Medicare Advantage plans present an alternative to Original Medicare and are provided by private insurance companies approved to offer Medicare coverage, instead of the federal government. Original Medicare plans include hospital insurance under Medicare Part A, and medical insurance under Medicare Part B. Medicare Advantage plans, often called Medicare Part C, must include the same type and level of coverage as Original Medicare. These plans often include additional benefits, such as prescription drug coverage under Medicare Part D and services such as dental, vision and hearing care. Since there are several types of plans available and the insurance carriers set the prices for covered services, not the federal government, the cost of Medicare Advantage plans vary.
A 2019 analysis performed by the Kaiser Family Foundation determined that about two-thirds of the 64 million Medicare beneficiaries across the country were covered by traditional Medicare. The analysis also noted that the number of Medicare beneficiaries enrolled in private plans had nearly doubled over the last decade, resulting in 39% of Medicare beneficiaries nationwide being enrolled in a Medicare Advantage plan in 2020. However, the popularity of Medicare Advantage varies tremendously from state to state, as evidenced by a 47% enrollment rate in Hawaii and only 1% enrollment in Alaska. While Arkansas has a somewhat low enrollment rate of 29%, it’s higher than the neighboring states of Oklahoma and Mississippi, which have enrollment rates of 24% and 22%, respectively.
Seniors in Arkansas interested in enrolling in Medicare Advantage will find numerous insurance providers offering a variety of plans, so they may need help comparing options. This guide provides details on each type of plan available in Arkansas, as well as information about enrollment and eligibility requirements and Medicare Part D prescription drug coverage. Arkansas seniors who can’t decide which Medicare Advantage plan is right for them will also find a list of state and local resources that provide information, assistance and counseling to help them better understand the Medicare Advantage program and get the coverage they need.
There are several types of Medicare Advantage plans for Arkansas seniors from a number of insurers, but they may not be available to every resident. Some plans aren’t available in all 75 counties and others limit membership. The most common plans are Health Maintenance Organizations, or HMOs, and Preferred Provider Organizations, or PPOs. Medicare recipients may also choose from a limited number of Private-Fee-For Service and Medical Savings Account plans and there are a few Special Needs Plans available under specific conditions.
Health Maintenance Organizations (HMOs)
HMOs typically have the strictest network rules and the lowest premiums compared to other Medicare Advantage plans. HMO members must choose a primary care provider within the plan’s network and get a referral from their provider before seeing a specialist, or getting certain tests. Members who receive health care services outside the HMO network will likely have to pay for the entire cost themselves, unless it’s due to an emergency.
Preferred Provider Organizations (PPOs)
PPOs are more flexible than HMOs and don’t require plan members to choose a primary care provider or get referrals before seeing specialists. PPOs will also pay a portion of the cost if a member receives care outside of the plan’s network, but co-pays and coinsurance rates are lower when using network providers. For this added flexibility, members usually pay higher premiums and deductibles compared to other Medicare Advantage plans.
Private-Fee-For Service Plans (PFFSs)
The insurance companies that offer PFFS plans get to decide how much they pay providers and how much the plan members pay for health care services, so costs can vary. Some PFFS plans have provider networks, and allow members to see any provider within the network. Plans without a network allow members to see any Medicare-approved provider or hospital that accepts the plan’s payment terms. PFFSs give members more freedom to choose their own providers, but these plans typically charge higher premiums in exchange.
Medical Savings Accounts (MSAs)
MSAs combine a high deductible health plan with a special health savings account, similar to non-Medicare Health Savings Account plans. Medicare sends money annually to a Medicare beneficiary’s MSA provider, who deposits a portion of these funds into the member’s savings account. A member then uses this money to pay for their health care expenses until their annual deductible is met and their plan coverage begins. With MSAs, members may choose their own health care providers.
Special Need Plans (SNPs)
SNPs may charge a monthly premium on top of a Medicare Part B premium, so costs may be higher than with other plans. SNP members must get their care from providers within their plan’s network and need a referral to see specialists. These plans also strictly limit enrollment to those who meet specific conditions. There are three types of SNPs offered in Arkansas: D-SNPs that cater to beneficiaries who are dually eligible for Medicare and Medicaid, I-SNPs for beneficiaries in certain institutions such as nursing homes, and C-SNPs for those with specific diseases or illnesses, such as end-stage renal disease or diabetes.
Prior to enrolling in Medicare Advantage, seniors must first be enrolled in Original Medicare. Anyone who is eligible for Medicare Parts A and B is also eligible to enroll in Medicare Advantage. However, certain Medicare Advantage plans, such as SNPs, may have additional eligibility requirements.
Medicare Advantage has specific enrollment periods. One can only join a Medicare Advantage plan during the following periods:
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
Medicare Advantage plans that include prescription drug coverage are usually listed as MA-PDs and may have higher premiums or charge a separate premium for the included drug plan. However, not every Medicare Advantage plan in Arkansas covers prescription drugs. In most cases, HMO and PPO plans include a prescription drug plan, but if they don’t, beneficiaries aren’t allowed to sign up for separate Medicare Part D drug coverage. Members who join a separate Medicare drug plan will be disenrolled from their Medicare Advantage plan and returned to Original Medicare. PFFS plans may offer prescription drug coverage, but if they don’t, members are allowed to join a separate Medicare drug plan. Members in an MSA plan must sign up for Medicare Part D drug coverage, because prescription drugs aren’t covered under these plans. SNPs are always required to provide prescription drug coverage. Medicare recipients must sign up for some type of Medicare prescription drug coverage when they first become eligible, or they could face a late enrollment penalty that they’ll have to pay as long as they have a drug plan, even if they switch plans.
