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Q1Group 2016 PDP Analysis: Is your 2015 Medicare Part D prescription drug plan or Medicare Advantage plan still being offered in 2016?

Category: Annual Medicare plan changes
Published: Oct, 19 2015 01:10:16


Each plan year, Medicare Part D and Medicare Advantage plan carriers have the option of not renewing their Medicare contract and their Medicare plans can be discontinued across the country or in a specific service area (State or ZIP Code).

This means that, if a 2015 Medicare plan provider does not offer any alternative plans for their existing members - then the 2015 members of the discontinued Medicare plan must find a new Medicare Part D or Medicare Advantage plan - or be without 2016 Medicare Part D or Medicare Advantage plan coverage.

The following chart shows examples of 2015 stand-alone Medicare Part D prescription drug plans that will no longer be available in 2016, along with the number of people who will be affected:

Discontinued 2015 Stand-Alone Prescription Drug Plans
with Membership
Plan Name States Members Affected
Alliance Medicare RX (PDP) MI 981
Colorado Access Vista Medicare PDP (PDP) CO 1,055
Health Alliance Medicare Prescription Plan - Basic (PDP) IL 985
Transamerica MedicareRx Choice (PDP) AK FL HI 1,908
Transamerica MedicareRx Classic (PDP) AK FL HI 246

 

What about 2016 Medicare Advantage plan mergers and terminations?
A large number of Medicare Advantage plan members will find that their 2015 Medicare Advantage plan will not be offered in 2016.  And many counties across the country 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.  As an 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.

What if your 2015 Medicare Part D plan or Medicare Advantage plan is not offered in 2016?
If your Medicare Advantage plan or Medicare Part D plan is discontinued in 2016, you may choose to join a new Medicare Advantage plan or Medicare Part D plan during the annual Open Enrollment Period.

However, if you do not enroll in a new Medicare Advantage plan or Medicare Part D plan by December 7th, you will be provided a Special Enrollment Period to join a 2016 Medicare plan from December 8, 2015 through February 28, 2016 (also called the Service Area Reduction Special Enrollment Period or SAR SEP).

Remember, if your current Medicare plan is discontinued next year, your 2015 Medicare prescription drug coverage will end on December 31, 2015.

If you wait until January to enroll in a 2016 plan, your new prescription drug coverage will take effect on February 1st, so you will have no prescription drug coverage for the month of January, and it continues that if you wait until February to enroll in a 2016 plan, your coverage will take effect on March 1st, so you will have no prescription drug coverage for January or February, 2016.

Our PDP-Compare and MA-Compare tools show the 2015 stand-alone Medicare Part D prescription drug plans (PDPs) and Medicare Advantage plans (MAs or MAPDs) across the country that will be merged, discontinued, or added in 2016.






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Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • 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.
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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.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.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.