What You Need to Know
Medicare Advantage plans include everything Original Medicare covers.
Options for Medicare Advantage plans in Wyoming are limited.
Unlike Original Medicare, Medicare Advantage caps your annual healthcare out-of-pocket
If you’re approaching age 65, or if you have already arrived, you need to be thinking about Medicare. One of the options to consider is a Medicare Advantage (MA) plan, although in Wyoming, you have only limited options.
Original Medicare consists of Part A (hospital coverage) and Part B (outpatient coverage). Medicare Advantage plans, also known as Part C, are offered by private insurance companies. They cover everything that Original Medicare does. But in addition to Medicare Part A and Part B, most MA plans offer additional benefits. And unlike Original Medicare, MA plans cap annual out-of-pocket costs.
What Types of Medicare Advantage Plans Are Available in Wyoming?
MA plan options are extremely limited in Wyoming. Unlike most other states, Wyoming does not offer any Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, or Special Needs Plans (SNPs). Choices are limited to Medicare Savings Accounts and Private Fee-For-Service plans, and even those options are scarce.
Lasso Healthcare offers two MSAs available in all 23 counties in Wyoming. United HealthCare offers two PFFS plans, but they are only available in six counties.1
Medicare Savings Accounts (MSAs) are high-deductible plans combined with a medical savings account. The plan deposits money into a bank account which you use to pay for Medicare-covered services before you meet your deductible. Once met, your plan pays covered expenses.
Private Fee-For-Service (PFFS) plans choose how much the plan will pay healthcare providers and how much you will pay out of pocket. You can go to any Medicare-approved doctor, other healthcare provider, or hospital that accepts the plan’s payment terms and agrees to treat you. Not all providers will.
Timing is key
You can only enroll in Medicare Advantage plans during a certain window of time.
What Are Prescription Drug Plan Options with Medicare Advantage?
One of the PFFS plans includes prescription drug coverage. If you choose any of the other plans, you can enroll in a separate drug plan for an additional fee. This standalone plan is known as Medicare Part D.
How Do You Choose Medicare Advantage Plans?
Cost and coverage are key factors in choosing any health insurance plan, so consider premium costs, other costs, and plan benefits.
Your premium is the amount you pay each month for the plan. The two PFFS plans have monthly premiums. MSA plans don’t charge monthly premiums. With all of these plans, you are still responsible for the Medicare Part B premium.
- Coinsurance is a percentage of the cost for services you pay once you meet your deductible.
- Copayments are fixed amounts you pay for office visits and/or prescription drugs.
- Deductible is the amount you must spend before your plan starts to contribute toward your healthcare expenses.
- Out-of-pocket maximum obligation is the highest amount you’re required to pay during the plan year.
Wyoming’s PFFS plans provide benefits that you don’t get with Original Medicare. These include coverage for vision, hearing, and telehealth services. PFFS plans also provide coverage if you have a health emergency when traveling outside the U.S.
Some Wyoming Medicare Advantage plans include benefits that you don’t get with Original Medicare.
When and How to Enroll in Medicare Advantage
You must enroll in Medicare Part A and B before you can enroll in an MA plan. Choose the appropriate enrollment period.
Initial Enrollment Period: The seven-month period beginning three months before, the month of, and the three months after your 65th birthday.
Open Enrollment Period (Annual Election Period): October 15 through December 7 annually. You can change MA plans, switch between MA and Original Medicare plans, and enroll in a Part D plan.
General Enrollment Period: January 1 through March 31 annually with coverage beginning July 1.
Medicare Advantage Open Enrollment Period: If you enrolled in Medicare during the General Enrollment Period, you may enroll in an MA plan from April through June with coverage beginning July 1.
Special Enrollment Period: Under certain circumstances, you may be able to enroll outside the scheduled periods without incurring a penalty:
- Change of service area – includes moving out of the provider network.
- Loss of coverage – such as losing coverage under Medicaid or an employer’s plan.
- Gain coverage – such as qualifying for group coverage under an employer or union plan.
- Plan changes – if your insurance company’s contract is terminated by Medicare.
What’s the Medicare Advantage Enrollment in Wyoming?
Most of Wyoming’s Medicare beneficiaries are enrolled in Original Medicare. Only 5,400 residents, or 4.3% of all Medicare beneficiaries in the state, are enrolled in PFFS plans or MSAs.
How Much Do Medicare Advantage Plans Cost in Wyoming?
If you choose the PFFS plan with prescription drug coverage, your monthly premium is $64. If you choose the PFFS plan without it, the premium is $40.2 You must also pay the Part B premium, which for most people is $148.50. Some higher-income seniors may pay more for Part B.3
If you want an MSA, there are two plans to choose between. One plan deposits $2000 in your Medicare Savings Account toward a $5000 deductible. The other plan deposits $3000 toward an $8000 deductible. After you meet the deductible, the MSA plan pays Medicare-covered expenses. You are also responsible for the monthly Part B premium.
How Do You Change Your Medicare Advantage Plan?
If you’re already enrolled in Medicare Advantage, you can make a change during Open Enrollment or General Enrollment periods. You can switch to a different MA plan or drop your MA plan and join Original Medicare.
What Are Alternatives to Medicare Advantage?
The alternative to an MA plan in Wyoming is Original Medicare, which includes Part A and B only. Many people who choose this plan also enroll in a Medicare Part D plan to pay for prescriptions. If you go this route, you may also want to purchase a Medigap policy from a private insurer to pay for uncovered expenses.
Medicare Advantage plans are similar to Original Medicare with a Medigap policy and a Part D plan, but there are differences. One advantage to MA plans is that they bundle all policies, eliminating the need to manage multiple plans.
What Are Medicare Resources in Wyoming?
Wyoming Department of Health – provides information about home and community-based services for adults age 65 and older who require nursing facility care.
Wyoming State Health Insurance Information Program (WSHIIP) – provides free information and assistance to help you choose Medicare coverage.
Now that you’ve learned more about Medicare Advantage plans in Wyoming, speak to a license agent to learn more or check the Medicare Plan Finder. Then, get enrolled during the appropriate enrollment period and get covered!