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2021 Medicare Part D Plans in NYS

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Posted: 16 Sep, 2011
by Valerie Bogart (New York Legal Assistance Group)
Updated: 17 Oct, 2020
by Valerie Bogart (New York Legal Assistance Group)

The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2021 runs from October 15 through December 7, 2020.    Every year, you should review your plan  options to see if your current plan still meets your needs - see more here what to  look for in the CMS Planfinder.  

2021 Part D and Medicare Advantage plans announced here by CMS.  

  1.  Stand Alone Part D (PDP) - 28 Plans in New York State for people in Original Medicare.  Chart shows "star ratings" from 2020,  the number of New Yorkers enrolled in plan in 2020, the 2021 premium and deductible.     SEVEN  of the 28 plans are "benchmark" plans that have a ZERO premium for people with Extra Help subsidy.  See other changes in PDP's since 2020 here 

  2.  Medicare Advantage (MA) Plans (MA-PD) offered in NYS -  Includes a column D noting  which 2020 plans are closing with members being "crosswalked" to a different plan, and which plans are closing with no "crosswalk."  Source is CMS Crosswalk for 2021 and q1Medicare.com.  Also shows which plans offering $35 insulin under new Savings program.   Members of closing MA-PD  plans with no "crosswalk" who have Extra Help will be reassigned to a stand-alone PDP unless they select a different plan, under same procedure described here for  members with Extra Help in PDPs that are closing.  See list of closing MA-PD plans, also marked on the chart

  3. Separate list of NYS Special Needs Plans. (SNP) - changes described here

The lists posted here are extracted from nationwide charts on the CMS website at  http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/.    Sanctioned plans are also available at that link. 

BENCHMARK Plans - Free for Medicaid, MSP Recipients & Others with Extra Help

Download Chart of SEVEN  BENCHMARK STAND-ALONE PDP PLANS with a FREE PREMIUM for people with FULL "EXTRA HELP" (Low Income Subsidy)   All of the benchmark plans in 2021 were benchmark in 2020 - there are no new benchmark plans.  However 2 plans that WERE benchmark in 2020 are closing.  See more on closing plans below.  

  • Benchmark plans are "Basic" Part D plans with premiums below the benchmark amount, which is  $42.27 in 2021.

  • "Enhanced" Part D plans cannot be "benchmark" plans even if their premium is below the benchmark amount. In an enhanced plan, the premium is subsidized for people with Extra Help but not always fully.  See this article.

  • People with Extra Help, such as people newly approved for Medicaid or a Medicare Savings Program, will be assigned to one of these SEVEN Plans if they don't pick their own plan. They can pick a plan that is not one of the 7 benchmark plans, but they'll be charged the difference between the benchmark premium of $42.27 and the plan's full premium listed on the chart of stand-alone Prescription Drug Plans.  For those with Full Extra Help, the BASIC Part D premium is subsidized up to $42.27  (the benchmark rate in 2021).  None of the Enhanced Part C premium is subsidized.

  • Here are the 7 benchmark plans, which were all  benchmark plans in 2020:

  1. Aetna Medicare Rx Saver (PDP) is now WellCare Medicare Saver Rx (PDP) 
  2. Cigna-Healthspring Rx Secure (PDP)
  3. Express Scripts Medicare - Value (PDP)
  4. Humana Basic Rx Plan (PDP) (formerly Humana Preferred Rx plan (PDP))
  5. SilverScript Choice (PDP) 
  6. WellCare Classic (PDP)
  7. EnvisionRxPlus (PDP) 

NYS Plan Changes from 2021 -

NEW in 2021 - $35 INSULIN CAP - Some PDPs, Medicare Advantage Plans, and SNPs offer the new Senior Savings Plan - which caps insulin costs at $35 - both in the deductible period and later.  BE AWARE that the individual may need to change the brand of insulin (only certain drug manufacturers participate in the program - Sanofi-Aventis, Novo Nordisk,  and Eli Lilly; see list of Model drugs (PDF) (check for updates).    The lists of PDPs and Medicare Advantage plans posted in this article have a COLUMN showing if the plan is in this program, which is obtained from CMS here

  • Only ENHANCED plans may offer this benefit, which means none of the BENCHMARK plans that are free for those with Extra Help offer them.  But anyone with Extra Help should have insulin costs capped at the Extra Help copays.  

