November 2019 | Issue Brief
Medicare Part D: A First Look at Prescription
Drug Plans in 2020
Juliette Cubanski and Anthony Damico
During the Medicare open enrollment period from October 15 to December 7 each year, beneficiaries can
enroll in a plan that provides Part D drug coverage, either a stand-alone prescription drug plan (PDP) as a
supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which
covers all Medicare benefits, including drugs. Among the 45 million Part D enrollees in 2019, 20.6 million
(46%) are in PDPs (excluding employer-only group PDPs). This issue brief provides an overview of PDPs
that will be available in 2020 and highlights key changes from prior years.
Key Findings
The average Medicare beneficiary will have a choice of 28 PDPs in 2020, one more PDP option than in
2019, and six more than in 2017, a 29% increase. A total of 948 PDPs will be offered in the 34 PDP
regions in 2020 (plus another 11 PDPs in the territories), an increase of 202 PDPs since 2017.
PDP premiums will vary widely across plans in 2020, as in previous years (Figure 1). Among the 20
PDPs available nationwide, average premiums will range sixfold from a low of $13 per month for
Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts Medicare Choice.
Two-thirds of Part D enrollees without low-income subsidies (9.0 million enrollees) will see their
monthly premium increase in 2020 if they stay in their same plan, while one-third (4.3 million) face
premium decreases. As an example, the 1.9 million enrollees without low-income subsidies in the
Humana Walmart Rx Plan, the third most popular PDP in 2019, will see their monthly premium double
$13
$14
$16
$17
$21
$22
$25
$29
$29
$30
$31
$31
$32
$34
$36
$42
$57
$57
$72
$79
$83
Humana Walmart Value Rx Plan^
WellCare Wellness Rx^
EnvisionRxPlus
WellCare Value Script
WellCare Medicare Rx Select
Cigna-HealthSpring Rx Secure-Essential
Express Scripts Medicare Saver
SilverScript Choice
WellCare Classic
Cigna-HealthSpring Rx Secure
Humana Basic Rx Plan
WellCare Medicare Rx Saver
AARP MedicareRx Saver Plus
AARP MedicareRx Walgreens
Express Scripts Medicare Value
National PDP average*
Cigna-HealthSpring Rx Secure-Extra
Humana Premier Rx Plan
WellCare Medicare Rx Value Plus
AARP MedicareRx Preferred
Express Scripts Medicare Choice
NOTES: PDP is prescription drug plan. Estimates are weighted by September 2019 enrollment; assume current PDP enrollees remain in their same
plan; and make no assumptions about plan choices by new enrollees for 2020. ^Reflects unweighted median because PDP is new for 2020. *National
average includes premiums for basic and enhanced PDPs.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Average Monthly Premiums for the 20 National Part D Stand-alone
PDPs Are Projected to Range Sixfold from $13 to $83 in 2020
Figure 1
Medicare Part D: A First Look at Prescription Drug Plans in 2020 2
in 2020, from $28 to $57, unless they switch plans. This is due to plan changes and consolidations,
with Humana consolidating two of its PDPs (Humana Walmart Rx and Humana Enhanced) into one
PDP for 2020 and renaming it Humana Premier Rx, with a $57 monthly premium.
The estimated national average monthly PDP premium for 2020 is projected to increase by 7% to
$42.05, weighted by September 2019 enrollment. The actual average premium in 2020 may be lower if
current enrollees switch to, and new enrollees choose, lower-premium plans during open enrollment.
In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and
specialty drugs, and cost sharing other than the standard 25% coinsurance, similar to 2019. More than
eight in 10 PDPs (86%) will charge a deductible, with most PDPs charging the standard deductible of
$435 in 2020.
Among all PDPs, median cost sharing is $0 for preferred generics and just $3 for generics, but $42 for
preferred brands and 38% coinsurance for non-preferred drugs (the maximum allowed is 50%), plus
25% for specialty drugs (the maximum allowed is 33%).
Medicare beneficiaries receiving the Low-Income Subsidy (LIS) will have a choice of seven premium-
free PDPs in 2020, on average, one more than in 2019. In 2020, nearly 20% of all LIS PDP enrollees
who are eligible for premium-free Part D coverage (1.3 million LIS enrollees) will pay Part D premiums
averaging $18 per month unless they switch or are reassigned by CMS to premium-free plans.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 3
Findings
Part D Plan Availability
A larger number of Part D plans will be offered in 2020 than in recent years.
The average beneficiary will have a choice of 28 PDPs in 2020, one more PDP option than in 2019 and
six more than in 2017 (a 29% increase) (Figure 2). Although the number of PDP options in 2020 is half
of what it was at the peak in 2007 (when there were 56 PDP options, on average), this is the third year
in a row with an increase in the average number of stand-alone drug plan options. In 2020,
beneficiaries will also have access to 24 MA-PDs, on average, a 44% increase in MA-PD options since
2017 (excluding MA plans that do not offer the drug benefit; overall, an average of 28 MA plan options
will be available in 2020).
A total of 948 PDPs will be offered in the 34 PDP regions in 2020 (plus another 11 PDPs in the
territories), an increase of 47 PDPs (5%) over 2019, and 202 more PDPs (a 27% increase) since 2017
(Figure 3).
