Medicare Advantage Plans in Arkansas

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, telehealth, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but some qualify earlier due to disability or conditions such as ALS or ESRD. It’s important to understand key enrollment periods to avoid penalties or lapses in coverage:

• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Periods

What Types of Medicare Advantage Plans Are Available in Arkansas?

Arkansas offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists. You must choose a primary care physician (PCP), and care outside the network usually costs more unless it’s an emergency.
• Preferred Provider Organizations (PPOs): Offer more flexibility in provider choice, allowing out-of-network care at higher costs and typically no referrals required.
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider who accepts the plan’s terms. Some plans include provider networks to help lower costs.
• Special Needs Plans (SNPs):
  • C-SNPs: For people with chronic conditions such as diabetes, cancer, or heart disease.
  • I-SNPs: For individuals living in a nursing facility or requiring in-home nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those who qualify for both Medicare and Medicaid. These plans often include extra benefits like dental, drug coverage, and transportation—typically at low or no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible Medicare Advantage plan with a medical savings account that your plan funds to help cover healthcare costs.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Arkansas include Part D drug coverage. However, MSAs and some PFFS plans do not. If your plan does not include prescription drug benefits, you may:

• Enroll in a separate Part D plan (only allowed with certain plans like PFFS).
• Be subject to a late enrollment penalty if you delay and lack creditable drug coverage.

Before enrolling, check the plan’s formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Before enrolling, review this guide to Medicare Advantage costs. Consider:

• Premiums: Many Arkansas plans have $0 premiums, while others charge a monthly fee.
• Deductibles, Coinsurance & Copays: These determine your out-of-pocket costs.
• Out-of-Pocket Maximums: MA plans cap your annual costs for covered services.
• Extra Benefits: Many plans include vision, dental, hearing, telehealth, transportation, OTC allowances, and fitness program memberships.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: Starts 3 months before your 65th birthday and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop MA plans.
• General Enrollment (Jan 1–Mar 31): For those who enroll in Medicare Part B during this time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by events such as:
  • Moving outside your plan’s service area
  • Losing employer/union or Medicaid coverage
  • Plan termination
  • Qualifying for an SNP due to a chronic condition

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Once your new coverage begins, your previous plan will automatically end.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system helps you compare plans based on quality and performance:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These annual ratings reflect both health plan services (Part C) and drug plan services (Part D).

What Are Medicare Resources in Arkansas?

Arkansas provides several Medicare assistance programs:

• Arkansas SHIIP Program: Offers free Medicare counseling to help you choose the right plan.
• Arkansas SMP Program: Educates beneficiaries on identifying and preventing healthcare fraud.
• Arkansas Insurance Department: Accepts insurance complaints.
• Arkansas Medicaid: Helps low-income individuals pay for healthcare services. Call 1-855-372-1084 for assistance.

Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover out-of-pocket costs that Original Medicare doesn’t pay, such as deductibles, copayments, and coinsurance.

• You must be enrolled in Medicare Parts A and B to buy a plan.
• Enroll during your six-month Medigap Open Enrollment Period (starts when you enroll in Part B) for guaranteed issue.
• Medigap doesn’t cover prescriptions—you’ll need a separate Part D plan.
• Ten standardized plans are available, with Plans F, G, and N being most popular.
• Medicare Supplement Plan G had the highest enrollment in 2023 and is growing rapidly.
• Plan F is unavailable to new Medicare beneficiaries after 2020.

Learn more about Medicare Supplement plans in Arkansas.

Next Steps

If a Medicare Advantage plan in Arkansas is right for you, compare available options in your area. Review plan premiums, benefits, provider networks, and out-of-pocket costs. Then, be ready to enroll during the appropriate enrollment period to secure your coverage.