 28 Stand-alone PDP plans - changes in 2021

  • FOUR plans are new: 

    • THREE  "Blue Rx" plans sponsored by BlueCross BlueShield: Empire-Excellus-WNY&NEN  

    • SilverScript SmartRx (sponsored by Aetna).  

  • NAME CHANGE:   EnvisionRx plans are now "Elixir" plans. 

  • THREE 2020 plans are closing.  In addition to the TWO formerly benchmark plans described above that are closing, a third plan is closing - 2020 Journey Rx Value.  

  • The maximum annual Part D deductible in 2021  is $445
    • 17 of the 28 NYS plans charge the maximum  $445 or $440. 
    •   4 plans charge NO deductible.   The lowest premium with a  a plan with a ZERO deductible is Blue Rx. Plus Plan ($72.70 premium)
    •   7 plans have deductibles ranging from $100 to $325.
    • People with Extra Help subsidy have no deductible even if plan normally charges one.  
  • The highest premium in NYS is $94.80/mo (AARP MedicareRx Preferred, an enhanced plan that is the 2nd most popular PDP plan in NYS with 147,264 enrollees in 2020 - it has no annual deductible).

    • The lowest premium in NYS is $7.30/month  - with SilverScript SmartRx (Aetna)(this  new "enhanced" plan charges the maximum deductible of $445) 
    • The average premium is $45.03 and the median is $37.70.  
    • People with Extra Help get a credit of $42.27 toward their monthly premium for any "Basic" plan, and a credit in varying amounts up to $42.27 for any Enhanced plan. 

  • Plans with highest enrollment in 2020 are:
    1. SilverScript Choice (220,587 members)($35 premium, $290 deductible)(BENCHMARK PLAN**) 
    2. AARP MedicareRx Preferred (147,264 enrollees)($94.80 premium, $0  deductible). 
    3. Cigna Secure Rx (75,307)($38.30 premium,  $445 deductible)(BENCHMARK PLAN**)
  • ** BENCHMARK plans have a $0 premium and $0 deductible for those with Full Extra Help

PLAN CLOSINGS in 2021 - Who is Reassigned and Who must Pick a New Plan?

A.  3 PDPs are closing in 2021, of which TWO  were benchmark plans in 2020  :

  • TWO closing BENCHMARK PLANS - so more people with Extra Help enrolled in these:
  1. Magellan Rx Medicare Basic (PDP)(had 31,176 NYS members in 2020) 
  2. Journey Rx Standard (PDP) from MII Life Insurance, Inc. (had 7,164 NYS members in 2020)

3.  3rd closing plan not benchmark - 2020 Journey Rx Value (fewer Extra Help members enrolled)

  • Members of all 3  closing plans who have Extra Help will be randomly reassigned to a different Part D "benchmark" plan  effective Jan. 1, 2021 if they do not select their own plan before late December.  This includes including those who have Medicaid or an MSP.  Members of Medicare Advantage plans that are closing, where the plan is not being crosswalked to or consolidated with another plan, also will be reassigned to a PDP (not a Medicare Advantage plan) with the same series of notices. See list of MA-PDs that are closing in NYS here. 

  • October 2020 - They will receive notice from their plan and  from CMS (blue notice No. 11208)  that plan is closing and that they should select a different plan.  

  • December 2020 - CMS will send them  a second BLUE notice  No. 11496 that  specifies which benchmark plan they will be assigned to if they do not select one themselves.  This notice lists all prescription drugs they took from Jan – Aug 2020 and states whether these drugs will be covered by the randomly assigned plan. 

The notice also explains that hey will be able to change plans between Dec. 7 - Dec. 31, 2020  using a "Special Enrollment Period"  or "SEP" for people whose Part D plan is closing.  Additionally, because they have Extra Help, they can change plans once in the first quarter of 2021.   See complete chart of "SEP"s by Medicare Rights Center. 

  • TIP:  Since they are RANDOMLY reassigned, it is important for them to select a plan that meets their needs - their drugs are on the plan's formulary and within any quantity limits or other restrictions, and their preferred pharmacy is in the plan's preferred network.  

