Do you live in Arkansas? Are you 65 or older? Or will you be turning 65 soon? Then you are eligible to enroll in Medicare Plans in Arkansas. Traditional Medicare has two parts – Part A, and Part B – which are designed to cover most of a retired person’s health care needs. However, it does not cover 100% of all medical costs and procedures. These coverage gaps may need to be supplemented with additional or replacement insurance. We will discuss them in detail later on in this article.
Coverage and Benefits
Your employment history plays a part in determining what your Medicare premiums will be. Regardless of your history, you will be required to pay a premium for access to Medicare Part B. You may also be required to pay an additional premium for Part A if you have been employed for fewer than 40 quarters (or 10 years). Your Social Security Office can give you specific information on exact prices and requirements.
The difference between mandatory and optional Medicare coverage largely depends on your own individual needs. Once you apply for and qualify for Medicare, you will automatically be enrolled in Part A benefits. If you decide to accept Medicare benefits, no matter what other coverage options you choose, you cannot opt out of these hospital care benefits. In most circumstances, you may choose to opt out of Part B. But that isn’t always the case. Part B benefits, for the most part, cover healthcare and supplies which aren’t related to a hospital stay.
Medicare Part C is entirely optional – but if you choose to go with such a plan, the essential core benefits of Original Medicare are not. These essential core benefits – as mandated by federal law – are equal to Parts A&B of Original Medicare coverage. But unlike Original Medicare, you cannot choose to accept or reject Part B benefits on a Medicare Part C plan. The same is true if you want to enroll in part D prescription drug coverage. If you have original Medicare and you also want Medicare Part D, you have to accept Parts A and B, or you’ll have to find a prescription drug plan offered by a private entity.
Below is a table that outlines basic forms of Traditional Medicare coverage:
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Medicare Plans in Arkansas
The state of Arkansas has a grand total of 552,375 citizens currently enrolled in Medicare. Of those, 19% (104,951) have instead opted to take on a Medicare Advantage plan. But Medigap policies are more popular in Arkansas – 152,998 citizens have them (that’s nearly 28%!). The remaining 53% could be supplementing Original Medicare through an employer’s plan, or through a private one. Or they could be putting themselves at risk by having no supplemental coverage at all.
Before you read any further, make sure you are already enrolled in the Medicare program – residents can’t qualify for Arkansas Medicare supplement insurance without first being enrolled in the federal Medicare program.
Why are Medicare Supplement Plans so Important for Arkansas Residents?
Supplemental coverage is important because retirement incomes are dwindling while the cost of health care keeps going up. Without supplemental coverage, the gaps in Traditional Medicare could leave you with thousands of dollars in unexpected medical bills which your budget cannot accommodate. You can reference the table below for a few of these examples:
|Medicare Part A Costs||Medicare Part B Costs|
Supplemental coverage protects you from spending hundreds or thousands of dollars per day for hospital services, as well as necessary outpatient expenses. There are several popular supplemental coverage options which can protect you and give you piece of mind. This article will cover the top two in further detail.
The cost of living in Arkansas is relatively reasonable; unfortunately, healthcare costs in Arkansas are not. And they are on the rise. This is a very unfortunate situation given that most elderly Arkansas residents will have a difficult time paying their medical bills given their fixed-income. But there are supplemental medicare insurance plans you can purchase for yourself to mitigate these future costs.
If you are 65 and older, if you qualify for Medicare, and if you are worried about the rising costs of healthcare, then you should seriously consider a Medicare Supplement Plan. The small monthly premium is largely manageable for most seniors, and such plans go a long way towards protecting you from the ever-increasing expenses which come from your specific healthcare needs. The plans are simple and the companies who offer them work with you and the federal government to make sure your claims are handled in the fairest way possible.
Why are these plans necessary? Well, unfortunately, there’s only so much that Medicare will cover. Medicare Part A has the most expensive gaps; if you stay in the hospital too long, or if you need too many expensive procedures (such as blood transfusions), Medicare will pass those costs on to you. And they will be expensive. Medicare Part B is very comprehensive, but can still come with some pretty pricey deductibles, co-pays, and coinsurance that you may forget to budget for. Finding an affordable Medicare supplement policy can help you save money on these unexpected costs so that you don’t have to worry about whether or not you can afford proper healthcare.
If you’re ready to plug the gaps in your Original Medicare coverage, you have options. Those options are either a Medicare Advantage plan (Medicare Part C) or a Medicare Supplement Plan. Both of these plans are fairly different, and certain ones may be more effective than others depending on your situation.
Your Arkansas Coverage Options: Medicare Supplement Plans
If you’ve ever heard the term “Medigap” before, it was most likely in reference to a Medicare supplement plan. They are specifically tailored to cover the most common “gaps” in Original Medicare. The ten government-approved plans are: A, B, C, D, F, G, K, L, M, and N. E, H, and I no longer exist. The Medicare Modernization Act rendered them obsolete in 2010, and they were taken out as a result. No matter what plan you choose, it will offer the same benefits as it would in any other state. The provider and overall costs, however, will vary by location.
Each plan offers the following benefits:
Additional Arkansas Coverage Options: Medicare Advantage Plans
Medicare Advantage may also sometimes be referred to as Medicare Part C. Part C essentially replaces Original Medicare with a private health insurance plan. However, due to government mandates, that private plan must offer all of the same benefits as Part C. Some plans even offer additional benefits to entice potential customers. The important thing to understand is that the federal government will no longer be responsible for your health coverage if you go with a private insurer and purchase a Medicare Advantage plan.
