Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Home
  • Contact
  • MAPD
  • PDP
  • 2020
  • FAQs
  • Articles
  • Search
  • Contact
  • 2020
  • FAQs
  • Articles
  • Latest Medicare News
  • Search


Top Ten Ways Your Medicare Part D or Medicare Advantage plan Can Change in 2020

Category: Annual Medicare Plan Changes
Published on 2019-10-23 12:09:18


First, staying with your 2019 plan into 2020?

If you decide to stay with your current 2019 Medicare Part D or Medicare Advantage plan into 2020 – and you understand how your Medicare plan is changingyou do not need to do anything – and you will be automatically re-enrolled into your Medicare plan along with any changes your plan is making for 2020.  In addition to our list of Top Ten plan changes below, be sure to review your plan’s Annual Notice of Change (ANOC) letter to learn more about your 2020 Medicare plan coverage.

(1)  Your 2019 Medicare plan may no longer be offered in 2020.

Over 1.1 million people are currently enrolled in a 2019 Medicare Advantage plan (MA or MAPD) that will no longer be available in 2020.  Although a number of counties around the country will experience significant changes in their Medicare Advantage plan landscape, the counties seeing the largest number of terminated 2020 Medicare Advantage plans are: Miami-Dade, FL losing 17 plans and Jefferson County, PA losing 15 plans.  You can click here to read more in our article about Medicare plans affected by Service Area Reductions.

(2)  You may be automatically reassigned to a different 2020 Medicare plan.

Over 2 million Medicare Advantage plan members and an additional 740,000 members of stand-alone Medicare Part D plans will be automatically “crosswalked” or merged into another Medicare plan in 2020.  For example, members of the 2019 Humana Enhanced (PDP) will be automatically reassigned to the 2020 Humana Premier Rx Plan (PDP).  You can click here to read more about Medicare Part D plan mergers or consolidations.

(3)  Your 2019 Medicare plan may change its name.

The nearly 2 million members of the 2019 Humana Walmart Rx Plan (PDP) will find their plan’s name changing to the 2020 Humana Premier Rx Plan (PDP), with a larger formulary and significantly higher premiums (same plan ID, but a different plan name).  And the new 2020 Humana Walmart Value Rx Plan (PDP) will be introduced with a premium of $13.20 in every state.

(4)  Your monthly 2020 Medicare Part D premium may be increasing.

Without changing stand-alone Medicare Part D plans, over 4 million Medicare beneficiaries will see a monthly 2020 Medicare Part D premium increase of over 20% - with 1.5 million people currently enrolled in a 2019 Part D plan seeing their premiums double in 2020.  The good news is about 8.4 million people will see a 2020 premium decrease of up to 73%

You can click here to see examples of 2019 Medicare Part D plans that are increasing their 2020 premiums.  Please keep in mind that there may be low- or $0 premium Medicare Advantage plans (MAPDs) available in your area.

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

The standard 2020 Medicare Part D (PDP) deductible will increase to $435, up from the standard 2019 deductible of $415.  About 6.7 million Medicare PDP beneficiaries are enrolled in a Part D plan that will see an even larger Initial Deductible increase from $25 to $260.  An additional 3.8 million Medicare Part D beneficiaries will see their $0 deductible disappear.  You can click here to read more about initial deductible changes and examples of Medicare Part D plan’s increasing their 2020 initial deductible. 

(6)  Your 2020 Medicare drug plan’s formulary or drug list may cover fewer medications.

Although some 2020 Medicare prescription drug plans will be adding more medications, based on our analysis, almost 2.5 million Medicare beneficiaries currently enrolled in a stand-alone 2019 Medicare Part D plan will see at least 100 fewer medications on their 2020 formulary.  But, please remember that a larger Medicare Part D plan formulary does not necessarily mean that the Medicare drug plan will cover all of your medications.  In addition, some of your low-cost generic medications, particularly tier one and two generics may have moved to a higher drug tier

Important:  Check to make sure your medications are affordably covered by your chosen 2020 Medicare Part D plan.

(7)  Your 2020 Medicare plan’s prescription drug cost-sharing may increase.

Medicare plans can change their fixed copayments from year-to-year (for example, you now pay $5 for a Tier 2 drug and in 2020 you will pay $10 for the same Tier 2 drug) – or plans may increase the co-insurance percentage (you now pay 35% of retail and in 2020 you will pay 44% of the retail drug price).  And some Medicare drug plans may change between co-insurance (percent of retail prices) to copayment as a cost-sharing model.  You can click here to see an example of how the 2019 Humana Walmart Rx plan will change from 20% co-insurance to a $42 copayment for Tier 3 Preferred Brands as it becomes the 2020 Humana Premier Rx plan – this change will affect approximately 2 million plan members.

