We want to remind you that, if you decide to stay with
your current 2018 Medicare plan into 2019, 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 2019.
How might your Medicare plan change in 2019?
- Your 2018 Medicare plan may no longer be offered in 2019. About 1.4 million people are
currently enrolled in 2018 Medicare Advantage plans that will no longer be
available in 2019. 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 2019 Medicare Advantage plans are found
in: Minnesota. For example, Becker, Cass, Clay, Crow
Wing and Hubbard Counties will each lose thirty-two (32) Medicare
Advantage plan options in 2019 (and have the introduction of nine (9) new 2019
Medicare Advantage plans). An additional 87,000 people enrolled in stand-alone
Medicare Part D plans, will find their coverage discontinued in 2019. You can click
here to read more in our article about Medicare plans affected
by Service Area Reductions.
- You may be automatically
reassigned to a different 2019 Medicare plan. Over 800,000 current members of stand-alone
2018 Medicare Part D plans and 200,000 Medicare Advantage plan members will be
automatically “crosswalked” or merged into another Medicare plan in 2019. For example, members of the 2018 Symphonix
Value Rx (PDP) will be automatically
reassigned to the 2019 AARP MedicareRx Saver Plus (PDP). You can click
here to read more about 2019 Medicare Part D plan mergers or consolidations.
- Your monthly 2019 Medicare Part D premium may be
increasing. Without changing
2018 stand-alone Medicare Part D plans, over 4.5 million Medicare
beneficiaries will see a monthly 2019 Medicare Part D premium increase of over
20%. The good news is about 6.2 million
people will see a 2019 premium decrease of up to 74%. You can click
here to see examples of 2018 Medicare Part D plans that are increasing
their 2019 premiums.
- Your plan’s Initial Deductible may increase. The standard
2019 Medicare Part D (PDP) deductible will increase to $415, up
from the standard 2018 deductible of $405. About 600,000 Medicare PDP beneficiaries are enrolled in 2018 Part D
plan that will see an even larger initial deductible increase of up
to $315. You can click
here to see an example list of Medicare Part D plan’s increasing their
2019 initial deductibles. The good news
is that about 1.2 million people will see a decrease in their current initial
deductible, with some
2018 Part D plans even moving to a $0 deductible in 2019.
- Your 2019 Medicare drug plan’s formulary or drug list may
cover fewer medications. Although some 2019
Medicare prescription drug plans will be adding more medications, based
on our analysis, over 11 million Medicare beneficiaries currently enrolled
in a stand-alone 2018 Medicare Part D plan will see at least 100 fewer
medications on their 2019 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. Important: Check to make sure your medications are affordably
covered by your chosen 2019 Medicare Part D plan.
- Your 2019 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 $3 for a Tier 1 drug and
in 2019 you will pay $5 for the same Tier 1 drug) – or plans may increase the
percentage of retail drug prices you pay for co-insurance (you now pay 27% of
retail and in 2019 you will pay 37% of the retail drug price). And some Medicare drug plans 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 California EnvisionRxPlus plan
will change from 15% co-insurance to a $29 copayment for Tier 3 Preferred
Brands on their 2019 plan formulary.
- Your Medicare prescription drug plan probably offers
preferred pharmacy pricing. About 99%
of all 2019 stand-alone Medicare prescription drug plans (PDPs) will
use different cost-sharing for preferred vs. standard network pharmacies (as
compared to 85% back in 2017). The Farm
Bureau Select Rx (PDP) in AL & TN, AR
Blue Cross - Medi-Pak Rx Basic (PDP) in AR, AR
Blue Cross - Medi-Pak Rx Premier (PDP) in AR, Regence
Medicare Script Basic (PDP) in ID & UT, and Asuris
Medicare Script Basic (PDP) in OR & WA will begin
using preferred network pharmacy pricing in 2019. 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.
- Your Medicare Advantage plan’s Initial
Coverage Limit may change. Some 2019 Medicare Advantage plans will offer a
variation on the standard drug plan Initial Coverage Limit of $3,820, with 2019
Initial Coverage Limits ranging from $3,130 to $8,000. The Initial Coverage Limit (ICL) is 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 retail
value of your prescription drug purchases. You
can click
here to read more about 2019 Medicare Advantage plans that have an increased
or decreased Initial
Coverage Limit.
- Your 2019 Medicare Part D plan may no longer qualify for
your state’s Low-Income Subsidy (LIS) $0 premium. In 2019, most states will offer about the
same number of Medicare Part D plans qualifying for the state’s LIS $0 premium
as they did in 2018. Florida will
continue to offer the smallest selection of only
two $0 premium LIS plans. Arizona offers the largest
selection of ten $0 premium LIS qualifying 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.
- Your Medicare Advantage plan’s provider network can change
at any time. Even though you have
checked to ensure that your healthcare providers are included in your 2019
Medicare Advantage plan's provider network, it is possible that your plan’s
network can change during the plan year. Although Medicare has established a case-by-case Special
Enrollment Period (SEP) allowing you to change Medicare plans if your plan
makes “significant” mid-year network changes, it is still not clear when this
SEP will be applied.
- Your 2019 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 2019, slightly more Medicare Advantage plans will offer a Medicare
Part A and Part B MOOP limit at or below the $3,400 voluntary maximum MOOP,
however 77% 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 2019 Medicare
Advantage plans.
Bottom Line: If you do not enroll into a new
Medicare Part D plan or Medicare Advantage plan next year, you will be automatically
re-enrolled into your current Medicare Part D or Medicare Advantage plan for
another year and your Medicare plan next year may cost you more money and provide different
coverage than are finding this year. If your current Medicare plan is being terminated next year and you are
not merged or “crosswalked” to another Medicare plan, you
may be without Medicare plan coverage on January 1
st.
The Good News: You have plenty of time to
review your Medicare plan coverage options during the annual Open
Enrollment Period that began on October 15
th and continues through
December 7
th.
How to learn more about the changes in your next year's 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 next year?
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 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 or
added next year. The MA-Compare tool includes links to the health coverage
details of all Medicare Advantage plans.