Some of the extra benefits in Medicare Part C might include dental or prescription drugs (or even more options than that). However, many of the networks in which Medicare Advantage operates are highly restricted. Just keep in mind that, with Medicare Advantage, you run the risk of losing your current doctors if you happen to sign up for one of these restrictive networks.
Confused about Health Maintenance and Preferred Provider Organizations? HMOs and PPOs are the network of health care providers which work with your Medicare Advantage plan to provide you with care.
What is the Difference Between Medicare Advantage and Medicare Supplement in Arkansas?
Medicare Advantage is also known as Medicare Part C. Medicare Advantage is a private health insurance plan, just like any other plan you would be eligible for before retirement. The difference is, however, that these plans are legally required to offer the same benefits as Original Medicare, and most or all of your monthly premium will be paid by the government. You will be financially responsible for any other expenses. Other expenses may include prescription drug coverage, vision, dental, or any other elective type of coverage which Original Medicare does not offer.
A Medicare Supplement Plan – often referred to as “Medigap” for short – does not replace Original Medicare with a private insurance policy. It merely supplements government healthcare with some additional coverage from a private insurance company. Medigap policies are usually smaller, less expensive plans which cover most or all of the gaps in your Medicare coverage (depending on which plan you choose). The plans are lettered: A-D, G, F, and K-N. F has the most comprehensive coverage, while plan A covers the least. Of course, the more coverage you purchase, the higher your monthly premium will be for that plan. But they are standardized across all 50 states so if you live in Arkansas, you don’t have to worry about whether or not you’ll get the same benefits as someone in Texas or California.
Medicare Advantage works differently. For starters, it completely replaces your Medicare benefits from the government instead of working with the government to pay out your claims. But don’t worry; by law, your private Medicare Advantage plan will offer you at least the same benefits that you would receive from Medicare Parts A & B. Better yet, you may be eligible for extra benefits like dental, prescriptions, and vision as well as coverage which covers Original Medicare gaps. Be warned, however – these extra coverages will cost more.
You’re also taking more of a gamble with a Medicare Advantage plan. It is a private plan run by a private company and doesn’t necessarily have the same guarantees that Medicare or a Medicare Supplement Plan would. You do have to qualify for coverage, and your provider can discontinue your coverage whenever they want as long as their reason for doing so is legal. Qualifying for Medicare and Medigap is much easier, and the only way you can lose that coverage is if you fail to pay your premiums or the Medigap supplement company goes out of business.
For answers to the most common questions about the difference between Medicare Advantage and Medigap policies, please see the chart below. It contains short and informative answers that can help you figure out which plan to choose.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Your insurance company will calculate how much your expenses should cost and base your monthly premium off of that. The government May pay the entire premium, or leave a small portion of the premium to you.||You pay the Medicare supplement company a small monthly premium in exchange for coverage.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||If the government will not agree to pay all of your premium, the rest of that expense will be yours, in addition to coinsurance, co-pays, and deductibles.||Each plan will require a relatively affordable monthly premium.|
|What will the plan cover?||Medicare Advantage plans start by providing the exact same benefits as Original Medicare – coverage gaps and all. You can choose to purchase additional coverage to cover the gaps, get dental, vision, and/or prescription drug coverage. But keep in mind such coverage can be substantially more expensive.||If you get a comprehensive plan such as Plan F, 100% of your coverage gaps will be taken care of. Less expensive plans will provide less coverage depending on the plan. Unfortunately, Medigap supplements do not cover dental, vision, or prescriptions.|
|Is it easy to budget my health care expenses?||The more medical care you need, the more expensive your costs will be. This makes it harder to budget with a Medicare Advantage plan unless you are in perfect health for your age.||It’s easy to budget your monthly premium. Additional co-pays, coinsurance, and deductibles are also fairly easy to plan for, depending on the level of coverage your plan offers.|
|Is my plan guaranteed? Or can it be cancelled?||Your plan is not guaranteed, and may be cancelled at any time by the discretion of your provider (as long as they have a legal reason to do so).||If you fail to pay your premiums or if the company goes bankrupt, you may lose your coverage. Otherwise, your plan is guaranteed.|
|Do I have to clear a pre-approval or pre-certification process?||Medicare Advantage plans do require a pre-approval or pre-certification process. This can make it harder to get coverage, or more expensive to pay for the coverage you get.||Qualifying for Medicare automatically makes you eligible for a Medigap policy. There is no pre-approval or pre-certification process.|
|Am I limited to specific doctors or hospitals?||In order to keep your premiums affordable, you will be restricted to a specific network of doctors and hospitals.||You’re only restriction is whether or not the doctor or hospital you visit accepts Medicare. since Medicare is almost universally accepted everywhere, you will have very few restrictions.|
|What type of plan is best for me?||If you are healthy enough to require little medical care, if you live in a densely populated area with plenty of Hospital/doctor choices, and if you don’t travel often, Medicare Advantage may save you money.||If you are mostly concerned with the gaps in Original Medicare coverage, if you travel often, and if you want your medical expenses to be a little bit more predictable, a Medigap plan may be perfect for you.|
More Helpful Medicare Resources in Arkansas
It’s important to do some research and clear up any confusion you may have regarding Arkansas Medicare supplemental insurance policies. Below is a helpful directory of contact information you can use to get answers to your health care inquiries. From there, you can make the decision that’s best for you.
Important Medicare-Related Healthcare Terms Arkansas Residents Need to Know
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.