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2016 Medicare Advantage Plans: Changes in 2016

October 6, 2016

Medicare Advantage (MA) plans are available from private, Medicare-approved insurance companies. Availability, premiums, and out-of-pocket costs can vary based on factors such as where you live, how comprehensive the plan’s coverage is, and the insurance company offering the plan. These plans can also change certain coverage details each year. Read below to learn about some of the changes you might see in Medicare Advantage plans in 2016.

According to the Center for Medicare & Medicaid Services (CMS), the agency revised a rule in early 2015 aimed at improving Medicare Advantage and Medicare prescription drug benefits in 2016. “This final rule implements statutory requirements, improves program efficiencies, strengthens beneficiary protections, clarifies program requirements, improves payment accuracy, and makes technical changes for Contract Year (CY) 2016.

In a July 2015, CMS reported that nearly a third of Medicare beneficiaries (17,710,809 out of 55,056,521) were enrolled in Medicare Advantage plans. More than 39,000 beneficiaries had Medicare prescription drug coverage, either through a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan.

Other Medicare Advantage plan changes in 2016

Medicare Advantage plans provide your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Part A still covers hospice care directly, but the rest of your Original Medicare benefits are delivered through the plan. Many Medicare Advantage plans include prescription drug coverage and sometimes other benefits, such as routine dental services.

There is no guarantee that once you enroll in a Medicare Advantage plan that the details (costs and/or coverage) will stay the same each year. You might want to review your plan’s Annual Notice of Change to make sure the benefits still fit your needs. Your plan sends this notice every fall.

Some Medicare Advantage plans may offer monthly premiums as low as $0, while others will charge a higher amount.  Your plan’s out-of-pocket costs (like deductibles, copayments, and/or coinsurances) may increase or decrease in 2016.

If you’re enrolled in a Medicare Advantage Prescription Drug plan, your plan’s formulary (list of covered prescription drugs) might change from year to year- this is another reason to re view your plan’s Annual Notice of Change. The formulary may change at any time. You will receive notice from your plan when necessary.

Finally, requirements may also change. Some Medicare Advantage plans require that beneficiaries only use health-care providers in a certain network, while others may require that beneficiaries choose a primary care physician. These restrictions may change from year-to-year just like cost and benefits for 2016 Medicare Advantage plans.