This increase is primarily due to the elimination of the “meaningful difference” requirement for
enhanced benefit PDPs offered by the same organization in the same region. Eliminating this
requirement means that PDP sponsors no longer have to demonstrate that their enhanced PDPs
offered in the same region are meaningfully different in terms of enrollee out-of-pocket costs. In 2020,
60% of PDPs (566 plans) will offer enhanced Part D benefits—a 46% increase in the availability of
enhanced-benefit PDPs since 2017, when just over half of PDPs (387 plans) offered enhanced
benefits.
The number of PDPs per region in 2020 will range from 24 PDPs in Alaska to 32 PDPs in California,
and will be the same or higher in 32 of the 34 PDP regions compared to 2019 (see map; Table 1).
56
55
50
47
30
31
31
35
29
26
22
23
27
28
16
26
26
21
14
15
15
15
15
17
17
18
21
24
0
10
20
30
40
50
60
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Stand-alone PDPs MA-PDs
NOTES: PDP is prescription drug plan. MA-PD is Medicare Advantage drug plan. Plan counts are beneficiary weighted. Number of PDPs is reported
at the region level; number of MA-PD plans is reported at the county level and excludes Special Needs Plans and MA plans without drug coverage.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2007-2020 Part D plan files.
The Average Medicare Beneficiary Has a Choice of 28 Stand-alone
Drug Plans and 24 Medicare Advantage Drug Plans in 2020
Figure 2
Medicare Part D: A First Look at Prescription Drug Plans in 2020 4
In 2020, nearly nine out of 10 PDP enrollees (88%) are projected to be in PDPs operated by five firms:
UnitedHealth, Humana, WellCare, CVS Health, and Cigna (based on PDP enrollment as of September
2019). All five firms offer PDPs in all 34 PDP regions in 2020.
Premiums
NATIONAL PREMIUM TRENDS
The estimated national average monthly PDP premium is expected to increase by 7% to $42 in 2020.
The estimated average monthly PDP premium for 2020 is projected to be $42.05, weighted by
September 2019 enrollment (Figure 4). The 2020 premium estimate represents a 7% increase ($2.92)
from the weighted average monthly premium of $39.13 in 2019. It is likely that the actual average
1,429
1,866
1,824
1,687
1,576
1,007
1,041
1,031
1,169
1,001
886
746
782
901
948
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
NOTES: Excludes PDPs in the territories (n=11 in 2020).
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2006-2020 Part D plan files.
A Total of 948 Medicare Part D Stand-alone Drug Plans Will Be
Offered in 2020, a 27% Increase in Plan Availability Since 2017
Figure 3
NOTES: PDP is prescription drug plan.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2020 PDP landscape source file.
Medicare Part D Stand-alone Prescription Drug Plans in 2020
24-26 (12 states)
Number of PDPs
27-28 (20 states & DC)
29-30 (14 states)
31-32 (4 states)
Medicare Part D: A First Look at Prescription Drug Plans in 2020 5
weighted premium for 2020, after taking into account enrollment choices by new enrollees and plan
changes by current enrollees, will be somewhat lower than the estimated average.
Since 2006, the first year of the Medicare Part D drug benefit, the weighted average monthly premium
for PDPs has increased by 62%, but much of the increase occurred between 2006 and 2011; since
then, the average monthly premium has been relatively stable, between $37 and $41.
Two-thirds of the 13.3 million Part D PDP enrollees who are responsible for paying the entire premium
(which excludes Low-Income Subsidy (LIS) recipients) (67%, or 9.0 million enrollees) will see their
monthly premium increase if they remain in their current plan in 2020, while one-third (32%, or 4.3
million enrollees) will see a premium reduction if they stay in the same plan (Figure 5). Twenty percent
of non-LIS enrollees, or 2.7 million enrollees, will see a premium increase of $10 or more per month;
0.9 million non-LIS enrollees (7%) will see a premium reduction of the same magnitude.
7%
1%
25%
0.2% no change
34%
13%
20%
NOTES: PDP is prescription drug plan. Estimates assume current PDP enrollees remain in their same plan and makes no assumptions about plan
choices by new enrollees.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Two-thirds of Part D Stand-alone Drug Plan Enrollees Without Low-
income Subsidies Face Premium Increases If They Stay in Their
Current Plan in 2020
Figure 5
Monthly premium increases
Increase of $10 or more
Total Non-LIS Enrollment in PDPs in 2019 = 13.3 million
Increase of $5 to $9.99
Increase of less than $5
Monthly premium decreases
Decrease of $10 or more
Decrease of $5 to $9.99
Decrease of less than $5
$25.90
$27.27
$29.96
$34.81
$37.01
$37.98
$37.67
$38.41
$37.52
$37.02
$39.04
$40.42
$41.24
$39.13
$42.05
$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
NOTES: PDP is prescription drug plan. 2019 and 2020 estimates are weighted by September 2019 enrollment; all other years are weighted by March
enrollment in each year. Includes premiums for both basic and enhanced PDPs but not MA-PD plans. 2020 estimate assumes current PDP enrollees
remain in their same plan and makes no assumptions about plan choices by new enrollees.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2006-2020 Part D plan files.
