Medicare in Wyoming

Medicare is a federal health insurance program for adults aged 65 and older and those living with certain disabilities or serious medical conditions. Original Medicare consists of two parts. Part A covers hospital stays, nursing home care and some elements of home health care. Part B covers outpatient care, medical supplies and preventative care. The state spends around $1.1 billion on Medicare Parts A and B combined yearly, based on the latest numbers from 2021. Some seniors enrolled in Original Medicare opt to purchase supplemental coverage to help offset the cost of any services or treatments that do not fall under the umbrella of Medicare Parts A and B.

In addition to the two main components, there’s the option to add Part D, which covers the cost of prescription drugs. Some insurance providers offer Medicare Part C, or Medicare Advantage, which includes the benefits of Original Medicare plus other services such as vision or dental care. In Wyoming, around 18.6% of the population are 65 and over and, therefore, eligible for the Medicare program based on age. There are 119,518 people enrolled in Original Medicare in Wyoming as of 2023 out of 123,404 who are eligible, and 15,089 enrolled in Medicare Advantage. However, the Part C enrollment figures are relatively low at 12% compared to the national average of 48%.

Medicare Advantage offers additional benefits on top of Original Medicare, such as coverage for vision and dental services as well as prescription drugs. Medicare Advantage programs are open to all Medicare-eligible individuals in Wyoming, and interest in Medicare Advantage is growing in the state, with the number of enrollees increasing by 81% in 2023, up from 8,330 in 2022. Enrollment may continue to grow as the number of plans has increased, and premiums fell from $45.01 in 2022 to $36.46 in 2023.

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). Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, so enrollees should find it relatively easy to access care wherever they are in the United States.

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,600 for Part A and $226 for Part B in 2023. 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 Part C, also known as Medicare Advantage, is offered by private health insurance companies. This form of Medicare offers the same benefits as Original Medicare, with the exception of hospice care which is provided only by Medicare Part A. Medicare Advantage providers also offer additional benefits, such as prescription drug coverage, vision or dental care.

Seniors can choose from four different coverage types, including Special Needs Plans (SNPs), Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PMOs) and Private Fee for Service (PFFS) plans. It’s important to consider the network, referral options and out-of-pocket costs before choosing a plan.

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 August 2023, 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 2023 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.