Health insurance coverage is incredibly important for aging adults, making Medicare Advantage a valuable program to ensure seniors get the coverage they need. However, some seniors don’t take advantage of the program because they’re too overwhelmed by the application process and numerous health care options. Navigating through the enrollment and eligibility process and the various benefits, deductibles, co-pays, premiums and coverage options doesn’t have to hinder a senior’s participation in the program. Listed below are a few state and local resources in Arkansas that provide free services to Medicare-eligible seniors who need counseling and extra assistance to ensure they get the Medicare Advantage coverage they need.
The Arkansas Insurance Department heads up the Senior Health Insurance Information Program (SHIIP) along with assistance from the Area Agencies on Aging offices around the state. This program is designed to help Medicare-eligible seniors with questions about their Medicare benefits, summary notices and claim denials and appeals. Certified and trained Medicare beneficiary advisors provide free, unbiased counseling on the entire Medicare program, including Medicare Advantage, Medicare Part D prescription drug plans, Medicare savings plans and Medigap policies. Advisors also answer questions about Medicaid, long-term care insurance, home health benefits and other health insurance programs available to seniors in Arkansas. SHIIP counselors are available for one-on-one, personalized counseling to individuals and group presentations on a variety of health insurance topics. Staff members also may provide referrals to other helpful programs or agencies when necessary.
Schedule a personalized counseling session with the Arkansas SHIIP Office by calling 501-371-2782 or toll free at 800-224-6330. You can also send an email to [email protected] to request more information about the program, or find and contact your local office by referring to the SHIIP Partner map. Assistance is also available at your local Area Agency on Aging.Visit Website Email
The Arkansas Department of Human Services operates the Choices in Living Resource Center, which also acts as an Aging and Disability Resource Center to provide information about long-term services and support to Arkansas seniors. Trained program specialists help anyone who contacts the agency sort through the many options available and assist them in making informed decisions. The Arkansas DHS also oversees the Area Agencies on Aging located throughout the state, which serve multiple counties within their regions. AAAs offer counseling to seniors about Medicare, Medicare Advantage, Medicaid and Medicare Supplement Insurance. AAA counselors can provide information about and assistance applying for prescription drug and low-income senior programs. These services are provided at no cost.
Call the Choices in Living Resource Center directly at 866-801-3435 or contact them by email at [email protected] for more information about their various programs. You can also contact your local Area Agency on Aging to learn more about scheduling Medicare counseling.Visit Website Email
Seniors can get personalized Medicare assistance through the WestArk Retired and Senior Volunteer Program. WestArkRSVP volunteers receive intensive annual training through the Arkansas Insurance Department’s SHIIP program to provide knowledgeable advice to Medicare beneficiaries through its community outreach program. Trained counselors also conduct orientations for individuals new to Medicare to help them understand their options, including coverage and gaps. Staff members assist Medicare beneficiaries wanting to apply for a federal low-income subsidy, and the Arkansas Medicare Savings program, and help them choose the most appropriate and affordable Medicare Advantage plan and Medicare Part D prescription drug plan. Staff also educates Medicare beneficiaries about free preventative health care services. WestArkRSVP offers all their services free of charge to seniors and those with disabilities in the counties of Benton, Washington, Sebastian, Crawford, Boone, Carroll, Marion and Madison.
To sign up for free Medicare counseling, Medicare beneficiaries must make an appointment. Schedule your appointment at the RSVP Center in Fort Smith by calling 479-783-4155 or the RSVP Office in Rogers by calling 479-636-0578.
El Dorado Connections is a volunteer center sponsored by the South Arkansas Regional Health Center, a provider for the counties of Calhoun, Columbia, Dallas, Nevada, Ouachita and Union. As senior advocates, El Dorado Connections’ staff and a trained group of volunteers assist Medicare beneficiaries with problems in their Medicare coverage and help them enroll in Medicare prescription drug plans. The program also educates seniors and the public about reporting Medicare fraud and abuse.
Nonprofit CareLink is the Area Agency on Aging for central Arkansas and provides Medicare prescription drug counseling for residents in this area of the state. Staff members help seniors navigate the Medicare or Medicare Advantage application process and stay updated on their prescription drug plans. Many seniors find Medicare Part D options difficult to understand, which is compounded by their changing health needs and annual changes in their health care plans. CareLink’s trained staff attempts to alleviate confusion by helping Medicare recipients reevaluate their plans each year to ensure they always have the best coverage. Medicare-eligible seniors must schedule an appointment during the open enrollment period to receive a free evaluation, but staff may also perform reviews in the homes of older residents in central Arkansas. CareLink also schedules Medicare prescription drug counseling at various central Arkansas locations during open enrollment periods.
The Medicare Health Plan Resource Center offers no-cost, professional assistance in understanding Medicare benefits and options that come with little to no premiums. Advisors help Arkansas seniors new to Medicare with their questions about Medicare and Medicare Advantage health plans, including co-payments, coinsurance, deductibles and other program elements. They also cover Medicare supplements, Medigap policies and prescription drug plans that affect Medicare costs and coverage. Seniors can also learn more about home health care, long-term care, dental plans and vision and hearing benefits. Through Medicare education, advice and consultations, trained staff help beneficiaries decide which plans best fit their lifestyles. Medicare recipients can schedule free assistance at any of the three Medicare Health Plan Resource Center offices located in Fayetteville, Mountain Home and Little Rock.