The Estimated Average Monthly Premium for Medicare PDPs Is Projected
to Increase by 7% to $42 in 2020, Based on Current Enrollment
Figure 4
Medicare Part D: A First Look at Prescription Drug Plans in 2020 6
About three in 10 (29%) non-LIS enrollees (3.8 million) are projected to pay monthly premiums of at
least $60 if they stay in their current plans. More than 215,000 (2% of non-LIS enrollees) are projected
to pay monthly premiums of at least $100.
CMS reported that the average premium for basic Part D coverage offered by PDPs and MA-PDs will
be an estimated $30 in 2020. Our premium estimate is higher because it is based on PDPs only and
includes PDPs offering both basic and enhanced coverage (enhanced plans have higher premiums
than basic plans, on average). In contrast, the CMS estimate includes MA-PDs and excludes plans
offering enhanced coverage. In addition, our premium estimates are weighted based on current
enrollment and do not incorporate any assumptions about plan changes by current enrollees,
reassignment of Low-Income Subsidy enrollees by CMS, or plan choices by new enrollees.
In prior years, the average premium that we have calculated after taking into account enrollment
changes made during the open enrollment period and subsequent months has been somewhat lower
than our projection based on current enrollment. For example, the weighted average premium
calculated in September 2019 was $39.13, 5% ($2.08) below the projected premium for 2019 of $41.21
calculated prior to enrollment changes. The reduction is due to current enrollees switching to lower
premium plans, new enrollees choosing low-premium plans, and reassignment of some LIS
beneficiaries to lower-premium plans.
PREMIUM VARIATION AND CHANGES FOR NATIONAL PDPS
PDP premiums will continue to vary widely across plans in 2020, as in previous years.
Among the 20 PDPs available nationwide in 2020, average premiums will range sixfold, from a low of
$13 per month for Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts
Medicare Choice (Figure 1; Table 2).
Changes to premiums from 2019 to 2020, averaged across regions and weighted by September 2019
enrollment, also vary widely across PDPs, as do the absolute amounts of monthly premiums for 2020.
The 2.1 million non-LIS enrollees in the largest PDP, CVS Health’s SilverScript Choice (which had a
total of 4.4 million enrollees in 2019, including those receiving low-income subsidies) will face a $2
(7%) decrease in their average monthly premium, from $31 in 2019 to $29 in 2020.
In contrast, the 2.0 million non-LIS enrollees in the second largest PDP, AARP MedicareRx Preferred,
will face a $4 (6%) increase in their average monthly premium between 2019 and 2020, from $75 to
$79. This is the second highest monthly premium among the national PDPs in 2020.
Plan changes and consolidations will affect the premiums paid by many current enrollees in Humana’s
PDPs. For 2020, Humana is consolidating two of its PDPs (Humana Walmart Rx and Humana
Enhanced) into one PDP and renaming it Humana Premier Rx. It is also renaming Humana Preferred
Rx to Humana Basic Rx, and introducing an entirely new PDP, Humana Walmart Value Rx Plan.
o The weighted average monthly premium for Humana Premier Rx will be $57 in 2020. For the 1.9
million non-LIS enrollees in the Humana Walmart Rx plan (the third most popular PDP in 2019) who
will be automatically enrolled in Humana Premier Rx, the monthly premium will more than double,
from $28 to $57, if they do not switch plans for 2020 (Figure 6). Beneficiaries enrolled in Humana
Medicare Part D: A First Look at Prescription Drug Plans in 2020 7
Walmart Rx in 2019 will not be automatically enrolled in the new Humana Walmart Value Rx plan,
which has a substantially lower premium ($13 per month); they will have to switch during the open
enrollment period if they want this lower-premium plan option.
o Conversely, the 0.6 million non-LIS enrollees in Humana Enhanced who will also be enrolled
automatically in the consolidated plan, will see a 25% reduction in their monthly premium, from $76
to $57, if they remain enrolled in the Humana Premier Rx Plan for 2020.
PREMIUM VARIATION BY REGION
Average PDP monthly premiums for 2020 will vary across the 34 PDP regions, from $33 in Hawaii to $49
in New Jersey (see map; Table 1).
$28
$76
$57 $57
NOTES: PDP is prescription drug plan.
1
Enrollment as of September 2019; includes enrollees with and without low-income subsidies; 2019 premiums
are weighted by September 2019 enrollment.
2
2020 enrollment estimate assumes current Humana PDP enrollees do not switch plans and does not
incorporate new enrollees; 2020 premium estimate is weighted by September 2019 enrollment.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
More Than 2.6 Million Humana PDP Enrollees Will Be Affected by Plan Changes
for 2020, with a Large Premium Increase for Many Unless They Switch Plans
Figure 6
Humana
Enhanced
0.7 million
Humana
Walmart Rx
Plan
2.0 million
Humana
Premier Rx
Plan
2.6 million
2019 enrollment
1
2020 enrollment
2
Humana
Walmart
Monthly premiums in 2019
1
and 2020
2
Humana
Enhanced
Humana
Premier
Rx
Humana
Premier
Rx
2019
2020
2020
2019
NOTES: PDP is prescription drug plan. Premium estimates are weighted by September 2019 enrollment.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Medicare Part D Stand-alone Prescription Drug Plan
Weighted Average Monthly Premiums in 2020
$38.59-$40.96 (20 states)
$41.33-$43.32 (18 states)
$44.54-$49.10 (7 states)
Weighted average
premiums
$33.97-$37.84 (5 states & DC)
Medicare Part D: A First Look at Prescription Drug Plans in 2020 8
All 34 PDP regions have at least one PDP with a premium under $20. For example, the new Humana
Walmart Value Rx Plan is available in all regions with a monthly premium of $13.20, while the new
WellCare Wellness Rx PDP is available nationwide with premiums ranging from $13.10 to $15.70. At
the high end, seven PDPs, with a total of 100,000 enrollees in 2019 (less than 1% of total PDP
enrollment), have monthly premiums of at least $125. The highest is $191.40 for BlueCross Rx Plus
PDP, which is offered in the South Carolina region.
