Medicare Advantage Plans in Arkansas

checkmark Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: November 17, 2020

 

Medicare Advantage provides an alternative to beneficiaries who are eligible for Original Medicare. While Original Medicare has separate coverage and costs for hospital insurance (Medicare Part A) and medical insurance (Medicare Part B), a Medicare Advantage plan bundles both together. It may also include prescription drug coverage (Medicare Part D) and cover services that Original Medicare doesn't, including vision, dental, and hearing care. Original Medicare is managed by the federal government, while Medicare-approved private insurance companies handle Medicare Advantage plans.

Key Point Module

  • 1 In 2019, there were 40 Medicare Advantage plans available in Arkansas.
  • 2 22% of the total Medicare population in Arkansas is enrolled in Medicare Advantage plans as of 2018.
  • 3 In 2018, Original Medicare spent an average of $10,044 per beneficiary in Arkansas, which is 1% lower than the national average.
  • 4 Available Medicare Advantage plans range from 10 to 37 across Arkansas’ 75 counties.

Insurance companies are paid by Medicare to provide coverage for enrolled beneficiaries and must follow Medicare’s rules, so plan members have all the same rights and protections as they would under Original Medicare. There are several types of Medicare Advantage plans to choose from, including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service plans, and Special Needs Plans. While the availability of these plans varies based on the insurance provider and geographic location, your specific needs ultimately determine which plan is right for you.

Medicare Advantage Plans in Arkansas

Types of Medicare Advantage Plans

The most common plans offered through Arkansas’ Medicare Advantage program are HMOs and PPOs. There are also some PFFS plans and a few SNPs with specific conditions attached. Several insurance companies offer Medicare Advantage plans in Arkansas, but not every provider serves every county. There are also specific rules regarding eligibility and enrollment. Medicare-eligible seniors with questions about Medicare Advantage coverage can contact state and local resources that help them find the right plan.

Health Maintenance Organizations (HMO)

HMOs typically have the lowest premiums compared to other Medicare Advantage plans and often have low or no deductibles, but they also tend to have the strictest network rules. Plan members must choose a primary care physician within the HMO’s network of providers, who determines the type of treatment(s) needed. Members must also get referrals from their PCP before seeing specialists or getting certain tests. Unless it’s an emergency, members who receive healthcare services from a non-network provider must pay the entire cost of care themselves.

Preferred Provider Organizations (PPO)

PPOs typically have higher premiums and require a deductible, but they offer more flexibility than HMOs. While PPOs also have a network of providers, they will pay a portion of the cost if a member receives healthcare services outside the plan’s network. However, plan members receive the lowest copay and coinsurance rates when they use network providers. PPO networks tend to be larger, providing a better selection of in-network doctors, hospitals, and specialists. Also, plan members aren’t usually required to choose a PCP or need a referral to see a specialist.

Private Fee-For-Service Plans (PFFS)

PFFS plans are offered by private companies that decide how much they pay and how much the plan members pay for healthcare services. Some PFFS plans have a network, and members can see any provider within this network. Others may not have a network, and members can see any Medicare-approved provider that accepts the plan’s payment terms. Either way, plan members have more freedom to select their own providers without having to choose a PCP or get referrals to see specialists. Costs for these plans vary, but out-of-pocket expenses tend to be higher compared to other plans.

Special Needs Plans (SNPs)

There are three types of SNPs, which all limit membership to beneficiaries who meet specific conditions. The most common types are Dual Eligible SNPs, for beneficiaries eligible for both Medicare and Medicaid, and Institutional SNPs, for beneficiaries in institutions, such as nursing homes. Chronic Condition SNPs are the most restrictive and are only open to beneficiaries with certain chronic or disabling illnesses or diseases. With all SNPs, enrollees must receive their care from network providers. The cost for these plans may be higher than others, and there may be an extra monthly premium charge on top of a Medicare Part B premium.

Enrollment & Eligibility for Medicare Advantage Plans in Arkansas

Eligibility

To be eligible for Medicare Advantage Plans in Arkansas, applicants must be aged 65 and older or have a qualifying disability that allows them to enroll earlier and be eligible for Original Medicare Part A and Part B. They must also be a U.S. citizen or permanent resident, live in an area where Medicare Advantage plans are sold and not be enrolled in Medigap insurance. Most plans don’t accept those with end-stage renal disease, although an SNP may be an option. If an Arkansas senior already receives Social Security or Railroad Retirement Board benefits, they’re automatically signed up for Medicare Parts A and B when they turn 65. Those who prefer a Medicare Advantage plan must sign up during an appropriate enrollment period.

