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Top 10 ways your current 2021 Medicare plan can change in 2022

Category: Annual Medicare Plan Changes
Published on 2021-10-21 12:19:15


Many people are reluctant to change their Medicare Part D or Medicare Advantage plan coverage year-to-year.   However, millions of Medicare beneficiaries will see significant changes in their 2022 Medicare costs and coverage.

If you are staying with your current 2021 Medicare plan into next year, please be sure to review your plan’s Annual Notice of Change ( ANOC ) letter and use the list below to help you look for important changes that might impact your 2022 coverage.


(1)  Your 2021 Medicare plan may no longer be offered in 2022.

Over 190,000 people are currently enrolled in a 2021 Medicare Advantage plan ( MA or MAPD ) or Medicare Part D plan ( PDP ) that will no longer be available in 2022.  These 190,000 people will lose their 2021 Medicare plan coverage in 2022 - unless they enroll into another Medicare plan.

As examples, the counties seeing the largest number of terminated 2022 Medicare Advantage plans are: Monroe County, PA losing 11 plans and Lackawanna County and Luzerne County in PA both losing 10 plans.  You can click here to read more in our article about Medicare plans being discontinued in 2022.


(2)  You may be automatically reassigned to a different 2022 Medicare plan.

Over 4.4 million people, 1.2 million enrolled in 2021 Medicare Advantage plan and an additional 3.2 million people enrolled in a 2021 stand-alone Medicare Part D plan, will be automatically “ crosswalked ” or merged into a different 2022 Medicare plan -with changes to their plan cost and coverage.  For example, members of the 2021 Florida Wellcare Rx ( PDP ) will be automatically reassigned to the 2022 Wellcare Value Script (PDP).  You can click here to read more about Medicare plan mergers or consolidations.


(3)  Your monthly 2022 Medicare Part D premium may be increasing.

Almost 4.4 million Medicare beneficiaries will see their monthly 2022 Medicare Part D premium increase 20% or more.  Over 150,000 people currently enrolled in a 2021 Part D plan will see their plan premium double in 2022.  The good news is about 2.5 million people will see a 2022 premium decrease of 1% to 66%.

You can click here to see examples of 2021 Medicare Part D plans that are increasing their 2022 premium.  Please keep in mind that, in addition to lower-premium Part D plans, there may be low- or $0 premium Medicare Advantage plans (MAPDs) available in your area.


(4)  Your plan’s Initial Deductible may increase.

The 2022 standard Medicare Part D deductible will increase to $480, up from the 2021 standard deductible of $445 – affecting 9.8 million people.  Over 3.4 million Medicare beneficiaries are enrolled in a Part D plan having an even larger initial deductible increase of $70 or more .  You can click here to read more about initial deductible changes and examples of Medicare Part D plan’s increasing their 2022 initial deductible.


(5) Your 2022 Medicare plan’s Initial Coverage Limit (ICL) may change.

All stand-alone 2022 Medicare Part D plans use the standard Initial Coverage Limit (ICL) of $4,430.  However, some 2022 Medicare Advantage plans offer an ICL other than the standard – ranging from $4,150 to $10,000.  Your drug plan’s ICL sets the boundary between your Medicare Part D plan's Initial Coverage Phase and the Donut Hole or Coverage Gap.  The ICL is measured by the total retail value of your prescription drug purchases.  You can click here to read more about 2022 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.


(6)  Your 2022 Medicare drug plan’s formulary or drug list may cover fewer medications.

Although some 2022 Medicare prescription drug plans will be adding more medications, based on our analysis , over 1.1 million Medicare beneficiaries currently enrolled in a stand-alone 2021 Medicare Part D plan will see at least 100 fewer medications on their 2022 formulary.  In addition, some of your low-cost generic medications, particularly tier-one and tier-two generics may have moved to a higher drug tier.

Important: Remember that a larger formulary does not necessarily mean that the Medicare drug plan will cover all of your medications.  So please, check to make sure your medications are affordably covered by your chosen 2022 Medicare Part D plan.


(7) Your 2022 Medicare plan’s prescription drug cost-sharing may change.

Medicare plans can change their fixed copayments from year-to-year (such as raising Tier 1 drugs to a $5 co-pay)– or plans may increase the co-insurance percentage (for example , instead of a fixed 25% co-insurance, you will pay 45% for Tier 4 drugs in 2022).  And some Medicare drug plans may change between co-insurance (percent of retail price) to copayment as a cost-sharing model.

You can click here to see an example of how the SilverScript Choice (PDP) will change from a $35 co-pay to 17% co-insurance for Tier 3 Preferred Brands (meaning, you will save money in 2022 if your Tier 3 drugs have a retail cost under $206) – this change will affect almost 3.4 million current plan members.


