Kansas Medicare Advantage Plans — You Have Options

If you’re looking at Medicare options in Kansas, you know Medicare Part A and B, or Original Medicare, doesn’t fully cover your health services or put a cap on out-of-pocket costs. Medicare Advantage (MA), or Medicare Part C, provides more comprehensive coverage through private insurers while giving you the same protections as Original Medicare.

What You Need To Know

You’ll save money with many Medicare Advantage plans by staying within your network of doctors and facilities. 

Most MA plans offer prescription drug coverage, which isn’t included in Original Medicare.

There are several enrollment periods during the year when you can sign up. 

What Types of Medicare Advantage Plans Are Available?

You have a few different options for Medicare Advantage plans, depending on your needs. Standard plan types are:

• HMO: Health Maintenance Organization
  • This plan generally has the lowest monthly premiums and the most restrictive network. Referrals to a specialist are made by your primary care physician. You’ll pay more out-of-pocket if you go outside your network.
• PPO: Preferred Provider Organization
  • This offers a broader network than an HMO. Many plans don’t require you to choose a primary care physician or to get referrals to see a specialist, but monthly premiums are generally higher.
• SNP: Special Needs Plans
  • For people who use more medical services than the general public. There are different types:
    • C-SNP:¹ Chronic condition special needs plans, for those managing one or more chronic conditions like diabetes, heart disease or cancer.²
    • D-SNP: Dual-eligible special needs plans, for people who are eligible for Medicare and Medicaid.
    • I-SNP:³ Institutional special needs plans, for those receiving care in a skilled nursing facility or another type of institution.
• PFFS: Private Fee For Service plans:⁴ These plans allow you to see any eligible provider at preset rates. You typically don’t have a network, and you don’t need to select a primary care provider. 
• MSA:⁵ A Medicare Medical Savings Account plan combines a high-deductible MA plan with a plan-funded savings account you can use for healthcare costs. 

What Are Prescription Drug Options With Medicare Advantage?

Many Medicare Advantage plans in Kansas include Medicare Part D prescription drug coverage. Check your plan’s drug formulary, or list of approved medications, to make sure your medications are included. 

If your plan doesn’t include prescription drug coverage, you can purchase a separate Part D plan. 

How Do You Choose Medicare Advantage Plans?

Check the details when you’re choosing a Medicare Advantage plan, because monthly costs can vary by insurer. 

Costs to consider are:

• Premiums
  • The monthly amount you pay for an insurance plan. Costs vary by plan and coverage. There are zero-premium options that don’t charge you a monthly cost beyond the Medicare Part B premium ($170.10 in 2022), but your out-of-pocket costs may be higher as a result.
• Copays 
  • The set amount you pay for a covered service. You pay a $0 to $20 copay for primary care visits and $0 to $50 for specialists. 

• Coinsurance
  • The percentage of costs you pay for a covered service after you’ve met your deductible, if there is one. You pay up to 20% coinsurance for primary care visits and 20% coinsurance for specialists and other services.

• Deductibles
  • The amount you pay each year out-of-pocket before your insurer starts to pay for covered services. 

• Maximum Out-of-Pocket Costs
  • You pay a certain amount of costs that aren’t covered before the cap kicks in. Out-of-pocket maximums range from $3,000 to $7,550 for in-network services. Out-of-network services have out-of-pocket maximums as high as $10,000.

• Other Plan Benefits
  • Dental: Many plans include coverage for teeth cleaning and other services. 
  • Vision: Many plans include coverage for eye exams and glasses or contact fitting. 
  • Telemedicine: Many plans cover virtual doctor visits and other remote services.
  • Other perks: Many plans include coverage for fitness programs and transportation help. 

When and How to Enroll in Medicare Advantage?

You can sign up for Medicare Advantage as soon as you’re eligible for Original Medicare. Your Initial Enrollment Period begins three months before the month you turn 65 years old, and ends three months after you turn 65. 

The Annual Election Period runs October 15 through December 7 and allows you to change plans for the following year. Plan changes go into effect January 1. Enrolling in a new plan will generally cancel your current plan on December 31.

The Medicare Advantage Open Enrollment Period runs January 1 through March 31. You can change your Medicare Advantage plan or return to Original Medicare. 

The General Enrollment Period runs January 1 to March 31 each year. You can sign up then if you missed the Initial Enrollment Period for Medicare Part A and B. However, your coverage won’t begin until July 1.

In certain situations, you can qualify for a Special Enrollment Period. Those include: You move out of your service area, you lose or gain coverage eligibility, your current plan changes, or you’re diagnosed with a condition that qualifies you for a C-SNP. 

How Do You Sign Up?

You can sign up generally in three ways:

1. Contact the insurance company directly. 
2. Work with a Medicare-certified insurance agent, who can help you pick a plan and get enrolled.
3. Contact Medicare online or by phone. 

How Much Do Medicare Advantage Plans Cost in Kansas?

In many Kansas ZIP codes⁶ there are zero-premium plan options and plans ranging from $29 to $131 per month.

What If You Want to Change Your Medicare Advantage Plan?

You can change your plan during the Medicare Annual Election Period, October 15 to December 7, or the Open Enrollment Period, January 1 to March 31. 

What Are Alternatives to Medicare Advantage? 

Medicare Part A and B: You can stick with Original Medicare if it offers enough coverage for your needs.

Medicare Supplement: These plans help you pay the costs not covered by Original Medicare. 

Medicare Supplement plus Medicare Part D: You can purchase a separate Part D prescription drug plan to combine with your Medicare Supplement plan. 

Program of All-Inclusive Care for the Elderly (PACE):⁷ This federal program offers comprehensive, community-based health services to those who qualify.  

What Are Medicare Resources in Kansas? 

Kansas Department for Aging and Disability Services: The Senior Health Insurance Counseling for Kansas program⁸ offers free one-to-one counseling, education and other services.

Kansas Insurance Department:⁹ The site offers resources for Medicare Part D and other plans. 

Medicaid: The Kansas Medical Assistance Program (KMAP)¹⁰ is available to those who qualify based on income level or disability. 

Your county public health department can also help you access Medicaid or other programs.

State Medicare Advantage Data in Kansas

Next Steps

If a Medicare Advantage plan is the best fit for your health needs, compare different insurers in your area to find a plan. Be sure to sign up for a plan that offers the right amount of coverage for the right cost.