Enrollment Periods

Eligible Arkansas residents can enroll in a Medicare Advantage plan during one of four enrollment periods:

  • Initial coverage election periods are open to anyone joining Medicare for the first time. This seven-month-long period begins three months prior to the enrollee’s 65th birthday and ends three months after their birthday month.
  • Annual election periods are open to current Medicare recipients enrolling in Medicare Advantage for the first time, or current Medicare Advantage members wanting to change their plans, and run from October 15 to December 7.
  • Annual open enrollment periods run from January 1 to March 31. They’re available to current enrollees wanting to switch Medicare Advantage plans or switch back to Original Medicare.
  • General enrollment periods run from April 1 to June 30. They’re open to Medicare recipients who already had Medicare Part A and enrolled in Medicare Part B during the open enrollment period, but now want to join a Medicare Advantage plan.

Prescription Drug Coverage

Medicare recipients must sign up for Medicare prescription drug coverage when they first become eligible or incur a late enrollment penalty. Many Medicare Advantage plans in Arkansas include prescription drug coverage but have varying rules if they don’t. SNPs are legally required to provide prescription drug coverage. PFFS plans typically include drug coverage and allow enrollees to sign up for a separate Medicare Part D plan if they don’t. While most HMOs and PPOs have prescription drug plans, enrollees can’t sign up for separate Medicare Part D coverage if their plan doesn’t, or they’ll be switched back to Original Medicare and lose their Medicare Advantage plan.

Medicare Advantage Resources in Arkansas

It’s incredibly important for aging adults to have access to health insurance coverage. Arkansas’ Medicare Advantage program is a valuable tool that ensures seniors have the coverage they need. Nevertheless, some seniors don’t take advantage of this program because they don’t understand the enrollment process or how the program works. To encourage participation in Medicare Advantage, Arkansas has state and local programs that provide personalized Medicare counseling that’s usually free of charge to qualifying recipients.

Arkansas Insurance Department

The Arkansas Insurance Department oversees the Senior Health Insurance Information Program, which operates statewide. SHIIP is designed to help Medicare-eligible seniors navigate the enrollment process with free counseling on Medicare, Medicare Advantage, Medigap, Medicare Part D, and long-term care insurance. Seniors can also ask questions about benefits, summary notices, claim denials and appeals, and get advice about how to save money on Medicare premiums and co-pays. SHIIP counselors are certified and trained Medicare beneficiary advisors and offer one-on-one, personalized counseling to individuals and provide group presentations on various health insurance topics.

Contact Information: Website | 800-224-6330

Arkansas Department of Human Services

The Arkansas Department of Human Services operates the Choices in Living Resource Center, which acts as an Aging and Disability Resource Center, providing information about long-term services and support to Arkansas seniors. Trained program specialists help seniors sort through their long-term care needs, including Medicare application and prescription drug assistance. It also oversees Arkansas’ Area Agencies on Aging located throughout the state. AAAs offer free counseling and assistance with Medicare, Medicare Advantage, Medicaid, Medicare Supplement Insurance, senior benefit programs, prescription drug programs, and eligibility for low-income senior programs.

Contact Information: Website | 866-801-3435

CareLink is a nonprofit agency and the AAA serving Little Rock and central Arkansas that provides Medicare Prescription Drug Counseling. CareLink’s trained staff members also help seniors navigate the Medicare enrollment process and assist current Medicare recipients with annual reevaluations of their plans to ensure they have the best coverage. Medicare-eligible seniors may schedule an appointment to receive a free evaluation by contacting CareLink by phone or online during the open enrollment period, or they can email requests for information and assistance to [email protected]. Staff may also visit homebound residents of central Arkansas to provide assistance.

Contact Information: Website | 501-372-5300 or 800-482-6359

WestArk Retired and Senior Volunteer Program

WestArk RSVP’s Community Outreach Program assists Western Arkansas residents applying for Medicare, Medicare Advantage, Medicare Part D, low-income subsidies, and Arkansas Medicare Savings Programs, and those seeking free preventative healthcare services. Volunteers receive intensive training annually through the Arkansas Insurance Department’s SHIIP program and provide counseling to new Medicare enrollees and current Medicare beneficiaries who need assistance with coverage and gaps. Services are free to seniors and disabled persons and are available throughout the year. Appointments are required and can be made by phone.

Contact Information: Website | 479-783-4155 or 479-636-0578