Also referred to as Medicare Part C, Medicare Advantage is an alternative to Original Medicare and its Part A and Part B hospital and medical insurance. Medicare Advantage plans are offered by private insurance companies and have different out-of-pocket costs depending on the level of coverage. Individuals covered under Medicare Advantage receive the same basic services traditional Medicare provides but may also enjoy additional coverage options, such as for prescription drugs and hearing, dental and vision care.
Approximately one-third of all Medicare recipients were enrolled in Medicare Advantage in 2019, and enrollment is expected to rise to approximately 47% by 2029, according to research from the Kaiser Family Foundation. The total number of recipients varies from state to state. Seventeen percent of Original Medicare beneficiaries in Kansas are enrolled in Medicare Advantage, while Hawaii has the highest number of enrollees at 47%. The neighboring state of Colorado has 43% enrollment, while Missouri has 39%.
Seniors have several choices of Medicare Advantage plans in Kansas, including HMO, PPO, SNP, PFFS and MSA plans. This guide explains the different plan types, how to obtain prescription drug coverage and when an individual may enroll in Medicare Advantage. For seniors in Kansas who need assistance in determining which plan works best for their needs, this guide also includes a list of Medicare Advantage resources.
Seniors in Kansas have several different types of Medicare Advantage plans to choose from. These plans include: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), Private Fee-For Service (PFFS) plans and Medical Savings Accounts (MSAs).
Health Maintenance Organizations (HMOs)
HMOs have their own network of doctors, health care providers and hospitals who agree to accept payments of a certain amount for services provided. Because the fees are previously agreed on, the premiums are generally lower for HMOs than other types of Medicare Advantage plans. Individuals enrolled in an HMO plan are required to stay within the network of providers for any required services. If a plan member chooses to go outside of the network, they may be responsible for the entire cost of services. Members are also required to select a primary care physician, and visits to a specialist usually require a referral from a PCP.
Preferred Provider Organizations (PPOs)
Like HMOs, PPOs have a network of health care providers, including hospitals and physicians, who provide services to members at a specific rate. Unlike HMOs, PPOs offer greater flexibility, so members may receive care from providers both in and outside of the network, and referrals are generally not required in order to see a specialist. Greater flexibility is usually associated with higher out-of-pocket costs and higher monthly premiums and there is usually a higher annual deductible that must be met in order to receive full benefits.
Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are designed for individuals with chronic illnesses or those with disabilities that require a specific treatment, as well as those who are in nursing homes. Medicare Advantage SNPs coordinate their benefits to the targeted providers and medications that best meet the needs of the members they serve. Unlike other types of Medicare Advantage plans, SNPs are required to provide prescription drug coverage, and in most cases the member must have a primary care physician or a care coordinator to assist with any health care needs.
Private Fee-For Service (PFFS) Plans
PFFS plans provide a list of providers who agree to accept the insurance and members aren’t required to select a primary care physician. Out-of-pocket costs are capped each year and specialists are available without a referral. While premiums may be lower for PFFS, the number of providers who accept the plan may be limited.
Medical Savings Accounts (MSAs)
Medical Savings Accounts have high deductibles that members must reach before receiving benefits. Once a year the plan deposits a specific amount into a savings account for medical expenses. This amount is generally lower than the plan’s deductible. In most cases, once the money in the savings account has been used, the individual must pay the full cost of treatment until reaching the deductible. Once the deductible is met, the MSA covers the cost of treatment for the remainder of the year.
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.
In Kansas, Medicare Advantage plans that include prescription drug coverage are referred to as Medicare Advantage Prescription Drug plans (MA-PD). Individuals covered under a MA-PD should not enroll in Medicare Part D, which is the Original Medicare stand-alone prescription drug plan. Those who enroll in both plans will be automatically disenrolled and placed back in an Original Medicare plan. While some medical plans that offer prescription drugs are bundled and require only one monthly premium, some members may have to pay two separate premiums.
Medicare Advantage offers a wealth of benefits for seniors in need of medical coverage. In most cases, the range of benefits provided are greater than those offered under Original Medicare. Because there are so many different plans and options to choose from, it can be challenging for some seniors to navigate through the choices and find the plan that is best suited for their needs. The following list of state and local resources in Kansas can help seniors obtain assistance with choosing an appropriate plan to maximize their benefits.
Free for seniors living within the state, the Senior Health Insurance Counseling for Kansas (SHICK) program connects individuals with trained volunteers within the community who can provide answers to questions about Medicare and other insurance-related issues. There are volunteers located throughout many communities who educate and help seniors choose which insurance plan best suits their needs, including choosing how much insurance is needed, the type of coverage they should have and understanding the cost of premiums. This one-on-one counseling is available free of charge both on the phone or in-person. The organization also provides information through public forums, presentations and through printed materials.
The Kansas Department of Health and Environment helps seniors determine their eligibility for Medicare and other programs and protects the rights of each consumer. The organization website also includes policy memos concerning long-term care, VA benefits and any eligibility changes as they are updated.
Seniors in Kansas who are enrolled in Medicare and have limited incomes may receive help with out-of-pocket insurance costs through a Kansas Medicare Savings Program. These programs may help with insurance premiums, deductibles and copayments. Available savings programs include the Qualified Medicare Beneficiary (QMB), Low Income Medicare Beneficiary (LMB) and Expanded Low-Income Medicare Beneficiary (ELMB), which can all lower the cost of Medicare premiums and cost-sharing expenses. To qualify, seniors must be 65 and older and currently receiving Medicare.
The Kansas Senior Medicare Patrol helps prevent Medicare abuse and fraud throughout the state and educates recipients on how to protect against identity theft and health care fraud. The program trains volunteers, helps seniors file reports and provides publications and information about fraud warnings. The program is free to all seniors who are applying for or currently enrolled in Medicare.
To learn more about Medicare fraud in Kansas or to sign up as a volunteer, contact the Kansas Department for Aging and Disability Services at 1-800-432-3535.
The Kansas Aging and Disability Resource Centers (ADRCs) help individuals of all ages, including seniors, plan for their future and long-term health needs. The organization provides counseling and a list of resources about Medicare and other insurance-related issues, including prescription drug coverage. Through local community offices, the resource centers can also guide seniors through their options and connect them with the available support services.
The KCMPA is the only accountable care organization in the state of Kansas that participates in the Medicare Shared Savings Program (MSSP). This organization is comprised of 12 primary care practices in Kansas and Missouri that helps keep medical costs low for seniors with limited incomes.
To learn more about which physicians participate in the MSSP, contact the organization at 1-816-673-9061.
The Kansas Area Agencies on Aging (AAAs) provide seniors with information and options counseling on Medicare. This assistance is available for free to seniors of all income levels and includes information about the best type of insurance to pay for nursing home care, caregivers and assisted living.