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

About 95% of all 2020 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 a preferred network pharmacy and, for the same Tier 1 drug, a $6 co-pay when purchased at a standard network pharmacy.  You can click here to see more examples of standard and preferred pharmacy cost-sharing.  You can contact your plan’s Member Service department to find preferred pharmacies in your area.

A word of caution about mail-order cost-sharing when using the Medicare.gov plan finder.  As of October 23rd, the Medicare.gov plan finder only calculates drug costs for mail-order using the plan’s “standard” mail-order cost-sharing rather than the plan’s “preferred” mail-order cost-sharing.  As a result, the mail-order cost-sharing is, in most cases, higher than it would be if Medicare was using the preferred mail-order cost-sharing as they did in past years.

(9)  Your 2020 Medicare Part D plan may no longer qualify for your state’s Low-Income Subsidy (LIS) $0 premium. 

In 2020, most states will offer about the same number of Medicare Part D plans qualifying for the state’s Low-Income Subsidy (LIS) $0 benchmark premium.  The state offering the smallest selection of $0 premium LIS PDPs is Ohio, offering only two 2020 $0 premium LIS plansArizona will offer the largest number of $0 premium LIS plans (12 plans).  For more about the changing landscape of LIS $0 premium plans, you can click here for our article comparing LIS plan availability since 2007.   

If a Medicare Part D plan no longer qualifies for the full LIS $0 monthly premium, Medicare will automatically move LIS recipients to a new plan that does qualify.  However, if you selected your own plan, Medicare will NOT move you to a new plan, even if your plan no longer qualifies for the $0 premium.   You will need to select a new plan during AEP or you will pay a partial premium in 2020.  You can click here to read more.

(10)  Your 2020 Medicare Advantage plan’s Initial Coverage Limit (ICL) and/or Maximum Out-of-Pocket (MOOP) limit may change.

Some 2020 Medicare Advantage plans will offer a variation on the standard drug plan Initial Coverage Limit (ICL) of $4,020, with 2020 MAPD ICLs ranging from $2,750 to $10,000.  In addition, one 2020 stand-alone Medicare Part D plan (in New York) has an ICL under the $4,020 standard. The Initial Coverage Limit 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 2020 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.

In 2020, slightly more Medicare Advantage plans will offer a MOOP limit at or below the $3,400 voluntary maximum.  However 76% of Medicare Advantage plans continue to have a MOOP greater than $3,400.  You can click here to learn more about the maximum out-of-pocket limits for 2020 Medicare Advantage plans.  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.


The Bottom Line to our Top Ten List.


If you do not enroll into a new 2020 Medicare Part D plan or Medicare Advantage plan, you will be automatically re-enrolled into your current Medicare plan for 2020 and your 2020 Medicare plan may cost you more and provide different coverage than in 2019. 

If your 2019 Medicare plan is being terminated in 2020 and you are not merged or “crosswalked” to another 2020 Medicare plan, you may be without Medicare plan coverage on January 1st.

The Good News:  You still have plenty of time to review your 2020 Medicare plan coverage options during the Annual Open Enrollment Period (AEP) that began on October 15th and continues through December 7th.


Need a fast way to see how your Medicare Advantage or Medicare Part D plan is changing in 2020?

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 2020.  MA-Compare includes links to the health coverage details of all 2019 and 2020 Medicare Advantage plans.


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

To see the annual 2019 / 2020 changes in stand-alone Medicare Part D plan details,PDP-Compare.com


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

To get you started with an overview of the 2020 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 2019 & 2020 Health Plans” link to see annual changes in plan features or go directly to MA-Compare.com.


Not sure where to begin with 2020 Medicare Part D prescription drug coverage?

For an overview of the 2020 Medicare Part D prescription drug plan (PDP) landscape, please see our article: “More low-cost 2020 Medicare Part D PDP options, but many people in 2019 plans may pay higher 2020 Part D premiums”.

For a summary of the 2020 Medicare Advantage (MA and MAPD) plan landscape, please see our article: "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".

If you would like an overview of the Medicare Part D and Medicare Advantage plan program, then you can click here for more information.

Copyright Q1Group LLC, Saint Augustine, Florida (2019)








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.