Medicare in Arkansas

Medicare is the federally managed health insurance program for seniors over the age of 65 and adults with certain disabilities. It currently serves over 644,000 Arkansas residents, up from 520,000 in 2010. While enrollment in Original Medicare has stalled, enrollment in Medicare Advantage plans tripled from 2010 to 2020. The majority of the state still uses the traditional program, but at the current pace, the number of Medicare beneficiaries enrolled in Advantage plans will surpass Original Medicare by the end of 2030. 

Original Medicare has two components. Part A is available for free as long as seniors or their spouses paid taxes for a certain period throughout their lifetimes. It covers emergency care and other inpatient hospital care, skilled nursing treatment, hospice care and some home health services. Part B covers preventative care, outpatient medical procedures, medical supplies and equipment, medical transportation and diagnostic testing. The standard Part B premium costs $170.10 per month in 2022. 

Medicare Part C is most popularly known as the Medicare Advantage program. It allows Medicare enrollees to choose a plan administered by a private insurance company instead of the traditional benefits provided by the government. Advantage plans let people customize their coverage by adding benefits they’d miss out on if they remained on Original Medicare, such as vision, dental and prescription drug coverage.

Medicare Part D is a prescription drug plan that retirees may enroll in and is a great choice especially for those who selected Original Medicare. Most Advantage plans include prescription drug coverage (Part D). Medicare Supplement plans are also available for seniors who’d like to offset their out-of-pocket expenses. 

This guide reviews all the Medicare options for seniors in the state of Arkansas. It explains how retirees may customize their coverage to suit their needs as well as where to request assistance reviewing plans, applying for benefits and determining if they qualify for financial aid. 

Options for Medicare Coverage in Arkansas

While Original Medicare has been the trusted source of basic coverage for many seniors in Arkansas, some people require more coverage than the program offers. Seniors have several options that allow them to create custom coverage by selecting policies sold by private insurance companies serving the state while enjoying federal subsidies that make premiums more affordable. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is an alternative to traditional Medicare coverage. Advantage plans are sold by private insurance companies but must offer the same benefits provided by Parts A and B (with the exception of hospice care which remains covered under Medicare Part A). Advantage plans often include coverage for vision and dental care, prescription drugs and other useful benefits. Seniors may receive special discounts on gym memberships and other wellness services, which can allow them to live healthy lives. Annual out-of-pocket limits also help enrollees budget more effectively for their medical expenses.

The four types of Medicare Advantage plans are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plans (SNP). Eligibility rules, premiums, copayments, coinsurance and requirements to see a specialist may all vary between Advantage plans. 

Who Should Consider Medicare Advantage

An Advantage plan might be a good choice for someone who:

• Is in overall good health and may be eligible for lower premiums
• Wants comprehensive coverage not provided by Original Medicare
• Needs to have more control over out-of-pocket expenses
• Wishes to enroll in dental or vision coverage

The Top 10 Medicare Advantage Plans in Arkansas

Arkansas seniors have a lot of Advantage plans to choose from. The following table provides information on the most popular insurance providers as of April 2022 based on enrollment data, monthly cost range and satisfaction ratings. More information on Medicare Part C is available on the Medicare Advantage Plans in Arkansas page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Arkansas

Enrolling in Medicare can be a complex process, especially for those who wish to sign up for an Advantage plan. Several programs and agencies in Arkansas offer free assistance to seniors, from helping them learn more about their benefits to assisting with enrollment paperwork, preventing fraud and determining if seniors qualify for financial assistance to help with their out-of-pocket expenses or long-term care.