  • Members of these 3 closing plans who do NOT have Extra Help --
  • also receive notices from the plan and CMS (Notice  No. 11438telling them they need to pick a different plan for 2021, but they are not reassigned to a plan if they do not pick one. 
  • If they do not choose a new plan to start Jan. 1, 2021, they will receive a  CMS Non-Renewal Action Notice  No. 11452 in January 2021 reminding  them that they have a Special Enrollment Period ending February 28, 2021 to join a plan - because their plan closed. 

B.  Medicare Advantage-Prescription Drug  Plans - (MA-PD)  - changes List of Plans NYS

  • There are so many plans, many sponsored by the same insurance company, making it hard to compare.  Albany County, for example has 72 MA plans, and Manhattan has 105 plans, including Special Needs Plans for Dual Eligibles, people in Nursing Homes, and other subgroups.  Many plans operate only in certain counties.   This site has plan info by county. 

  • Like the stand alone PDPs, the maximum annual drug deductible is $445 in 2021.  Medicare Advantage plans have a "MOOP"  or Maximum Out-of-Pocket (MOOP) limit on enrollee spending that includes costs for all in-network Part A and Part B Services (but does  not limit Part D costs)($7550 in 2021 - some plans have lower MOOP limit)

MA-PD Plans CLOSING in 2021 - (see complete list MA-PD plans 2021 here)

Some plans are closing altogether.  Others are just changing their ID number or their members are being "crosswalked" to a similar plan in the same company.  See crosswalked plans below.  Members of CLOSING plans who have  Extra Help will be reassigned but to a Stand-Alone PDP, not to another Medicare Advantage plan, using same procedures as for PDPs that are closing - see here.  Members without Extra Help will NOT be reassigned but will have a SEP in case they don't enroll by Dec. 7th - the SEP is from Dec. 8th - Feb. 28th, 2021

  • Bright Advantage Choice (HMO)(in NYC) - closing

  • Empire MediBlue Plus H8432-013 (HMO) closing in Manhattan only, in other counties being crosswalked

  • HumanaChoice H5970-023 (PPO) and H5970-022 (PPO) closing (NYC, Long Island)(note  a different Humana Choice plan with ID 021 is not closing - members being crosswalked)

  • Humana Gold Plus  H3533-023 (HMO)(closing in NYC, Nassau & Suffolk  counties)

  • Humana Gold Plus H3533-030 (HMO) closing in BRONX 

  • Sunrise Advantage Community Plan (HMO) is closing 

MA-PD Plans with Members "crosswalked" to a different plan, usually plan of the same name with a different ID number (but sometimes new name).   See CMS crosswalk chart

  • Empire MediBlue Plus (HMO) H8432-017 - crosswalked to same plan name  H8432-38 (various upstate counties - see chart)

  • Empire MediBlue Core (HMO) H8432-012 - crosswalked to H8432-037-1 (NYC, Westchester, Saratoga)

  • Fidelis - Fidelis Medicare $0 Premium (HMO) and Fidelis Medicare Advantage Flex (HMO-POS) are changing ID numbers, and changing from BASIC plans to ENHANCED plans  with the change from the "Fidelis Legacy Plan" to new ownership as Fidelis Plan (now owned by Centene).  

  • Humana Gold Plus

    • H3533-021  (HMO) members will be crosswalked to Humana Gold Plus H8533-032 (NYC)

    • H3533-020 (HMO) members will be crosswalked to same plan H3533-001 (Broome, Chemung, Steuben, Tioga)

    • H3533-021 (HMO) members will be crosswalked to same plan H3533-32 (NYC) 

  • HumanaChoice H5970-021 - members crosswalked to Humana Choice H5970-024 (NYC, Nassau, Suffolk)

  • WellCare Choice (HMO) H4868-21 crosswalked to same plan  ID H4868-020 (NYC except Bronx)

  • Wellcare Rx (HMO) is being crosswalked to and consolidated with  Wellcare Compass H4868-16 (NYC - combined 6600 members) - new name COMPASS

MA-PD - NEW PLANS 

  • Aetna Medicare Credit Plan (PPO) and Aetna Medicare Eagle Plan (PPO) - BOTH are NEW PLANS 

  • EmblemHealth VIP Reserve (HMO) - NEW PLAN

  • Empire MediBlue HealthPlus (HMO)  new plan

  • Healthfirst Signature (HMO) - NEW plan in NYC, Nassau, Westchester 

  • HumanaChoice H5970-024 (PPO) is opening (NYC, Nassau, Suffolk)  

