In a report entitled “Medicare Part D: A First Look at Plan Offerings in 2016” (October 2015), the Kaiser Family Foundation analyzed the Part D market in 2016 and found, among other things, that:
- In 2016, beneficiaries in each region will have a choice of 26 PDPs, on average, down by 4 from 2015.
- The average PDP premium (weighted by 2015 plan enrollment) is projected to increase by 13 percent from 2015 to 2016, from $36.68 to $41.46 per month. Even if a number of beneficiaries switch or are reassigned to lower-premium plans, the average premium increase for 2016 is likely to be the largest since 2009.
- More than one-third of the 11.2 million PDP enrollees who do not receive Low-Income Subsidies (LIS) would pay premiums of $60 or more per month in 2016 if they stay in the same plan.
- Beneficiaries receiving the LIS will have access to 7 plans for no monthly premium in 2016, on average, fewer than in any past year. About 1.9 million LIS enrollees who are slated to be in PDPs where they will pay premiums must switch plans or be reassigned by CMS in order to have premium-free coverage in 2016.
The report also notes: “As in the past, Part D enrollees need to consider that their plan may require coinsurance, rather than flat copayments, for brand-name and specialty drugs, and differential cost sharing for prescriptions depending on their choice of pharmacy. These factors, as well as which drugs are included on a plan’s formulary, may affect out-of-pocket costs as much as premiums.”
Kaiser also recently issued a report looking at 10 years of the Part D drug benefit entitled “Medicare’s Drug Benefit Is Firmly-Established After Its First Decade, With Flat Premiums in Recent Years but Higher Cost-Sharing Over Time” (October 2015).
In a separate report entitled “What’s In and What’s Out? Medicare Advantage Market Entries and Exits for 2016” (October 2016), the Kaiser Family Foundation found that “the Medicare Advantage market is relatively stable in terms of plan participation and beneficiary choice.” Their findings include:
- On average, Medicare beneficiaries will be able to choose among 19 Medicare Advantage plans in 2016, a slight increase from last year (18 plans per beneficiary).
- The majority of plans available in 2015 will continue to be offered in 2016.
- A smaller number of plans will exit or enter the market than in any year since 2012.
- In most states, the total number of plans offered in 2016 will be greater than or equal to the number offered in 2015.
- Among the minority of 2015 plans exiting the market in 2016, most have relatively low enrollment, which means that relatively few beneficiaries will be affected by the market exits.
- Several firms will offer Medicare Advantage plans for the first time in 2016, including some that will be led by local, established health care systems.
Compare these findings about MA plans with a June 2015 KFF report discussed in a previous Alert https://www.medicareadvocacy.org/reports-of-import-trustees-and-kaiser-family-foundation/, which include that MA plans provide less financial protection to Medicare enrollees than they have in the past, and average out of pocket spending limits have continued to rise, “exposing enrollees with significant medical needs to higher costs.”