Medicare in Wyoming

The federal government offers medical coverage to older adults age 65 and over and to younger adults with certain disabilities under its Medicare plan. Though Wyoming is the smallest state, with 578,803 people, many residents qualify for Medicare, with nearly a fifth of the population receiving Medicare. Wyoming has over 110,000 Medicare users, and more than 96% had Original Medicare plans in 2021.

Original Medicare has two parts: Part A and Part B. Through Part A, seniors receive coverage for inpatient care in a hospital, nursing home care, hospice, and some home health care needs. Anyone who paid Medicare payroll taxes or was married to someone who did for a sufficient number of years receives Part A at no cost. Part B is the coverage for basic day-to-day medical care and supplies. In 2022, the premium for Part B is $170.10.

Seniors who want additional options can choose Medicare Advantage plans, also known as Medicare Part C. These plans must provide what Original Medicare offers, but they come from private health insurance companies. This allows the plans to offer additional coverage, such as prescription drug coverage or dental. 

Seniors can also buy Part D, which is prescription drug coverage. Part D is available for Original Medicare and other Medicare plans. Most Advantage Plans include Part D, and therefore seniors choosing these plans do not need a separate enrollment in Medicare drug coverage. 

Original Medicare users can add Medicare supplement plans to their coverage, also known as Medigap. Medigap covers the costs not covered in the policyholder’s other Medicare coverage, and it comes from private health insurance companies. Those enrolled in the Advantage plans don’t need Medigap. 

All of these options can be confusing and, at times, overwhelming. This guide breaks down the options for Medicare in Wyoming, including the personalized options available through Part C. With this information, older adults and their caregivers can make better decisions about their health coverage.

Options for Medicare Coverage in Wyoming

Seniors in Wyoming have more than one way to get Medicare coverage. These options ensure that seniors can choose a plan that is a good fit for their needs and budget. These options include coverage through the federal government as well as plans provided through private health insurance companies that offer additional coverage choices.

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)

When Original Medicare is not the best fit, some beneficiaries will opt for Medicare Advantage coverage, also known as Medicare Part C. These plans come from private health insurance companies that must provide the same benefits as Original Medicare, except for hospice care, which only Medicare Part A covers. They often offer additional coverage not usually part of Medicare, such as prescription drug coverage (Part D). Many plans also include dental or vision care. 

Medicare Advantage plans include four basic types of coverage. Seniors can choose from Health Maintenance Organization (HMO), Special Needs Plans (SNPs), Preferred Provider Organization (PPO) and Private Fee for Service (PFFS) plans. Each plan has its own out-of-pocket costs. The plan’s regulations determine eligibility, networks and referrals.

Who Should Consider Medicare Advantage

Seniors may find Medicare Advantage to be a good option if they:

• Want better control over their medical costs
• Are in fairly good health, so may benefit from lower premiums
• Could benefit from coverage outside of Original Medicare
• Like the idea of a managed care plan

The Top Medicare Advantage Plans in Wyoming

Seniors in Wyoming have multiple plans available if they opt for Medicare Advantage coverage. This table highlights the top plans based on the number of people enrolled. The table shows facts such as how much these beneficiaries paid for coverage as of April 2022, the types of plans the provider offers, and the plan’s Medicare Star Rating. Applicants can learn more about their Medicare Advantage options at the Medicare Advantage Plans in Wyoming 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 Wyoming

Medicare options and the applications for coverage can be confusing and overwhelming. In Wyoming, there are several resources for older adults to receive one-on-one support and counseling as they navigate these choices. These resources help Medicare beneficiaries and applicants, as well as their caregivers, understand their Medicare coverage, get help with applications and appeals, and learn about health care coverage choices. These programs are available at no cost to seniors.