If you’ve signed up for Medicare, you may be wondering whether it’s enough coverage for your needs. Original Medicare, or Part A (hospital insurance) and Part B (outpatient insurance), doesn’t cover your prescription drugs and won’t limit your annual out-of-pocket expenses.
You can get more coverage with a Medicare Advantage plan, or Medicare Part C. Most Medicare Advantage (MA) plans include coverage for prescription drugs and an out-of-pocket maximum that limits your costs. MA plans are run by private insurance companies, but must provide the same coverage as Original Medicare.
What You Need to Know
- A Medicare Advantage plan must offer the same coverage as Original Medicare.
- Many MA plans provide coverage for prescription drugs.
- You can sign up for a Medicare Advantage plan when you enroll in Original Medicare.
What Types of Medicare Advantage Plans Are Available?
Medicare Advantage plans in Arkansas use a network of doctors and medical facilities to lower the cost of your care. Plan types include:
- Health Maintenance Organization (HMO): These plans require you to pick a primary care physician (PCP) and to get a referral to see a specialist. You’ll pay more out-of-pocket if you use out-of-network facilities for services, except in certain emergencies.1
- Preferred Provider Organization (PPO): You can save money by using an in-network doctor, but you don’t need to choose a PCP and you don’t need a referral for a specialist.
- Special Needs Plans (SNP): You’re eligible for these plans if you meet certain health conditions.2
- Chronic Condition SNP (C-SNP): These plans are available if you have a chronic health condition, such as diabetes or cancer.
- Institutional SNP (I-SNP): You’re eligible for these plans if you live in a nursing home or require in-home nursing care.
- Dual-Eligible SNP (D-SNP): These plans require you to be eligible for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): Your plan decides how much it will pay for services, as well as how much you’ll need to pay. You won’t need to pick a PCP.
- Medicare Medical Savings Accounts (MSA): These plans combine a high-deductible insurance plan and an MSA to pay for out-of-pocket expenses.
How to Save
You’ll save money in an MA plan by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
Original Medicare doesn’t include Medicare Part D, or coverage for prescription drugs. However, 89% of 2021 Medicare Advantage plans include prescription drug coverage.3 If you enroll in a Medicare Advantage plan in Arkansas, it’s likely to cover prescriptions.
Before you join a plan, make sure your prescriptions are covered by checking the drug formulary, or list of covered medications.
How Do You Choose Medicare Advantage Plans?
To choose the right plan for you, be sure to consider the costs and benefits of the plan, such as:
- Premiums: The monthly cost of your plan. You will likely need to pay the Medicare Part B premium ($148.50 for most people in 2021) in addition to the premium for your MA plan. Some providers in Arkansas offer zero-premium MA plans. However, your other costs may be higher on a zero-premium plan.
- Other Costs
- Deductible: Your annual out-of-pocket costs for care before your plan starts paying for services.
- Coinsurance: This is the amount you’ll have to cover for the cost of medical care, usually as a percentage of the total cost.
- Copay: A fixed price for a certain medical service.
- Out-of-Pocket Maximum: A yearly cap on your out-of-pocket medical expenses, usually excluding premiums.
- Plan Benefits
- Vision: Coverage for services such as eye exams or frames.
- Dental: Covers services including teeth cleaning or annual checkups.
- Telehealth: Coverage for remote health services, such as a phone consultation or video office visit with your doctor.
- Additional Perks: Many Medicare Advantage plans in Arkansas offer additional benefits like gym membership reimbursement or transportation services.
Most Medicare Advantage plans offer vision and dental coverage.
When and How to Enroll in Medicare Advantage?
You must enroll in Medicare Part A and B before you join an MA plan in Arkansas. You’re first eligible to enroll in Original Medicare during your Initial Enrollment Period. This period runs from three months before you turn 65 to three months after you turn 65.
You’ll still be able to join Medicare if you miss your Initial Enrollment Period. You can sign up anytime during the General Enrollment Period each year from January 1 to March 31. However, you might have to pay a late penalty on your Medicare premiums if you enroll after your Initial Enrollment Period.
Medicare signup is done through the Social Security Administration. You can enroll for Medicare online, over the phone or at your local Social Security office. Once you’re signed up for Medicare, you can join Medicare Advantage plans in Arkansas. Enrollment periods for MA plans include:
- Initial Enrollment Period: Join an MA plan when you first sign up for Original Medicare.
- Medicare Annual Election Period: Choose a Medicare Advantage plan during open enrollment from October 15 to December 7 each year.
- Medicare Advantage Open Enrollment Period: Switch back to Original Medicare or change your MA plan annually from January 1 to March 31.
- Special Enrollment Period: You may be eligible to enroll in an MA plan outside of the usual enrollment period if you meet certain criteria, including:
- You’ve moved outside of the service area of your current plan.
- You get health coverage from an employer or union plan.
- You’re about to lose your existing coverage, including Medicaid eligibility.
- Your current plan is leaving the Medicare program.
- You’ve been diagnosed with a health condition that’s better served by an SNP.
How Much Do Medicare Advantage Plans Cost in Arkansas?
The cost of Medicare Advantage plans in Arkansas varies based on a few factors, including your location. The average monthly cost for an MA plan in Arkansas is $14.49.4 Your premiums in Little Rock or Fayetteville could be between $0 and $131 per month.5
You’ll need to consider other costs, such as your deductible or out-of-pocket maximums, when choosing between plans.
What If You Want to Change Your Medicare Advantage Plan?
The best way to change Medicare Advantage plans in Arkansas is to switch during an annual open enrollment period. After switching, your old plan is automatically canceled once your new plan’s coverage starts.
What Are Alternatives to Medicare Advantage?
A Medicare Advantage plan isn’t your only option for healthcare coverage. Other programs or options in Arkansas include:
- Program of All-Inclusive Care for the Elderly (PACE): This program provides comprehensive medical care. You must live within the service area of a program center and meet income requirements to qualify.6
- Original Medicare: You can stay with Medicare Part A and B if it provides enough coverage for your needs.
- Medicare Supplement: Known as Medigap, these policies provide additional coverage to Original Medicare.
- Medicare Supplement with Part D: A Medigap policy doesn’t include prescription drug coverage, so you’ll need to purchase a Part D plan separately.
What Are Medicare Resources in Arkansas?
- Senior Health Insurance Information Program of Arkansas (SHIIP): This program provides free, unbiased counseling and resources to help you enroll in Medicare and choose a plan.7
- Arkansas Insurance Department: The department’s website offers resources to help you understand your Medicare options and prepare for enrollment.8
- Arkansas Medicaid: Medicaid is a federal program run by each state and helps provide affordable health insurance for those with low income or disability.9
If you think a Medicare Advantage plan is right for you, start comparing plans available in your area so you are ready to sign up during your Initial Enrollment Period.