Average premiums are projected to be higher in 33 out of 34 regions, increasing by between $1 and $6
in 32 out of 34 regions. In California, the average premium will decrease by less than $1 from the 2019
average, while in Virginia, the average premium will increase by less than $1 from the 2019 average.
Benefit Design and Cost Sharing
In 2020, all PDPs will offer an alternative benefit design, different from the defined standard benefit, which
has a $435 deductible (an increase from $415 in 2019) and 25% coinsurance for all covered drugs
between the deductible and the initial coverage limit. Part D plans can also provide enhanced benefits,
including a lower (or no) deductible, reduced cost sharing, and/or a higher initial coverage limit than under
the standard benefit design.
In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and
specialty drugs and cost sharing other than the standard 25% coinsurance. As of 2020, Part D enrollees
will no longer be exposed to a coverage gap, sometimes called the “doughnut hole,” when they fill their
prescriptions; coinsurance in the coverage gap phase will be 25% for both brands and generics.
BASIC VERSUS ENHANCED BENEFITS
In 2020, 60% of PDPs, or 566 plans (excluding plans in the territories), will offer enhanced benefits, an
increase in the number of enhanced-benefit PDPs compared to prior years (Table 3). As noted earlier,
this increase is a response by Part D plan sponsors to the elimination of the requirement to
demonstrate a “meaningful difference” (measured by enrollee out-of-pocket costs) between enhanced
plans offered by the same firm in the same region. The overall share of PDPs offering basic Part D
benefits in 2020 is roughly the same as in 2019 (40%), but the number of basic-benefit plans in 2020
will be higher than in 2019 (382 vs. 348). As in recent years, no plans will offer the defined standard
benefit.
The average premium in 2020 for enhanced benefit PDPs ($57) is 85% higher than the monthly
premium for PDPs offering the basic benefit ($31) (weighted by September 2019 enrollment).
DEDUCTIBLES
The number and share of PDPs that charge a deductible is increasing, from 71% in 2019 to 86% in
2020 (Table 3). A larger share of PDPs (69%) will charge the standard deductible in 2020 than in 2019
(52%). The standard deductible amount is $435 in 2020; the average deductible is increasing by nearly
$100 between 2019 and 2020, from $238 to $335 (weighted by September 2019 enrollment).
There are some notable changes in deductibles among the national PDPs for 2020.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 9
o In 2020, only two of the 20 national plans will charge no deductible in all regions (AARP MedicareRx
Preferred and WellCare Medicare Rx Value Plus), down from five national PDPs that charged no
deductible in all or most regions in 2019.
o Enrollees in SilverScript Choice paid no deductible in 28 out of 34 regions in 2019, but in 2020,
enrollees in this plan will pay deductibles ranging by region from $215 to $435 (the maximum
deductible amount).
o Enrollees in Humana Enhanced paid no deductible in 2019, but those who remain in the new
Humana Premier Rx plan in 2020 will be charged the standard $435 deductible in 33 out of 34
regions.
o In contrast to these increases, enrollees in Express Scripts Medicare Choice will see a reduction in
their deductible, from $350 in 2019 to $250 in 2020.
The average premium in 2020 for PDPs that charge no deductible ($81) is more than double the
monthly premium for PDPs that charge the standard deductible ($36) or a partial deductible ($32)
(weighted by September 2019 enrollment).
COST SHARING
As in recent years, all PDPs in 2020 will use tiered cost sharing. The typical five-tier design includes
tiers for preferred generics, generics, preferred brands, non-preferred drugs (which includes both
brands and generics), and specialty drugs. Five-tier formularies have been the most common type
since 2013. Part D enrollees will face modest cost-sharing amounts for generic drugs in 2020 but much
higher cost sharing for brands and non-preferred drugs, and a mix of copayments and coinsurance for
different formulary tiers (Figure 7).
Overall, PDP cost-sharing amounts in 2020 are relatively similar to 2019 levels (Table 4). For generic
tiers, median copayments across all PDPs are $0 for the preferred generic tier and $3 for the generic
tier in 2020.
$5
$10
$47
50%
33%
$0
$1
$25
32%
25%
$0
$3
$42
38%
25%
Preferred
generics
Generics Preferred
brands
Non-preferred
drugs
Specialty
Highest cost sharing amount
among national PDPs
Lowest cost sharing amount
among national PDPs
Median for all PDPs
NOTES: PDP is prescription drug plan. Estimates are weighted medians based on September 2019 enrollment.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2020 Part D plan files.
Part D Enrollees Will Pay Low Copays for Generic Drugs in 2020, But Much
Higher Amounts for Brands and Non-preferred Drugs, and a Mix of Copays and
Coinsurance for Different Formulary Tiers
Figure 7
Medicare Part D: A First Look at Prescription Drug Plans in 2020 10
o Nine of the 20 national PDPs, including the largest PDP (SilverScript Choice), have a $0 copayment
for preferred generic drugs in 2020. Median copayments for generics range from $1 to $10 among
the 20 national PDPs; most charge $5 or less for generics.
