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Q1Group 2019 MA/MAPD Analysis Summary: Stable Medicare Advantage plan premiums, but beneficiaries in many counties will find significant changes in plan coverage and availability

Category: Annual Medicare plan changes
Published: Oct, 10 2018 06:10:02


A preliminary analysis of the 2019 Medicare Advantage plan (MA and MAPD) landscape data recently released by the Centers for Medicare and Medicaid Services (CMS) shows that Medicare beneficiaries may notice changes in Medicare plan availability (more plans in some areas); continued low monthly premiums; more Medicare Advantage plans offering some Donut Hole coverage; however, higher out-of-pocket spending limits (MOOP).

First, a brief review of Medicare Advantage plans: 
(1) A Medicare Advantage plan includes your Medicare Part A (in-patient and hospitalization coverage), Medicare Part B (out-patient and physician coverage), and may include additional healthcare benefits (such as vision, dental, or fitness coverage). (2) A Medicare Advantage plan may include Medicare prescription drug coverage (MAPD) or can be offered without drug coverage (MA). (3) You cannot add a stand-alone Medicare Part D plan (PDP) plan, if you are enrolled in a Medicare Advantage (MA) plan, -- unless your Medicare Advantage plan is a MSA or PFFS plan. (4) A Medicare Advantage plan is not a Medicare Supplement (Medigap plan) and cannot be used with a Medicare Supplement.

Highlights of the 2019 Medicare plan landscape with links to additional information:
  • The total number of 2019 Medicare Advantage plans will increase.
    Across the country, there will be 14% more Medicare Advantage plans offered in 2019. Overall, there will be 3,431 Medicare Advantage plans (MAs and MAPDs) available in 2019, as compared to 3,001 Medicare Advantage plans offered in 2018. You can click here to read more about the number (and type) of Medicare Advantage plans available in 2019.

  • Most 2019 Medicare Advantage plans will offer prescription drug coverage (MAPDs).
    As in past years, around 92% of 2019 Medicare Advantage plans will include prescription drug coverage (MAPDs). You can click here to read more about the annual changes in the number of Medicare Advantage plans offering prescription drug coverage.

  • Most Medicare Advantage plans are HMOs.
    The majority (around 77%) of 2019 Medicare Advantage plans will be Local HMOs (Health Maintenance Organizations). However, there will be a 21% increase in 2019 Medicare Advantage plans that are Local PPOs (Preferred Provider Organizations). You can click here to read more about the different types of Medicare Advantage plans offered in 2019.

  • Even with more Medicare Advantage plans offered in 2019, many counties will see significant changes in their Medicare Advantage plan landscape.
    When viewed in detail, many 2018 Medicare Advantage plans will be terminated in 2019 or merged into other 2019 plans. The counties with the largest number of 2018 Medicare Advantage plans that will no longer be available in 2019 are found in Minnesota. You can see more 2019 Medicare plan changes using our 2018/2019 Medicare Advantage plan compare tool: MA-Compare.com/2019. You can click here to read more about changes in Medicare Advantage plan availability across the country.

  • 2019 Medicare Medical Savings Accounts (MSAs) will be more widely available.
    In 2019, Medicare Medical Savings Accounts (MSAs) will be available in 19 states (1,262 counties) across the country. In 2018, MSAs were available to Medicare beneficiaries in only 111 counties across two states. Unlike other Medicare Advantage plans, MSAs are made up of a high-deductible health plan and a medical savings account funded by an annual tax-free deposit. MSA members can use the medical savings account to pay for healthcare costs before the health plan deductible is met.  MSA members can enroll in any available stand-alone Medicare Part D plan (PDP) for their drug coverage.

  • Monthly 2019 Medicare Advantage plan premiums will remain low.
    As in past years, close to 77% of all 2019 Medicare Advantage plans will have monthly premiums under $50, with around 39% of the 2019 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.

  • More 2019 Medicare Advantage Special Needs Plans (SNPs) - with large changes in the SNP landscape.
    Although about 28% of the 2018 Medicare Advantage Special Needs Plans (SNPs) will be discontinued in 2019. There will be an introduction of so many new 2019 SNPs, that there is a resulting 9.5% increase in the total number of SNPs. Overall, there are fewer 2019 Chronic Illness SNPs, with more Dual-Eligible (Medicare-Medicaid) SNPs and Institutional SNPs. You can click here to learn more about the 2019 Medicare Advantage Special Needs Plans and how the SNP landscape has changed since 2014.

  • A few more 2019 MAPDs have a $0 Rx deductible and $0 premium.
    21% of all 2019 Medicare Advantage plans will include prescription drug coverage with a $0 premium and $0 drug coverage deductible. You can click here to read more about the 2019 $0/$0 Medicare Advantage with Prescription Drug Coverage plans (MAPDs).

  • A few 2019 Medicare Advantage plans will offer some variation of the standard Initial Coverage Limit (ICL) of $3,820.
    A higher ICL means that you can buy more medications before reaching the Donut Hole. You can click here to read more about Medicare Advantage plans offering a variation in the standard Initial Coverage Limit.

  • Slightly more 2019 MAPDs will offer Donut Hole coverage.
    37% of MAPD plans will offer some level of additional drug coverage should you reach the 2019 Donut Hole -- as compared to 34% of MAPDs in 2018.

    All MAPD plans will honor the 2019 Donut Hole discount that will increase to 75% for brand-name drugs (you pay 25%) and 63% for generic medications (you pay 37%).

  • More 2019 Medicare Advantage plans will have a higher Medicare Part A and Part B Maximum Out-of-Pocket (MOOP) Limit.
    The number of Medicare Advantage plans having the statutory maximum MOOP of $6,700 will increase to 30% of all 2019 Medicare Advantage (up from 28% in 2018). You can click here to learn more about the Maximum Out-of-Pocket Limits for 2019 Medicare Advantage plans and how MOOPs have changed since 2014.
Need an overview of Medicare Advantage plan options in your area?
To get you started with your review of 2019 Medicare Advantage plans available 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 2019 Medicare Advantage plan finder (MA-Finder) to review plans in your area - found directly at: MA-Finder.com/2019. The MA-Finder currently displays the plan premium, prescription deductible, Gap or Donut Hole coverage availability, and Medicare Part A and Part B Maximum Out-of-Pocket limit (MOOP), drug tier cost-sharing, health coverage information, formulary information and star ratings.

You can also use our 2018 / 2019 MA-Compare tool to see how your 2018 Medicare Advantage plan is changing in 2019.  Our Medicare Advantage comparison tool can be found directly at: MA-Compare.com/2019.

No need to rush.
The Annual Enrollment Period (AEP) for 2019 Medicare Part D plans and Medicare Advantage plans begins on Monday, October 15th and continues through Friday, December 7th, with 2019 Medicare plan coverage beginning on Tuesday, January 1, 2019. For more information, Medicare beneficiaries can telephone Medicare at 1-800-633-4227 to speak with a Medicare representative.

Some Extra Help recipients may need to act to keep their 2019 Extra Help status.
The 2018 / 2019 CMS, SSA, and Medicare plan mailings schedule is online and includes notices for people who need to submit information to keep their 2019 Extra Help status. So be sure to review anything you receive from Medicare or the Social Security Administration as some Medicare Part D Extra Help recipients will need to act or risk losing their Medicare Part D Extra Help or Low-income Subsidy (LIS) in 2019.  Please click here to read more about the LIS mailings. When in doubt, contact your local Medicaid office for more information or call Medicare at 1-800-633-4227.






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  • 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.
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    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.