs) will be discontinued in 2016 as compared to 16% of the 2014 Special Needs Plans that were discontinued in 2015.  The good news is that such a large number of new SNPs are being introduced in 2016, that overall, there is actually an increase of one (1) SNP for 2016.  You can click here to learn more about the 2016 Medicare Advantage Special Needs Plans and how the SNP landscape has changed since 2014.

  • Most (90%) of 2016 Medicare Advantage plans will include prescription drug coverage (MAPDs), with 2,286 MAPD plans available in 2016 as compared to the 2,216 MAPDs available in 2015.  However, slightly fewer Medicare Advantage plans without prescription coverage (MA) will be offered in 2016, with 266 plans available as compared to 278 MAs available in 2015.  You can click here to read more about the changes in Medicare Advantage plans that offer prescription drug coverage over the past few years.

  • A large number of 2016 Medicare Advantage plans will include prescription drug coverage and have a $0 premium and $0 drug deductible.  You can click here to read more about the 2016 Medicare Advantage plans that have a $0 premium and a $0 initial deductible for prescription drug coverage.

  • Some 2016 Medicare Advantage plans will offer a variation in the standard drug plan Initial Coverage Limit of $3,310.  You can click here to read more about 2016 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.

  • Slightly more 2016 Medicare Advantage plans (MAPDs) will offer Donut Hole coverage for prescriptions purchased while in the Coverage Gap.  The 2016 Donut Hole discount will continue to provide a 55% discount for brand-name drugs and the generic drug discount will increase to 42%.

  • More 2016 Medicare Advantage plans will lower their Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit from the $6,700 maximum.  The number of 2016 Medicare Advantage plans having the statutory maximum MOOP will decrease to 33% -- down from 48% in 2015.  You can click here to learn more about the Maximum Out-of-Pocket Limits for 2016 Medicare Advantage plans and how MOOPs have changed since 2014.

  • As in prior years, no Medicare Advantage plans are offered in Alaska.

Need an example?

To get you started with an overview of the 2016 Medicare Advantage plans 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 2016 Medicare Advantage plan finder (or MA-Finder) that can be found directly at: MA-Finder.com/2016.  The MA-Finder displays the plan premium, prescription deductible, Gap or Donut Hole coverage availability, and Medicare Part A and Part B Maximum Out-of-Pocket limit (or MOOP), drug tier

You can also use our 2015/2016 MA-Compare tool to see how your 2015 Medicare Advantage plan is changing in 2016.  Our Medicare Advantage comparison tool can be found directly at: MA-Compare.com/2016.






Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs




Ask a Pharmacist*
Have questions about your medication?

» Answers to Your Medication Questions, Free!
Available Monday - Friday
8am to 5pm MST
*A free service included with your no cost drug discount card.







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.