Most PDPs charge copayments for preferred brand tiers, but nearly one in 10 PDP enrollees (9%) will
be in plans that charge coinsurance in 2020 (based on September 2019 enrollment). For preferred
brand tiers, the median copayment in 2020 is $42; the median coinsurance rate is 25%.
o Of the 18 national PDPs that charge copayments for preferred brands, the amounts range from $25
to $47; 11 of these 18 PDPs charge $40 or more, including four that charge $47 (Humana Walmart
Value Rx Plan. SilverScript Choice, WellCare Medicare Rx Select, and WellCare Medicare Rx Value
Plus).
Virtually all PDPs are using coinsurance for the non-preferred drug tier in 2020. The median
coinsurance PDPs charge for non-preferred drugs in 2020 is 38%.
o Among the 20 national PDPs, coinsurance for non-preferred drugs in 2020 varies from 32% (AARP
MedicareRx Walgreens) to 50% (Cigna-HealthSpring Rx Secure-Extra), the maximum allowed for
this tier by CMS guidelines (which is higher than the maximum coinsurance allowed for specialty
drugs). Half of the national PDPs (10) charge 40% or more for non-preferred drugs.
Specialty tier coinsurance ranges from 25% to 33% for all PDPs, the maximum allowed by CMS
guidelines. Most (15) of the national PDPs charge 25% for specialty tier drugs in 2020; two charge
33%. In 2020, the threshold for drugs to qualify for placement on a specialty tier is $670 for a one-
month supply of the drug, the same amount since 2017.
Low-income Subsidy (Benchmark) Plans
In 2020, a larger number of PDPs will be premium-free benchmark plans—that is, PDPs available for no
monthly premium to beneficiaries receiving the Low-Income Subsidy (LIS)—than in recent years.
On average (weighted by Medicare enrollment), LIS beneficiaries have seven benchmark plans
available to them for 2020, or one-fourth the average number of PDP choices available overall. All LIS
enrollees can select any plan offered in their area, but if they enroll in a non-benchmark plan, they must
pay some portion of their chosen plan’s monthly premium.
In 2020, a total of 244 PDPs will be premium-free benchmark plans. This number represents roughly a
quarter of all PDPs in 2020. The number of benchmark plans in 2020 is 29 more than in 2019 (a 13%
increase) and the largest number of benchmark plans available to LIS enrollees since 2015 (Figure 8,
Table 1).
Of the 244 benchmark plans in 2020, 53 plans qualify through the “de minimis” policy, close to twice
the number in 2019 (29). The de minimis policy makes it easier for plans to qualify as benchmark plans
and retain their current LIS enrollees by allowing them to waive a premium amount of up to $2 above
the regional LIS benchmark. Although benchmark plans that qualify through the de minimis policy can
keep their existing LIS enrollees, they cannot receive auto-assigned enrollees. This means that only
191 PDPs in 2020 (20% of all PDPs, or 78% of all benchmark plans) are eligible for auto-assignment.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 11
BENCHMARK PLANS BY REGION
The number of benchmark plans available in 2020 will vary by region, from just two benchmark PDPs
in Ohio (out of 28 PDPs overall) to 12 benchmark PDPs in Arizona (out of 31 PDPs) (see map; Table
1). Benchmark plan availability will be the same or higher in 32 of 34 regions between 2019 and 2020.
In 2020, 95% of LIS PDP enrollees are projected to be in PDPs operated by five firms: CVS Health,
WellCare, Humana, UnitedHealth, and Cigna (based on enrollment as of September 2019). All five
sponsors offer PDPs that qualify as benchmark plans in all 34 PDP regions in 2020.
408
489
442
308
307
253
252
218
273
229
169
207
202
186
191
154
53
62
75
113
79
54
49
24
14
29
53
408
643
495
308
307
315
327
331
352
283
218
231
216
215
244
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
De minimis plans*
Benchmark plans
NOTES: PDP is prescription drug plan. *De minimis plans can retain Low-Income Subsidy beneficiaries despite exceeding the benchmark premium
by a minimal amount (up to $2 in 2020).
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2006-2020 Part D plan files.
In 2020, 244 Part D Stand-alone Drug Plans Will Be Available Without a Premium
to Enrollees Receiving the Low-Income Subsidy (“Benchmark” Plans)
29% 34% 27% 18% 19% 31% 31% 32% 30% 28% 25% 31% 28% 24% 26%
Share
of all
PDPs:
Figure 8
NOTES: PDP is prescription drug plan.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2020 PDP landscape source file.
Medicare Part D Benchmark Plans in 2020
2-5 (7 states)
Number of Benchmark PDPs
6-7 (18 states)
8-9 (20 states)
10-12 (5 states & DC)
Medicare Part D: A First Look at Prescription Drug Plans in 2020 12
IMPACT OF BENCHMARK PLAN CHANGES FOR LOW-INCOME SUBSIDY
ENROLLEES
More than one million LIS beneficiaries—1.3 million, or nearly 20% of LIS enrollees in PDPs—are
enrolled in PDPs in 2019 that will not qualify as benchmark plans in 2020 (Figure 9). CMS will reassign
these LIS beneficiaries to another plan if they were randomly assigned to their current plan, but those
who have chosen their current plan must switch on their own to avoid paying a premium if they remain
in their 2019 plan.
