Are you concerned about costly coverage gaps associated with Medicare Parts A and B? Then you might be thinking about a Medicare Part C (Medicare Advantage) policy to protect you from these gaps. However, unlike with other Medicare supplement policies, you will be replacing your Medicare benefits with an equivalent or better set of benefits from a private company – the government will no longer be involved in your health care.
Federal Regulations for Medicare Advantage
You won’t have to worry about being sold a shoddy policy with Medicare Advantage – federal laws mandate that your policy be as comprehensive, if not more comprehensive, than Traditional Medicare. In order to make it worth your while, though, many providers will craft an Advantage policy for you which includes Medicare Parts A & B benefits, protection from coverage gaps, and more. MAPD plans include provisions for prescription drug (Medicare Part D) benefits.
Medicare Advantage Enrollment In Arkansas
Medicare Advantage plans seem to be a little less popular in Arkansas when compared to other states. Only 21% of Arkansas seniors who are enrolled in Medicare are receiving their benefits through a Medicare Advantage plan (as opposed to Medigap supplement or a group plan). However, there are a variety of Advantage plans to choose from, as the chart below shows:
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
Plan rates vary by state, as well as by county and zip code. Your age, your overall health, and other significant factors will determine how much or how little your provider will charge you for a Medicare Advantage policy. Take a look at what seniors near you are paying (on average) for their plans:
Most Popular Medicare Advantage Plans in Arkansas
Not only will your rates vary by plan and provider, but Medicare Advantage policies will also vary by provider network limitations. There are networks, HMOs especially, which are affordable for many seniors but also highly restrictive. Other networks can be quite costly, but you won’t have as much trouble gaining access to the doctors and hospitals of your choice.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Before you decide on a Medicare Advantage plan, make sure that your provider network will give you access to the hospitals and doctors that you want most. Not all networks will give you 100% freedom of choice. PPOs and PFFS networks tend to be more flexible, while HMOs are usually restrictive. Also, keep in mind that the rules and restrictions can change at any time.
Where you generally need to get your care and services from for:
- HMO Plans: Medicare Advantage plans that are HMOs limit your ability to choose healthcare physicians. HMOs operate comprehensive healthcare networks that include primary care physicians, specialists, hospitals, imaging centers, therapists, labs etc. and require that plan members use that network for their care. There are exceptions for emergency care and out-of-state dialysis. In addition, some plans offer Point of Service (POS) provisions that allow you to use out-of-network providers but typically these services are at a much higher copay.
- PPO Plans: PPOs also operate networks but with a difference. If you opt for a PPO you can pick from any of the healthcare providers and facilities in the network, or you can use out-of-network providers. If you go out-of-network, your copay will be significantly higher than using a network provider.
- PFFS Plans: Private-Fee-For-Services plans have no restrictions on who you use as a healthcare provider so long as they accept the coverage. Not all will. These plans have no networks and rely on making deals with providers one on one. Typically, the plan will have an online directory of participating physicians but it’s still a good practice to confirm the provider will accept the insurance when making an appointment.
- Special Needs Plans: Special Needs Plans (SNP) are designed to provide focused care for people with chronic diseases. These plans typically limit providers to those in the Medicare SNP Network. These groups are heavily populated with providers who are specialists in a specific disease or condition.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans: With an HMO, your primary care physician, which you may or may not be able to choose, is your “healthcare dispatcher” responsible for referring you to specialists, labs, hospitals, etc. within the HMO network. Some plans do offer a Point of Service feature that will allow you to use providers outside the network for a premium copay.
- PPO Plans: PPOs also have networks. However, unlike HMOs you can use any provider who will accept the insurance. If you do use out-of-network healthcare providers, be prepared to pay a higher copay.
- PFFS Plans: Private-Fee-For-Service plans have no restrictions on the providers you choose. However, before you see a provider, make certain that he or she accepts your insurance. Not all will even though they accept Medicare. It’s a good idea to verify that your insurance is accepted every time you make an appointment even if they have accepted it in the past.
- SNP Plans: If you are a member of a Special Needs Plan the physicians that will treat you are limited to the specialists in the Medicare SNP Network. There are exceptions. If you need emergency care due to a sudden onset of illness or injury and End Stage Renal Disease dialysis outside the area.
Finding a doctor who accepts Medicare is pretty easy using the Medicare’s physician search tool. The same is true for locating doctors and facilities available on Medicare Advantage plans. Most plans have online directories that you can use to see if your doctors are members. But keep in mind, there may be conditions.
Drug, Vision and Dental Coverage
Medicare Advantage policies are one of the few Medicare supplement plans which can combine your Medicare benefits, provide for coverage gaps, and take care of ancillary needs (such as vision, dental, and prescription drugs) all under the same policy. You can pick and choose the options you need, depending on your provider. But remember that the more comprehensive your plan is, the more expensive it will likely be.
Many Medicare Advantage plans offer some health care benefits. Typically these are limited to annual eye exams, lens, glasses, and contacts. These benefits are usually only available from participating vendors. By comparison, original Medicare only provides eye exams for diabetes and age related macular degeneration.
Basic dental care is offered by some Medicare Advantage programs. Participating dentists offer routine annual exams including x-rays, cleaning, and filings. A list of dentists can be found in the plans directory. It’s important to note that the coverage is only for these basic services. Other procedures like crowns, root canals, and dentures are not covered.
Enrollment Options & Best Time To Enroll
Unlike some Medicare supplement policies, the provider of your Part C insurance must adhere to new laws and forego the medical underwriting process – even in the face of pre-existing conditions – as long as you stick to the Open Enrollment Period. Unless you are plagued by End Stage Renal Disease, you shouldn’t have much to worry about. However, if you do suffer from ESRD, know that certain states have policies in place which can help you get the coverage you need. For more information on enrollment, our Medicare Advantage Enrollment Page has plenty of information to help you meet your needs.
- Initial Enrollment Period: For best results, try to enroll in a Medicare Advantage plan within your first 6 months of Medicare enrollment.
- Annual Enrollment Period (AEP): You have the option of changing or cancelling your Medicare Advantage and Part D drug plan between October 15th and December 7th every year.
- Special Enrollment Period (SEP): If you lose your employer plan coverage, move out of your coverage area, or lose coverage from your provider, you could qualify for an SEP.
What Medicare Advantage Plan Is Best For Me?
Only you can determine what the best Medicare Advantage is for your specific circumstances. However, it’s important that you select well because changing is somewhat problematic due to enrollment period complications. At a minimum, the plan you choose should provide healthcare providers that you have confidence in and have copays and deductibles that are within your budget.
Premiums are always a concern but many of the plans have zero-payment plans. If you qualify for one of these and enroll within the available enrollment period, then the emphasis falls on copay amounts, premium amounts for using out-of-network providers, and deductibles. Also consider the company’s reputation, financial standing, and the length of time they have been serving your part of Arkansas.
- Medicare.gov – Enrollment
- Medicare.gov – Special Enrollment Periods (SEPs)
- Medicare.gov – Things to Know about Medicare Advantage Plans
- The Kaiser Family Foundation Medicare Enrollment Spotlight