Introduction to Medicare Advantage in Kansas (Part C)

Have you ever heard of Medicare supplement insurance? It’s a special type of insurance policy designed to protect seniors living on a fixed income from the potentially disastrous medical expenses. Sadly, Medicare Parts A and B doesn’t cover everything when it comes to doctor and hospital services. One particular policy which is designed to protect seniors from these gaps in coverage is called Medicare Part C (or “Medicare Advantage” for short).

Federal Regulations for Medicare Advantage

Unlike most Medicare supplement insurance, Medicare Advantage is a fully comprehensive policy which replaces your Traditional Medicare benefits with coverage from a private company. But don’t worry – the government closely regulates these policies to make sure you don’t get sold any less coverage than you deserve. Most plans include the same exact coverage as Medicare Parts A & B, as well as benefits for their coverage gaps. Some plans, called MAPD plans, also incorporate Part D prescription drug benefits.

Medicare Advantage Enrollment In Kansas

Medicare Advantage plans seem to have a bit of competition in Kansas. 15% of seniors in the state are choosing to have their Medicare benefits managed through an Advantage plan. one can only assume that the other 85% are getting benefits through government Medicare, a private health plan from an employer, or through some other means.

Plan Type Enrollment Percentage
HMO Plans 59%
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

There are dozens of factors which can raise or lower your monthly premium for a Medicare Advantage plan. Enrolling in Medicare late (after the age of 65) might raise your costs, but a non-smoker will naturally get a lower rate than a smoker. The chart below displays estimated quotes of what seniors like you might be paying in your area; your exact rates will vary.

Most Popular Medicare Advantage Plans in Kansas

It’s easy to find the right Medicare Advantage plan within our rankings. We rank available plans in your area on the five star system, awarding a maximum of five stars to those companies who excel above the rest. Care management and customer service are top priorities of course, followed by value and the financial strength of the company. It’s a good idea to take a look at our ranking system before you blindly choose a company which might actually rank quite low on our list.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

For some seniors, you may be required to switch doctors or hospitals in order to receive care within your provider network. HMO networks are more restrictive with fewer options, while PPO and PFFS networks are more inclusive. Additionally, your provider has the ability to change who is and is not included within your provider network at any time. So be prepared to deal with these unexpected changes before you officially sign up for a policy.

Where you generally need to get your care and services from for:

  • Health Management Organization Plan – These plans usually restrict their network of care providers to a select few doctors, facilities, and hospitals. In part they do this to keep costs low, which can make your plan more affordable. When it comes to your emergency care, you don’t necessarily need to worry about whether or not the doctor or hospital you get that care from is in your provider network. But you may end up paying completely out of pocket if you go out of network for non-emergency care.
  • Preferred Provider Organization Plan – PPO plans give you a greater variety of choices when it comes to non-emergency care. They have a smaller network of preferred providers which will likely cost you the least. But if you feel that you must get care out-of-network, you will likely be able to find a provider that will accept your insurance at a reduced cost.
  • Private Fee-For Service Plan – PFFS providers are frequently changing their terms, and may not accept your insurance plan from one appointment to the next. It’s important that you communicate frequently with your insurance company and your doctor(s) to make sure you are still getting in-network care if you want to keep your costs low.
  • Special Needs Plan – If you have special medical needs, you may qualify for in insurance plan with a SNP network of doctors and experts who can manage your needs properly. ESRD is an example of special medical needs. Going outside of your SNP for care is difficult and expensive, like it is with an HMO plan. But your insurance provider will likely make exceptions if, for example, you need to visit an out-of-network hospital for an acute medical emergency.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – There are very few differences between a Medicare Advantage HMO and any other type of private HMO insurance plan. Both types of networks restrict the outpatient facilities, hospitals, and doctors you are allowed to visit. Both will make reasonable exceptions of you have to get emergency care out-of-network. And both will leave you likely paying 100% out-of-pocket for most non-emergency out-of-network care.
  • PPO Plans – This is another area where Medicare Advantage plans really don’t differ very much from their non-medicare counterparts. You can see almost any doctor or facility you want which accepts your medicare insurance. But not all of those doctors may be in your preferred network. If they are not, they may cost you more to see or visit. But it’s rare that you’ll be stuck in a situation where you have to pay for your costs 100% out-of-pocket.
  • PFFS Plan – If you have a private Fee-For-Service plan, it may not always be as simple as “if they accept Medicare, they will accept your insurance”. In a PFFS plan, your provider not only has to agree to accept Medicare but also your specific insurance plan and for the prices your insurance company is willing to pay. But this can change at any time, so it’s important to maintain communication with your care providers as well as your insurance company to make sure you don’t experience any lapse in coverage.
  • SNPs – Special Needs Plans are exactly what they sound like they are: plans for patients with special needs. if you have ESRD, for example, your plan may choose specific dialysis facilities for you that they believe are cost-effective and appropriate for the care you need. If you have to go outside your network for medical care, you may be able to negotiate with your insurance company to get the cost for that care reduced; but it will likely still be more expensive than if you had stayed in-network.

For your convenience, Medicare.gov has an easy and efficient database you can search to see if your preferred doctor(s) and facilities are included in your plan.

Drug, Vision and Dental Coverage

One positive benefit of Medicare Advantage, despite its drawbacks, is simplicity. You can purchase all different types of ancillary coverage options – including dental care and/or Prescription drug benefits – under one solitary policy. This makes managing your healthcare easier than juggling multiple insurance policies. However, keep in mind that the more you add to your policy, the more expensive it will be on a monthly basis.

  • Maintaining good vision is a health necessity at any age. Unfortunately, you’ll have to pay for that coverage out-of-pocket with Medicare Parts A and B alone. Medicare Advantage plans usually do have optional vision coverage, although it is not always guaranteed. It will depend on the company who sells you your plan, your exact location, and the types of vision health care providers you have in your area.
  • Even if the rest of your body is healthy, neglecting your teeth and gums can still have unfortunate health consequences. That’s why most Medicare Advantage plans offer elective dental coverage which you can add to your plan if you wish. It will likely raise your monthly premiums, but at the same time it will give you access to more affordable dentists and oral surgeons near you. Like with vision, Original Medicare doesn’t provide elective dental coverage.

Enrollment Options & Best Time To Enroll

Applying for a Medicare Advantage plan is fairly straightforward for seniors 65 years of age who are within their Initial Enrollment Period. However, if you are outside of that window, you may have to provide more information about your health status. You are also more likely to be rejected for pre-existing conditions, such as End Stage Renal Disease (ESRD). Your state department of insurance will have more information regarding how to qualify for coverage with a pre-existing condition. You can also visit our Medicare Advantage Enrollment Page to learn more.

  • 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?

There are three very important factors at play when choosing the right Medicare Advantage plan: choosing a company that will put your needs first, choosing a plan that is affordable, and choosing a plan that provides you with the benefits you need. Our five star rating system can help you narrow down those choices to a select few. But our expertise in the Medicare insurance industry can help you anticipate your future needs and take you the rest of the way.

It doesn’t help that you only have a limited amount of time to make a decision. And if you’re unsure about that decision, your options for trying out different plans and switching without penalty exist within an even smaller window. We can also help you navigate the treacherous waters of the Medicare enrollment period so that you get the plan you need at the price you want within the allowed time frame.

Sources:

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