These 1.3 million LIS beneficiaries face monthly PDP premiums that average $18 if they remain in their
current plan for 2020. More than 200,000 of these LIS beneficiaries are enrolled in the AARP
MedicareRx Preferred PDP, and they will pay a monthly premium of more than $47, on average, if they
stay in this PDP for 2020.
Discussion
Our analysis of the Medicare Part D stand-alone drug plan landscape for 2020 shows that millions of Part
D enrollees without low-income subsidies will face premium and other cost increases in 2020 if they stay
in their current stand-alone drug plan. There are more plans available nationwide in 2020, with Medicare
beneficiaries having nearly 30 PDP choices during this year’s open enrollment period. Most Part D
enrollees will be in a plan with the standard $435 deductible and will face low copayments for generic
drugs but substantially higher costs for brands, including as much as 50% coinsurance for non-preferred
drugs.
Some Part D enrollees who choose to stay in their current plans may see lower premiums and other costs
for their drug coverage, but two-thirds of non-LIS enrollees will face higher premiums if they remain in
their current plan, and many will also face higher deductibles and cost sharing. As in prior years, all Part
NOTES: PDP is prescription drug plan. LIS is Low-Income Subsidy. Analysis assumes no change in enrollment or reassignment of current LIS
enrollees. Distribution of plan-level enrollment does not sum to 100% due to rounding. 2020 premium estimates are weighted by September 2019
enrollment.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Two in 10 Low-Income Subsidy PDP Enrollees Are Projected to Pay
Premiums for Non-Benchmark Plans in 2020 if They Don’t Switch
34%
6%
9%
10%
16%
26%
All other plans
SilverScript Choice
Humana Premier Rx Plan
Express Scripts Medicare Value
AARP MedicareRx Preferred
WellCare Medicare Rx Saver
Total LIS Enrollment in PDPs in 2019 = 7.2 million
5.9
million
1.3
million
LIS enrollees whose 2019 plan
IS IS NOT
a premium-free plan in 2020
Distribution of LIS enrollees in plans that
are not premium-free for 2020:
Figure 9
82% 18%
$1
$47
$2
$28
<$1
Premium for
LIS enrollees
in 2020:
Medicare Part D: A First Look at Prescription Drug Plans in 2020 13
D enrollees could benefit from the opportunity to compare plans during open enrollment, since plans vary
in a number of ways that can have a significant effect on an enrollee’s out-of-pocket spending.
Juliette Cubanski and Tricia Neuman are with the Kaiser Family Foundation.
Anthony Damico is an independent consultant.
Methods
This analysis focuses on the Medicare Part D stand-alone prescription drug plan
marketplace in 2020 and trends over time. The analysis includes 20.5 million enrollees in
stand-alone PDPs, as of September 2019. The analysis excludes 17.4 million MA-PD
enrollees (non-employer), and another 4.6 million enrollees in employer-group only PDPs
and 2.3 million in employer-group only MA-PDs for whom plan premium and benefits data
are unavailable (as of March 2019).
Data on Part D plan availability, enrollment, and premiums were collected from a set of
data files released by the Centers for Medicare & Medicaid Services (CMS):
- Part D plan landscape files, released each fall prior to the annual enrollment period
- Part D plan and premium files, released each fall
- Part D plan crosswalk files, released each fall
- Part D contract/plan/state/county level enrollment files, released on a monthly basis
- Part D Low-Income Subsidy enrollment files, released once annually
- Medicare plan benefit package files, released each fall
- Medicare penetration files, released on a monthly basis
In this analysis, premium estimates are weighted by September 2019 enrollment unless
otherwise noted. Percentage increases are calculated based on non-rounded estimates
and in some cases differ from percentage calculations calculated based on rounded
estimates presented in the text.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 14
Tables
Table 1: Medicare Part D Stand-alone Prescription Drug Plans, Benchmark Plans, and Monthly
Premiums, 2019 and 2020
Number of
PDPs
Number of
Benchmark PDPs
Weighted Average PDP Monthly
Premium
State/territory
2019
2020
2019
2020
2019
2020
U.S. Total
901
948
215
244
$39.13
$42.05
Alabama
29
30
6
7
$41.65
$44.55
Alaska
22
24
7
7
$36.94
$38.93
Arizona
28
31
10
12
$38.29
$42.77
Arkansas
26
27
4
6
$34.30
$37.49
California
30
32
7
8
$43.50
$43.20
Colorado
26
26
7
7
$38.38
$42.36
Connecticut
26
25
7
7
$42.27
$44.78
Delaware
25
27
9
10
$39.33
$43.32
