Although Medicare Advantage (MA) has only been around since 2006, the program's popularity continues to grow every year. In 2019, over one-third of Medicare beneficiaries enrolled in a Medicare Advantage plan. This page explains Medicare Advantage plans in Arkansas, how the program works, and how to compare your options.
What Is Medicare Advantage?
Also known as Medicare Part C, Medicare Advantage allows beneficiaries to get their coverage through plans offered by private insurance companies.
Every Medicare Advantage plan must offer the same benefits you'd get with Original Medicare (Part A, hospital insurance, and Part B, medical insurance). However, most Medicare Advantage plans in Arkansas provide additional coverage as well. Common benefits include prescription drug coverage, fitness programs, and routine vision and dental care.
Arkansas Medicare Advantage Plans that Include Prescription Drug Coverage
One of the most common additional benefits you get with Medicare Advantage in Arkansas is prescription drug coverage. These are known as Medicare Advantage Prescription Drug plans (MA-PD). Around 90 percent of Advantage plans cover prescription medications.
Who Is Eligible for Medicare Advantage in Arkansas?
If you already enrolled in Medicare Parts A and B, you are eligible for Medicare Advantage. Please note that signing up for an MA plan does not exempt you from paying the Medicare Part B premium.
Most people become eligible for Medicare when they turn 65. However, around one-sixth qualify once they collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months.
Please note that if you did not begin collecting Social Security benefits at least 4 months before turning 65, you will have to choose to sign up for Medicare. Enrollment in Parts A and B is automatic if you qualify due to a disability.
When Can You Sign Up for a Medicare Advantage Plan in Arkansas?
Medicare limits plan enrollment to specific times.
Your Initial Enrollment Period (IEP) begins 3 months before the month you become eligible for Medicare and lasts for a full 7 months. So, if your 65th birthday or 25th month of collecting disability occurs in April, your IEP begins on January 1 and ends on July 31. If your birthday falls on the first of the month, those dates are pushed forward one month. In the above example, that would be December 1 through June 30.
The General Enrollment Period is available to anyone who failed to sign up for Medicare Part A and/or Part B during their Initial Enrollment Period. General Enrollment lasts from January 1 through March 31. Once it ends, you have from April 1 through June 30 to join a Medicare Advantage plan.
Medicare's Annual Enrollment Period (AEP) lasts from October 15 through December 7. You can make any coverage changes you like during AEP, including joining an Advantage plan.
The Medicare Advantage Open Enrollment Period (OEP) is only available to people who already have an MA plan. During OEP, you may change to a different Advantage plan or return to Original Medicare. If that change results in you losing your prescription drug coverage, you may also join a standalone Medicare Part D plan.
Finally, certain life changes may qualify you for a Special Enrollment Period (SEP). There are dozens of ways to qualify. Find the full list on Medicare.gov here.
Types of Medicare Advantages Plans in Arkansas
The four most common types of Medicare Advantage plans in Arkansas are:
- Health maintenance organizations: HMOs require their members to use a provider network and choose a primary care doctor who manages their care and writes referrals to specialists. If you use an out-of-network provider, you may be responsible for 100 percent of the cost.
- Preferred provider organizations: PPOs also have a provider network. However, they allow you to use an out-of-network provider for a higher out-of-pocket cost. They also do not require referrals to see a specialist.
- Private fee-for-service: PFFS plans set a price point for all covered services, with members paying the difference. Any provider who accepts the plan cannot refuse to treat you. However, if they don't accept your plan, they can deny you non-emergency treatment, even if they accept Medicare.
- Special needs plans: SNPs are limited to people who meet the plan's guidelines, which may vary from plan to plan. Common criteria include having a certain chronic health condition, living in an institution, and/or qualifying for both Medicare and Medicaid (known as dual eligibility).
The types of Advantage plans available vary depending on where you live.
How to Choose a Medicare Advantage Plan in Arkansas
Since they're sold by private insurance companies, Arkansas Medicare Advantage plans may vary considerably in terms of cost and coverage. Compare your options carefully to ensure you get the best plan for your particular needs. Look at the following metrics:
- Costs: May include a yearly deductible, monthly premium, and copayments or coinsurance.
- Coverage: Look closely at the plan's benefits to be sure you're comparing apples to apples. A plan that includes prescriptions, dental, and vision could save you money, even if it doesn't have a $0 premium, since you won't have to pay those costs out-of-pocket.
- Network: Provider networks may include doctors, nurse practitioners, hospitals, labs, clinics, pharmacies, and more.
- Ratings: Medicare releases plan ratings each fall, to help beneficiaries compare their options.
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Arkansas. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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