Medicare Advantage Plans in Alaska

checkmark Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: Jun 25, 2021

 

Medicare has a wide range of plans and benefits for seniors who are looking for high-quality health care coverage to suit their individual needs. Medicare Advantage, also known as Medicare Part C, offers seniors coverage for hospital and medical costs, as well as some extended options like prescription drugs, vision and dental care, and hearing services. Medicare Advantage plans are required by law to cover everything Original Medicare Parts A and B do and are managed by private health insurance agencies, instead of the federal government.

Key Points

  • 1 In 2019, there were 0 Medicare Advantage plans available in Alaska.
  • 2 1% of the total Medicare population in Alaska was enrolled in Medicare Advantage plans as of 2018.
  • 3 In 2018, Original Medicare spent an average of $7,540 per beneficiary in Alaska, which is 25% lower than the national average.
  • 4 There are currently no Medicare Advantage plans available in Alaska.

It is important that seniors consider their options carefully before making a decision. Each Medicare plan comes with its own set of network and eligibility rules, and comparing each plan and the benefits it provides will ensure that seniors make a decision that is aligned with their budget and health needs. The government has approved several different Medicare Advantage plans, including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service plans, and Special Needs Plans. The availability of each depends on the geographical location of the applicant and the plans on offer with each health insurance provider. 

Medicare Advantage Plans in Alaska

Types of Medicare Advantage Plans

Although Alaska’s Medicare Advantage program is nonexistent at the moment, new plans may become available in the future, and seniors should understand how these plans work. For example, Health Maintenance Organization (HMO) plans are the most restrictive, but they are also the most affordable. Seniors looking for maximum flexibility when it comes to selecting a network may decide that a Private Fee-For-Service plan is the most suitable option. Choosing a Medicare health plan may seem daunting, given the varying coverage and rules of each plan, but Alaska has a number of resources that provide free advice.

Health Maintenance Organization (HMO)

HMO plans require participants to receive all medical treatment from a specific network of healthcare providers. Emergency treatment and out-of-area urgent care are exceptions to this rule. In some cases, participants may be able to access other services from an out-of-network provider. However, costs are typically lower if treatment is received from a provider within the HMO network. Seniors enrolled in an HMO plan are also required to choose a primary care provider. HMO plans may be restrictive when it comes to network rules, but they are the most affordable Medicare Advantage plan available and always have low or no deductibles. 

Planned Provider Organizations (PPO)

PPO plans are offered by private insurance companies, and they also have their own network of hospitals, doctors, and healthcare providers. PPOs provide a little more freedom for seniors who want to choose doctors, hospitals, and specialists that are out of their plan’s network. However, choosing an out-of-network provider will usually cost more, with participants paying less if they receive treatment from in-network providers. Members of PPO plans do not need to choose a primary care doctor and usually don’t require a referral to see a specialist. 

Private Fee-For-Service Plans (PFFS)

PFFS plans also provide seniors with the flexibility to choose healthcare providers outside of their plan’s network. Participants can choose an out-of-network provider, as long as that provider accepts the terms of the plan; however, costs are usually lower if the participant stays within their network. It is down to each healthcare provider to determine how much participants pay for each service and how much the plan pays out. Due to their flexible rules, PFFS plans may come with higher premiums. In most cases, PFFS plans provide coverage for prescription drugs. 

Special Needs Plans (SNP)

Medicare Special Needs Plans (SNPs) are limited to people with specific illnesses and diseases or who live under special circumstances like in a skilled care facility. These plans have unique benefits, provider options, and drug coverage to meet the specific requirements of the enrollees they are designed to serve. Due to their nature, SNPs may not be widely available to all applicants. It is a legal requirement for SNPs to include prescription drug coverage. Participants on an SNP are usually required to choose a primary care doctor or to have a care coordinator assist with their health care. 

