New Medicare Advantage and Part D Plan Landscape Reveals Challenges Ahead

In late September, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees the Medicare program—released an overview of the upcoming year in Medicare Advantage (MA) and the Part D prescription drug program. Among the notable inclusions, CMS expects more people to join MA plans than ever before, shows a sharp increase in the number of plans available, and reveals the number of plans that will offer expanded supplemental benefits.

In 2018, approximately one third of all people with Medicare were enrolled in MA plans. Determining whether MA is the right choice for any beneficiary’s individual circumstances can be a very complicated decision, and we remain concerned that many people with Medicare do not have easy access to all of the tools and information they need to make those decisions. Previous research has made clear that people with Medicare often do not end up in the best plan for their needs, which can mean they spend more than they should or may even face having to switch doctors to stay in the plan’s network.

Unfortunately, this difficulty will be worse due to the proliferation of MA plans and the new, complicated offerings that people will need to wade through. The CMS overview shows an increase from 3,100 MA plans offered nationally to 3,700, with over 91% of beneficiaries having to choose between 10 or more plans.

In addition, CMS is allowing MA plans new flexibilities to offer certain supplemental benefits. While we support increasing the benefits people with Medicare receive from the program, CMS has not provided enough guidance to ensure these benefits are explained thoroughly to people who might choose to enroll. We predict that many beneficiaries and their families will be confused by the number of options and will not get the proper support to make the best choice for their circumstances. One valuable resource is the State Health Insurance Assistance Program (SHIP). Each state or territory has a SHIP where beneficiaries can receive unbiased, on-on-one counseling to help them choose the best options.

There is also good news in the overview: MA and Part D plan premiums have gone down slightly and access to both types of plans will be widespread. This means that beneficiaries who would benefit from these offerings will have access to them. But premiums going down is not the whole story. Many people with Medicare struggle to afford their out-of-pocket costs, especially for their needed medications.

We urge CMS to ensure that people with Medicare have access to the best tools and information to make important decisions about their coverage options.

Read the 2019 Medicare Advantage and Part D Prescription Drug Program Landscape.

Find your local SHIP.

Read more about our concerns with CMS guidance for MA and Part D plans.