District of Columbia
25
27
9
10
$35.09
$36.37
Florida
27
27
2
4
$42.45
$45.72
Georgia
26
28
4
6
$36.77
$38.59
Hawaii
24
25
4
5
$32.15
$33.97
Idaho
26
28
8
8
$37.92
$42.37
Illinois
27
28
7
8
$39.01
$42.30
Indiana
26
28
7
7
$37.17
$40.33
Iowa
28
29
6
8
$34.36
$39.49
Kansas
26
28
4
6
$38.33
$39.51
Kentucky
26
28
7
7
$37.32
$39.33
Louisiana
26
26
8
9
$37.26
$39.50
Maine
26
26
7
6
$39.46
$40.12
Maryland
25
27
9
10
$37.75
$40.96
Massachusetts
26
25
7
7
$39.95
$42.37
Michigan
29
30
9
9
$37.18
$39.93
Minnesota
28
29
6
8
$34.98
$39.75
Mississippi
24
25
5
7
$34.46
$36.05
Missouri
26
28
4
5
$38.30
$41.33
Montana
28
29
6
8
$35.73
$40.50
Nebraska
28
29
6
8
$34.08
$38.76
Nevada
26
28
3
5
$36.63
$40.38
New Hampshire
26
26
7
6
$38.56
$40.76
New Jersey
26
28
6
8
$43.82
$49.10
New Mexico
27
26
7
7
$33.15
$36.15
New York
23
27
8
9
$44.13
$47.84
North Carolina
28
28
7
9
$38.97
$41.82
North Dakota
28
29
6
8
$34.37
$37.84
Ohio
26
28
7
2
$37.68
$41.43
Oklahoma
28
29
7
8
$40.43
$41.58
Oregon
26
28
7
8
$35.64
$38.80
Pennsylvania
30
31
9
10
$38.94
$42.23
Rhode Island
26
25
7
7
$39.21
$42.57
South Carolina
26
28
3
5
$36.63
$42.85
South Dakota
28
29
6
8
$33.70
$39.65
Tennessee
29
30
6
7
$38.36
$41.83
Texas
27
30
5
5
$36.34
$39.68
Utah
26
28
8
8
$39.91
$44.54
Vermont
26
25
7
7
$38.58
$42.25
Medicare Part D: A First Look at Prescription Drug Plans in 2020 15
Table 1: Medicare Part D Stand-alone Prescription Drug Plans, Benchmark Plans, and Monthly
Premiums, 2019 and 2020
Number of
PDPs
Number of
Benchmark PDPs
Weighted Average PDP Monthly
Premium
State/territory
2019
2020
2019
2020
2019
2020
Virginia
27
29
6
7
$40.00
$40.36
Washington
26
28
7
8
$37.36
$40.52
West Virginia
30
31
9
10
$40.04
$42.91
Wisconsin
28
30
8
9
$40.31
$45.53
Wyoming
28
29
6
8
$38.95
$43.21
Puerto Rico
6
6
--
--
$42.40
$52.03
American Samoa
1
1
--
--
$34.70
$43.40
Guam
2
2
--
--
$39.88
$45.38
Northern Mariana Islands
1
1
--
--
$37.20
$30.20
U.S. Virgin Islands
1
1
--
--
$42.60
$47.40
NOTES: PDP is prescription drug plan. U.S. total count excludes PDPs in the territories. Totals include sanctioned plans closed
to new enrollees as of September of prior year. Average monthly premium is weighted by September 2019 enrollment.
Benchmark plan counts include “de minimis” plans, which can retain Low-Income Subsidy beneficiaries despite exceeding the
benchmark premium by a minimal amount (up to $2 in 2020). Benchmark plans are not shown for the territories because the LIS
is not available to residents of the territories.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 16
Table 2: National Medicare Part D Stand-alone Prescription Drug Plans in 2020
PDP name
Type of
plan
Benchmark
PDP
Enrollment
1
Weighted average
monthly premium
2
Number
(in
millions)
% of
total
Top
10 in
2019
2019
2020
%
change
ALL PDPs
20.49
100.0%
$39
$42
7%
AARP MedicareRx Preferred
Enhanced
3
No
2.21
10.8
2
$75
$79
6%
AARP MedicareRx Saver Plus
Basic
Yes
1.25
6.1
5
$34
$32
-4%
AARP MedicareRx Walgreens
Enhanced
No
0.74
3.6
8
$28
$34
23%
Cigna-HealthSpring Rx Secure
Basic
Yes
4
0.51
2.5
$32
$30
-5%
Cigna-HealthSpring Rx Secure-Essential
Enhanced
No
0.07
0.3
$22
$22
1%
Cigna-HealthSpring Rx Secure-Extra
Enhanced
No
0.15
0.7
$57
$57
<1%
EnvisionRxPlus
Basic
4
Yes
4
0.54
2.6
$17
$16
-3%
Express Scripts Medicare - Choice
Enhanced
No
0.05
0.2
$93
$83
-11%
Express Scripts Medicare - Saver
Enhanced
No
0.21
1.0
$24
$25
1%
Express Scripts Medicare - Value
Basic
Yes
5
0.45
2.2
$35
$36
2%
Humana Basic Rx Plan
Basic
Yes
4
1.57
7.7
$31
Humana Preferred Rx Plan
Crosswalked to Humana Basic Rx Plan
4
$31
-1%
Humana Premier Rx Plan
Enhanced
No
2.62
12.8
$57
Humana Walmart Rx Plan
Crosswalked to Humana Premier Rx Plan
3
$28
107%
Humana Enhanced
Crosswalked to Humana Premier Rx Plan
9
$76
-25%
Humana Walmart Value Rx Plan
Enhanced
No
New in 2020
$13
6
SilverScript Choice
Basic
Yes
4
4.40
21.5
1
$31
$29
-7%
WellCare Classic
Basic
Yes
4
0.89
4.3
7
$32
$29
-9%
WellCare Medicare Rx Saver
Basic
Yes
4
1.17
5.7
$31
Aetna Medicare Rx Saver
Crosswalked to WellCare Medicare Rx Saver
6
$29
6%
WellCare Medicare Rx Select
Enhanced
No
0.70
3.4
$21
Aetna Medicare Rx Select
Crosswalked to WellCare Medicare Rx Select
10
$17
23%
WellCare Medicare Rx Value Plus
Enhanced
No
0.52
2.5%
$72
Aetna Medicare Rx Value Plus
Crosswalked to WellCare Medicare Rx Value Plus
$60
20%
WellCare Extra
Crosswalked to WellCare Medicare Rx Value Plus
$71
1%
WellCare Value Script
Enhanced
No
0.74
3.6%
$15
$17
14%
WellCare Wellness Rx
Enhanced
No
New in 2020
$14
6
NOTES: PDP is prescription drug plan. Analysis excludes enrollees in employer group plans.
