We want to remind you that, if you decide to stay with
your current 2017 Medicare plan into 2018, your Medicare plan coverage and
costs can (and usually do) change each year - so please take time to know how
your current Medicare plan is changing in 2018.
What Medicare plan changes can you expect in 2018?
- 1.2 million 2017 Medicare
Advantage plan members will find their Medicare plan is no longer
available in 2018. Although a number of areas around the country
will experience significant changes in
their Medicare Advantage plan landscape, the counties seeing the largest
number of terminated 2018 Medicare Advantage plans are found in: FloridaNew York, and Ohio. For example,
fifteen (15) of the 81 Medicare Advantage plans currently available Queens County, New York will
no longer offered in 2018. You can to
read more in our article about Medicare plans affected by Service Area
Reductions.
- You may be automatically reassigned to
another 2018 Medicare Part D plan. Over 200,000 current
members of stand-alone 2017 Medicare Part D plans and Medicare Advantage
plans will be automatically “crosswalked” or merged into another Medicare
plan in 2018. For example, members of the 2017 First Health Part D
Premier (PDP) will be automatically reassigned to the 2018 First Health
Part D Value Plus (PDP). You can click here to read more about
2018 Medicare Part D plan mergers or consolidations.
- Your monthly 2018 Medicare Part
D premium may be
increasing. Without changing 2017 stand-alone Medicare Part
D plans, over 6 million Medicare beneficiaries will see a monthly
2018 Medicare Part D premium increase of over 20%. The good news is
about 7.6 million people will see a 2018 premium decrease of up to -46%. You can click here to see
examples of 2017 Medicare Part D plans that are increasing their 2018
premiums.
- Your plan’s Initial Deductible
(the amount you pay before coverage) may increase.
The standard 2018 Medicare Part D deductible will increase to $405, up
from the standard 2017 deductible of $400. About 400,000 Medicare
beneficiaries are enrolled in 2017 plan that will see an even larger
initial deductible increase of up to $115. You can click here to see an
example list of Medicare Part D plan’s increasing their 2018 initial
deductibles. The good news is that about 1.3 million people will see
a decrease in their current initial deductible, with some plans even
moving to a $0 deductible in 2018.
- Your 2018 Medicare drug plan’s
formulary or drug list may cover fewer medications.
Although some 2018 Medicare prescription drug plans will be adding more
medications, based on our analysis, over
6 million Medicare beneficiaries currently enrolled in a stand-alone
Medicare Part D plan will see at least 100 medications removed from their
2018 formulary. But, please remember that a larger Medicare Part D
plan formulary does not necessarily mean you will get more of your
medications covered. Important: Check to make sure your
medications are affordably covered by
your chosen 2018 Medicare Part D plan.
- Your 2018 Medicare plan’s
prescription drug cost-sharing may increase.
You will notice that Medicare plans can change fixed co-payments from
year-to-year (you now paid $1 for a Tier 1 drug and in 2018 you will pay
$3 for the same drug). And some plans change between co-insurance to
copayment as a cost-sharing model. You can click here to see an
example of how the 2018 EnvisionRxPlus plan will change from co-insurance
to a copayment for Tier 1 and 2 generics on their 2018 plan formulary.
- Your Medicare prescription drug
plan may begin using preferred pharmacies.
About 98% of all 2018
stand-alone Medicare prescription drug plans (PDPs) will use different
cost-sharing for preferred vs. standard network pharmacies (as compared to
85% in 2017). The SilverScript Choice (PDP), WellCare Classic (PDP), WellCare Extra (PDP), WPS MedicareRx Plan 1, and WPS MedicareRx Plan 2 will
begin using preferred network pharmacy pricing in 2018. As an example, the
California SilverScript Choice (PDP) will
have a co-payment of $3 for a Tier 1 medication at a preferred network
pharmacy and, for the same Tier 1 drug, a $7 co-pay when purchased at a
standard network pharmacy. You can contact your plan’s Member
Service department to find preferred pharmacies in your area.
- Some 2018 Medicare Advantage
plans will offer a variation on the standard drug plan Initial Coverage
Limit of $3,750, with 2018 Initial Coverage Limits ranging from $3,200 to
$8,000. You can click here to read more about
2018 Medicare Advantage plans that have an increased or decreased Initial Coverage Limit.
- Your 2018 Medicare Part D plan
may no longer qualify for your State’s Low-Income Subsidy (LIS) $0
premium. In 2018, most states will have fewer Medicare
Part D plans qualifying for the state’s Low-Income Subsidy (LIS) $0
premium. The state offering the smallest selection of $0 premium LIS
plans is Florida, with only two $0
premium 2018 LIS plans (down from three qualifying 2017 Part D
plans). For more about the decline in the number of LIS $0 premium
plans, you can click here for our article
comparing LIS plan availability since 2007.
- Your Medicare Advantage plan’s
provider network may change. During the past several
years some Medicare Advantage plan members have found that their
healthcare providers were dropped from the plan’s network. Remember,
even though you have checked to ensure that your healthcare providers are
included in your Medicare Advantage plan's provider network, it is
possible that your plan’s network will change during the plan year.
Although Medicare has established a Special Enrollment Period (SEP)
allowing you to change Medicare plans if your plan makes “significant”
mid-year network changes, it is not yet clear when this SEP will be applied.
- Your 2018 Medicare Advantage
plan’s Medicare Part A and Part B maximum out-of-pocket (MOOP) 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. In 2018,
fewer Medicare Advantage plans will offer a Medicare Part A and Part B
MOOP limit below the $6,700 maximum. You can click here to learn more about
the maximum out-of-pocket limits for 2018 Medicare Advantage plans.
And the Bottom Line: If you do not enroll into a new 2018 Medicare
Part D plan or Medicare Advantage plan, you will be automatically re-enrolled
into your current Medicare Part D or Medicare Advantage plan for 2018 and your
2018 Medicare plan may cost you more money and provide different coverage than
in 2017. If your 2017 Medicare plan is being terminated in 2018 and you
are not merged or “crosswalked” to another 2018 Medicare plan, you may be
without Medicare plan coverage on January 1st.
The Good News: You still have plenty of time to review your 2018
Medicare plan coverage options during the annual Open Enrollment Period that
began on October 15th and continues through December 7th.
How to learn more about the changes in your 2018 Medicare plan?
Your Medicare plan provider is required to summarize any Medicare Part D or
Medicare Advantage plan changes in your Annual Notice of Change letter (ANOC)
that you should have received in late-September or early-October. If you
have not received a copy of your plan’s ANOC letter, please call your plan’s
Member Services department and ask your plan to send another copy.
Need a fast way to see how your Medicare Advantage or Medicare Part D plan
is changing in 2018?
Our
PDP-CompareMA-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 co-payments or co-insurance rates for
different drug tiers. Both the PDP-Compare and MA-Compare also show the
Medicare Part D plans or Medicare Advantage plans that will be discontinued,
merged, or added in 2018. The MA-Compare tool includes links to the
health coverage details of all 2017 and 2018 Medicare Advantage plans.