Medicare Advantage, called Medicare Part C, is an alternative to Original Medicare (comprised of Medicare Parts and B). The difference is that where Original Medicare is federally-administered standardized care for all participants, Medicare Advantage provides a selection of coverage levels and costs through private insurance companies. Hearing, vision and prescription drug costs, not covered through Original Medicare, can also be covered through Medicare Advantage plans.
The popularity and profile of Medicare Advantage vary dramatically depending on the state. Nationally, around 34% of Medicare beneficiaries have chosen a Medicare Advantage alternative. Medicare Advantage plans have come only recently to the Wyoming insurance market, though, first becoming available to most of the state only in 2019. As such, Wyoming has one of the lowest rates of Medicare Advantage enrollment in America, with only 3% of recipients using it so far. The only state with a lower enrollment rate is Alaska at 1%. Wyoming’s neighboring states may prove more indicative of the likely trajectory of Medicare Advantage in the region, with enrollment rates ranging from 17% in Montana all the way up to 38% in Colorado.
Seniors seeking out Medicare Advantage plans in Wyoming have a variety of choices for plans and providers. In this guide, we discuss the four major plan types (HMO, PPO, SNP and PFFS) along with MA-PD plans that encompass coverage for prescription drugs. We also provide a selection of resources in Wyoming for those who need added guidance in navigating the complexities of Medicare and discovering the right plan for them.
Medicare Advantage provides a selection of several different types of plan. The plan types available for seniors in Wyoming include Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, along with Special Needs Plans (SNP) and Private Fee-for-Service coverage (PFFS).
Health Maintenance Organizations (HMO)
HMO plans are managed care arrangements based on the administration of care through specific networks of doctors, hospitals and other providers. They tend to offer lower premiums than other options with the trade-off of more limited flexibility in accessing care. An HMO plan beneficiary enjoys coverage only when receiving care within their specific network; going out-of-network can mean being responsible for the full cost of care. HMO plan members are required to have a primary care physician within the network whose referrals are a prerequisite for connecting with specialists.
Preferred Provider Organizations (PPO)
Preferred Provider Organizations (PPOs) have certain similarities with HMOs in that they deal in managed care through specified provider networks, and offer the best coverage for members within those networks. They do, however, offer greater flexibility. Whereas HMOs may entirely deny coverage for participants going outside their provider network, PPOs offer at least partial coverage for these kinds of excursions. PPO members can also generally access specialist care without a primary care physician’s referral. The lowest copay and coinsurance rates are, nevertheless, still available only when members stay within the PPO’s network, and PPO plans tend to have higher premiums.
Special Needs Plans (SNP)
The plans most focused on the needs of specific populations, such as those who are disabled, those who have been institutionalized or those coping with chronic conditions, are called Special Needs Plans or SNPs. These coordinated care plans limit enrollment to patients facing certain particular challenges or who are dually eligible for Medicare and Medicaid. They’re required to include prescription drug coverage and are focused on coordinating the efforts of health care providers in a targeted way to address the specific needs of their members.
Private Fee-for-Service (PFFS)
Private Fee-for-Service (or PFFS) plans proceed from a set of predetermined terms and conditions for how much they pay doctors, hospitals and other providers, and how much in turn plan members will be charged for treatment. Many PFFS plans allow members to contract separately with any provider who will accept the plan’s terms. There are PFFS plans that have their own care networks, in which case (much as with PPOs) it’s generally possible to contract with out-of-network providers but whose costs are generally lower inside the network. Some PFFS plans may include prescription drug coverage. If a plan doesn’t, it may allow members to enroll separately in a Medicare Part D plan.
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.
Coverage of prescription drugs is referred to as Medicare Part D and is not available through Original Medicare. It’s possible to enroll in a stand-alone Medicare Part D plan. Alternatively, this coverage is available through enrollment in a Medicare Advantage Prescription Drugs plan (MA-PD). Seniors cannot enroll in both types of plan at the same time in Wyoming. MA-PD participants need to continue paying their Part B monthly premiums along with their MA-PD premiums.
Medicare can be an invaluable resource for seniors. However, it can be difficult to sort through all the available options and information and find the choice that’s best for a given individual. Here, we’ve assembled some of the state and local resources that can help make sense of the system’s complexities and find the best possible options for coverage.
This federally mandated and state-run program is specifically focused on helping seniors (and other Medicare recipients) understand the ins and outs of Medicare coverage, to understand what they’re entitled to, and to answer their questions. WSHIIP maintains a team of dozens of volunteer counselors statewide to advise beneficiaries and help solve problems free of charge. These volunteers are required to attend annual training to ensure their knowledge and counsel is up to date.
Senior Medicare Patrols are funded by federal grants toward the objective of empowering senior Medicare beneficiaries, providing outreach and education to help people report complaints about abuse, fraud or substandard care. They present to groups and exhibit at events in the community and also work one-on-one with Medicare beneficiaries. Much like their cousin program WSHIIP, SMPs are a volunteer-powered initiative.
The Wyoming Insurance Department is tasked with the impartial enforcement of the state’s insurance regulations and laws, with maintaining a healthy marketplace and with the promotion of needed change. It hosts a number of resources for those seeking information about Medicare and Medicare Advantage, including downloads of informative handbooks that provide initial guidance for those researching plans and trying to work out what the different kinds of Medicare plans provide. The department also provides information on Medicaid, Medicare Supplement Plans and long-term insurance.
The American Association of Retired Persons (AARP) has been America’s most influential advocacy organization for seniors for over six decades. It supports a wide range of programs focused on helping Americans age with choice and dignity and played a prominent role in the formation of Medicare, for which the organization hosts a detailed online resource center. State branches such as AARP Wyoming are active in disseminating information, staging events and seminars, and providing education and webinars about how to interact with programs such as Medicare and Medicare Advantage.
A judicial branch organization affiliated with the Wyoming Supreme Court, Equal Justice Wyoming is dedicated to providing statewide assistance to low-income citizens in accessing legal counsel and civil justice. It provides free legal aid for individuals meeting certain qualifications, as well as Self-Help research and preparation facilities accessible to anyone. Among the many areas of the legal system for which it provides guidance and assistance is health care, including legal aid when navigating the health insurance marketplace.
Based out of the University of Wyoming, WIND is a unit in the College of Health Sciences that works to provide community services, individual and family supports, education, training and early intervention for people with disabilities, in particular developmental disabilities. Among the many programs and services that WIND provides is a TeleHealth network (WyTN). This is of potential interest to senior recipients of Medicare as it connects providers with the public and has informative webinars, education and training and informative documents at its resource center, many of them directly touching on Medicare and Medicare Advantage.