1
Enrollment as of September 2019,
includes enrollees with and without low-income subsidies; for enrollees being crosswalked into new plan for 2020, enrollment is
shown in the crosswalked plan. Top 10 in 2019 based on March 2019 enrollment.
2
Weighted by September 2019 enrollment.
3
In all
regions except territories.
4
In most regions.
5
In some regions.
6
Unweighted median because PDP is new for 2020.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 17
Table 3: Benefit Designs and Deductibles in Medicare Part D Stand-alone Prescription Drugs
Plans, 2019 and 2020
2019
2020
Share of PDPs offering (number of plans
1
)
Basic benefits
39% (348)
40% (382)
Enhanced benefits
61% (553)
60% (566)
Standard deductible
52% (468)
69% (654)
Lower deductible
19% (170)
17% (161)
No deductible
29% (263)
14% (133)
Weighted average monthly PDP premium
2
Basic benefits
$31.97
$30.90
Enhanced benefits
$48.76
$57.03
Standard deductible
$31.54
$36.03
Lower deductible
$33.93
$31.78
No deductible
$75.37
$80.60
NOTES: PDP is prescription drug plan.
1
Excludes plans in the territories.
2
Weighted by September 2019 enrollment.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
Medicare Part D: A First Look at Prescription Drug Plans in 2020 18
Table 4: Median Cost Sharing for National Medicare Part D Stand-alone Prescription Drug Plans,
2019 and 2020
Plan name
Formulary tier cost-sharing amounts
Preferred
generics ($)
Generics ($)
Preferred
brands
1
Non-
preferred
drugs (%)
Specialty
tier drugs
(%)
2019
2020
2019
2020
2019
2020
2019
2020
2019
2020
ALL PDPs
$1
$0
$5
$3
$40/
20%
$42/
25%
40%
38%
25%
25%
AARP MedicareRx Preferred
5
5
10
10
$40
$45
40%
40%
33
33
AARP MedicareRx Saver Plus
1
1
6
6
$25
$26
33
35
25
25
AARP MedicareRx Walgreens
0
0
5
5
$30
$40
32
32
25
25
Cigna-HealthSpring Rx Secure-Essential
1
0
3
2
20%
18%
49
43
25
25
Cigna-HealthSpring Rx Secure-Extra
4
4
10
10
$42
$42
50
50
31
31
Cigna-HealthSpring Rx Secure
1
1
3
2
$30
$30
36
36
25
25
EnvisionRxPlus
1
1
6
7
$34
$35
2
36
33
25
25
Express Scripts Medicare Choice
2
2
7
7
$42
$42
48
48
26
28
Express Scripts Medicare Saver
1
1
4
4
18%
$30
32
47
25
25
Express Scripts Medicare Value
1
1
3
3
$25
$25
39
35
25
25
Humana Basic Rx Plan
0
0
1
1
25%
25%
37
38
25
25
Humana Premier Rx Plan
1
1
4
4
$47
$42
35
44
25
25
Humana Walmart Value Rx Plan
n/a
1
n/a
4
n/a
$47
n/a
35
n/a
25
SilverScript Choice
3
0
13
1
$42
$47
45
38
33
27
WellCare Classic
0
0
2
2
$37
$32
41
34
25
25
WellCare Medicare Rx Saver
1
0
2
2
$30
$28
35
38
27
25
WellCare Medicare Rx Select
0
0
2
3
$47
$47
40
42
25
25
WellCare Medicare Rx Value Plus
1
1
2
4
$47
$47
47
47
33
33
WellCare Value Script
0
0
6
7
$40
$43
46
47
25
25
WellCare Wellness Value Rx
n/a
0
n/a
5
n/a
$40
n/a
46
n/a
25
NOTES: PDP is prescription drug plan. Estimates are weighted medians for those plans that vary cost sharing by region (weighted
by September 2019 enrollment). n/a is not applicable because plan is new for 2020.
1
Approximately 91% of September 2019
enrollees are in plans with a preferred brand copay and 9% are in plans with a preferred brand coinsurance.
2
11% of
EnvisionRxPlus enrollees will pay coinsurance of 15% for the preferred brand tier.
SOURCE: KFF analysis of Centers for Medicare & Medicaid Services 2019-2020 Part D plan files.