  • Humana Gold Plus H3533-001 (HMO) is opening in many upstate counties see list

  • Wellcare Absolute PPO, Wellcare Summit PPO (both new plans are in NYC and many upstate counties) 

Look carefully at copays or coinsurance amounts  for  drugs and services.  Though a plan may have a low premium or deductible, the coinsurance for hospital inpatient stays, Skilled Nursing Facility stays, chemotherapy and other services may be high.    See NCOA - Choosing Medicare Part D plans + Original Medicare  vs. Medicare Advantage

SPECIAL NEEDS PLANS (SNP) - Changes in 2021

  • SNP's CLOSED IN 2021:  (this varies by county) - see Chart of SNPs - filter by COUNTY column
    • ArchCare Community Choice (HMO D-SNP)(NYC, 5 other counties)
    • CenterLight Healthcare Direct Complete Plan (HMO I-SNP)(NYC, Westchester, Nassau)

    • Centers Plan for Nursing Home Care (HMO I-SNP) (Monroe County)??

    • Health Pointe Direct Complete Plan (HMO I-SNP) (NYC, Westchester, Nassau)

    • Sunrise Advantage Plan - Reflections C-SNP and HMO I-SNP (Nassau and Suffolk)

  • NEW SNP PLANS: (note this varies by county)
    • Aetna Medicare Assure Plan (HMO-D-SNP) - in NYC and most counties
    • EmblemHealth new plans --
      • VIP Dual-HMO-SNP (NYC + 10 counties),  
      • EmblemHealth VIP Dual Select (HMO D-SNP) (new in 3 upstate counties),
      • EmblemHealth VIP Solutions (HMO D-SNP)(new in NYC and 10 upstate counties)
    • Empire  MediBlue new plans - (NYC, Long Island, Hudson Valley only)
      • Empire MediBlue HealthPlus Dual Advantage (HMO D-SNP),  
      • Empire MediBlue HealthPlus Dual Connect (HMO D-SNP), 
      • Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)
    • Hamaspik - (NYC & Hudson Valley)
      • Hamaspik Medicare Choice (HMO D-SNP), 
      • Hamaspik Medicare Choice Select (HMO D-SNP)
  • Integra Balanced Medicaid Advantage (HMO D-SNP)(NYC & Nassau only)
  • UnitedHealthcare Dual Complete and Dual Complete One (HMO D-SNP)(expanded to more counties upstate)
  • WellCare Imperial (PPO D-SNP)(NYC and most of state)
  • New Plans In NYC only: 
    • MetroPlus UltraCare (HMO D-SNP)
    • EmblemHealth VIP Dual Reserve (HMO-D-SNP)
    • Centers Plan for Medicaid Advantage (HMO D-SNP)
    • Bright Advantage Senior Savings (HMO C-SNP)

EPIC REMINDER:

Reminder:  EPIC - NYS Drug insurance subsidy for people age 65+ -- does not provide coverage during the Part D deductible phase. EPIC members without Extra Help will want to try to find Part D plans with no deductible, if possible.

 In 2021,  EPIC will pay the premium up to $42.27/month for people in the EPIC FEE plan, and will credit EPIC deductible members $42.27/ month ($507.24/year) toward their annual EPIC deductible. For more on EPIC see this article and go to EPIC's website.

Helpful information about 2021 Medicare Part D -

Attached files
item 2021 NYS Special Needs Plan Landscape with insulin.xls (466 kb) Download
item Benchmark Plans 2020-2021 Comparison.2.pdf (215 kb) Download
item 2021 NYS PDP stand-alone plans.3.xlsx (85 kb) Download

Also read
item Medicare Part D - Overview
item CMS Prescription Drug Benefit Manual
item Pathways to Extra Help - the Part D low income subsidy and how it can help your clients
item The Medicare planfinder tool: get (almost) all the info you'll ever need to help you pick the best possible prescription drug plan

Also listed in
folder Medicare Part D -> What drugs are covered?

External links
http://www.wnylc.com/health/client/images/icons/article_out.svg http://www.cms.gov/PrescriptionDrugCovGenIn/Downloads/MA_SNP_Source2012.zip

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Selecting a drug plan       2020 Medicare Part D Plans in NYS


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