(8) Your Medicare plan’s cost-sharing can vary significantly between “preferred” and “standard” network pharmacies.

As in past years, about 97% of all 2022 stand-alone Medicare prescription drug plans (PDPs) will use different cost-sharing for preferred vs. standard network pharmacies.  As an example, the California SilverScript Choice (PDP) will have a co-payment of $0 for a Tier 1 medication at preferred network pharmacies and, for the same Tier 1 drug, a $5 co-pay when purchased at a standard network pharmacy.  You can click here to see more examples of standard and preferred pharmacy cost-sharing.  And, you can contact your plan’s Member Service department to find preferred pharmacies in your area using the toll-free telephone number found on your Member ID card.


(9)  Your 2022 Medicare Advantage plan’s Maximum Out-of-Pocket (MOOP) spending limit may change.

The Medicare Advantage plan MOOP threshold limits how much you will spend on co-payments and co-insurance for in-network, eligible Medicare Part A and Part B coverage.  A Medicare Advantage plan’s MOOP limit can change every year and ranges from $3,400 to $7,550 - with most 2022 Medicare Advantage plans having a MOOP over $3,450.  In addition, 40% of 2022 Medicare Advantage plans have a MOOP of either $6,700 or $7,550.  (Medicare Advantage plans designed for low-income beneficiaries have no MOOP).  You can click here to learn more about the maximum out-of-pocket limits for 2022 Medicare Advantage plans.


(10) Your 2022 Medicare plan may have added new features and coverage.

Low-cost Insulin Coverage. More 2022 Medicare Part D and Medicare Advantage plans now participate in the Senior Savings Model, offering various types of insulin for a $35 or less co-pay.  We show the text such as: “select insulin pay $35 copay” in our Medicare Part D Plan Finder ( https://PDP-Finder.com ) and our Medicare Advantage Plan Finder ( https://MA-Finder.com ).  You can then click the “ Browse Formulary ” link to check the plan’s formulary for the types of insulin covered.

Medicare Part B Premium Giveback:  More 2022 Medicare Advantage plans are now offering a Medicare Part B premium Giveback feature – where you will receive a partial (or full) refund of your Part B premiums.  Part B Giveback amounts for 2022 can range from $1 to $148.50.  Unfortunately, Medicare Advantage plans offering a Part B Giveback are not available everywhere, but you can use the Giveback filter in our Medicare Advantage Plan Finder ( https://MA-Finder.com ) to see the plans available and Part B Giveback amounts.

Supplemental Benefits: More 2022 Medicare Advantage plans are expanding supplemental healthcare benefits (dental, hearing aid, eyecare, OTC drugs, and fitness benefits) and non-health related benefits (limited meals, non-healthcare transportation).  You can find a list of supplemental benefits at the bottom of our Medicare Advantage plan detail pages.  Begin by viewing all Medicare Advantage plans in your area (for example: https://MA-Finder.com/15238 ) and then click on the plan name and then scroll down the page to see the list of Supplemental Benefits.  You can then telephone the plan (the toll-free number for Member Services is found at the top of the page) and ask for more details about the benefits.


The Bottom Line to our Top 10 List . . .

If you decide to stay with your current 2021 Medicare Part D or Medicare Advantage plan into 2022 – AND you understand how your Medicare plan is changingyou do not need to do anything – you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for 2022.

If your 2021 Medicare plan is being terminated in 2022 and you are not merged or “crosswalked” to another 2022 Medicare plan, you may be without Medicare plan coverage on January 1st.

The Good News: You still have plenty of time to review your 2022 Medicare plan options during the annual Open Enrollment Period (AEP) that continues through December 7th.  For more information, Medicare beneficiaries can telephone Medicare at 1-800-633-4227 and speak with a Medicare representative.

Need a fast way to see how your 2021 Medicare Advantage or Medicare Part D plan is changing in 2022?

Our PDP-Compare and MA-Compare tools allow you to compare changes in all stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans (MAs or MAPDs) across the country.

Our comparison tools show changes in monthly premiums and plan designs, as well as changes in cost-sharing rates for different drug tiers.  Both PDP-Compare and MA-Compare also show the Medicare plans that will be discontinued, merged, or added in 2022.  MA-Compare includes links to the health coverage details for all 2021 and 2022 Medicare Advantage plans.

Need an example of Medicare Part D plan changes in your area?

To see the annual 2021 / 2022 changes in stand-alone Medicare Part D plan details, simply click on your state:  AK 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.

Need an example of Medicare Advantage plan changes in your area?

To get you started with an overview of the 2022 Medicare Advantage plans in your area, just click on your state and then click on your county name – you can then choose the “Compare Changes in the 2021 & 2022 Health Plans” link to see annual changes in plan features or go directly to MA-Compare.comAL 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.






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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.