Enrollment & Eligibility for Medicare Advantage Plans in Alaska

Once Alaska’s Medicare Advantage program becomes established, seniors with Medicare Part A and Part B should be able to enroll, if they meet the following eligibility criteria: 

  • They must be aged 65 or older or have a qualifying disability.
  • They can’t be enrolled in a Medigap insurance plan.
  • They must live in an area where Medicare Advantage plans are available, a limiting factor in Alaska.
  • They must be a U.S. citizen or permanent resident.
  • They can’t have End Stage Renal Disease — SNPs may still be an option.

Enrollment Periods

Like many other health care plans, Medicare Advantage enrollment periods occur throughout the year. When applications can be accepted depends on the circumstances of the applicant. Some enrollment periods are only open to first-time applicants, while others are only available to existing Medicare members. The current national enrollment periods are:

  • Initial coverage election periods can only be accessed by first-time applicants. The enrollment period for applications starts three months before an applicant’s 65th birthday and ends three months after. 
  • Annual election periods run from October 15th to December 7th. This period is only available to existing members who wish to switch to a Medicare Advantage plan or move to a different plan. 
  • Open enrollment periods are limited to existing Medicare Advantage members who wish to go back to Original Medicare or change plans. This enrollment period starts on January 1st and ends on March 31st.  
  • Special enrollment periods start on April 1st and end on June 30th. Other special enrollment periods may be available at other times during the year. Only members of Medicare Part A who enrolled in Part B during an open enrollment period can switch to Medicare Advantage during this period. Seniors who have experienced life-altering events may also be able to enroll during special enrollment periods. 

Prescription Drug Coverage

Medicare prescription drug coverage is optional and offered to all Original Medicare members as Medicare Part D. Drug coverage is also often included with many Medicare Advantage plans as part of a bundle known as a Medicare Advantage Prescription Drug (MA-PD) plan. Members of an HMO or PPO plan may have prescription drug coverage included in their plan, although it may require a separate premium. If the HMO or PPO plan does not include prescription drug coverage, members cannot enroll in a stand-alone Medicare Part D plan or they will lose their Medicare Advantage plan and be automatically placed back into Original Medicare. PFFS members may have prescription drug coverage included in their plan — if they don’t, they can enroll in a stand-alone Medicare Part D plan. Special Needs Plans must always include prescription drug coverage. 

Medicare Advantage Resources in Alaska

It’s essential that Alaskan seniors have access to the highest quality health care possible and understand the Medicare plans and benefits available to them. Due to the varying nature of each plan and the eligibility and network rules associated with them, it can be a challenge for some seniors to make the right decision. Fortunately, Alaska has free resources that offer impartial advice designed to make the decision-making process easier. 

Alaska State Health Insurance Assistance Program (SHIP)

The Alaska State Health Insurance Assistance Program (SHIP) is staffed by volunteers who offer one-on-one counseling to seniors who are considering Medicare Advantage plans. Advice is available to help them choose the most suitable plan, take full advantage of the benefits available to them, and avoid common pitfalls. All advice is impartial and provided free of charge. 

Contact Information: Website | 800-478-6065

Alaska Senior Medicare Patrol (SMP)

The Senior Medicare Patrol (SMP) in Alaska is run by retired senior volunteers who are members of Medicare plans themselves. This puts them in the perfect position to assist fellow seniors and help them avoid Medicare abuse, fraud, and billing mistakes. From helping members understand their latest Medicare Summary Notice to informing them of the latest scams, Senior Medicare Patrol provides a useful free resource to Alaskan seniors. 

Contact Information: Website | 800-478-6065

Anchor-Age Center

Anchor-Age Center is a nonprofit organization that was founded to enhance the quality of life for Alaskan seniors. In addition to the activities and social interactions on offer at the center, the facility also provides free Medicare counseling. Volunteer counselors are on hand to assist with a wide range of Medicare topics, including assistance with Medicare enrollment; questions about Medicare billing, errors, and fraud; and how to apply for help paying for premiums and prescription drugs. 

Contact Information: Website | 800-478-6065

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Contributing Expert:

Roseann Birch, Medicare Consultant

With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.

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Reviewed by:

Leron Moore, Medicare Consultant

With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.