Medicare Advantage Plans in Kansas
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: November 24, 2020
Medicare Advantage, also referred to as Medicare Part C, gives Medicare-eligible seniors an alternative to Original Medicare with some differences. Original Medicare includes coverage for hospital insurance (Part A) and medical insurance (Part B), but prescription drug coverage (Part D) must be purchased separately. Medicare Advantage bundles Parts A and B, and usually Part D, and often includes extra services, such as vision, dental, hearing, and wellness. Medicare Advantage plans are offered by government-approved private insurance companies. They have varying out-of-pocket costs depending on the coverage level, while Original Medicare is managed by the federal government.
Key Point Module
- 1 In 2019, there were 50 Medicare Advantage plans available in Kansas.
- 2 16% of the total Medicare population in Kansas is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $10,146 per beneficiary in Kansas, which is 1% higher than the national average.
- 4 Available Medicare Advantage plans range from 3 to 40 across Kansas’ 105 counties.
Despite Medicare Advantage plans being supplied by private insurance companies, they must still follow Medicare’s coverage rules and provide members with the same rights and protections as they’d have with Original Medicare.
Medicare Advantage Plans in Kansas
Types of Medicare Advantage Plans
Kansas seniors have different types of Medicare Advantage plans to choose offered by several insurance companies. The offerings may include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service plans, and Special Needs Plans.
Plan availability varies depending on the provider and a senior’s geographic location. Kansas’ Medicare Advantage program includes HMO and PPO options with some PFFS plans and a limited number of SNPs for specific situations. A senior’s unique needs ultimately determine which available plan is right for them.
Health Maintenance Organizations (HMO)
An HMO plan limits coverage to health care services provided by a network of contracted doctors, hospitals, and other medical professionals. While this often allows for lower premiums than other Medicare Advantage plans and low or no deductibles, beneficiaries are required to stay within the provider network. Should they receive health care services from a non-network provider, they usually must pay the bill themselves, except for emergency treatment. Plan members also must choose a primary care provider and get referrals from their PCP before seeing any specialists.
Preferred Provider Organizations (PPO)
PPO plans offer more comprehensive coverage and greater accessibility to doctors and services, but typically have higher premiums and deductibles compared to HMOs. PPOs usually have a network of preferred providers who offer health care services at reduced rates to plan members, and these networks tend to be more extensive than HMO networks. Plan members usually aren’t required to choose a PCP or get referrals before seeing specialists. PPOs generally cover part of the cost of care if a member sees a non-network provider, but copay and coinsurance rates are lower if they stay within the network.
Private Fee-For-Service Plans (PFFS)
PFFS plans may offer a partial or full network of providers or no network at all. No matter the network type, plan members can see any provider they choose, so long as the provider is Medicare-approved and agrees to the plan’s terms and conditions of payment. PFFS plans pay providers on a fee-for-service basis and decide how much how much members pay for each type of health care service. PFFSs tend to cost more than other types of Medicare Advantage plans.
Special Needs Plans (SNP)
SNPs limit membership to beneficiaries who have specific chronic or disabling conditions, live in nursing homes and certain other institutions or are eligible for both Medicare and Medicaid. SNPs also require plan members to receive health care services from within their network of providers, who are chosen based on the special needs of the plan’s membership. Members must also have a PCP or a care coordinator to assist with their health care needs. Costs for SNPs tend to be higher, but the plans provide condition-focused coverage.
Enrollment & Eligibility for Medicare Advantage Plans in Kansas
Anyone eligible for Original Medicare Parts A and B is also eligible to enroll in a Medicare Advantage plan. Applicants for Medicare Advantage plans in Kansas must also be at least 65 years old or have a qualifying disability that allows them to enroll sooner, and reside in an area where Medicare Advantage plans are sold. Enrollees must also:
- Be a U.S. citizen or permanent resident
- Not be enrolled in Medigap insurance
- Not have end-stage renal disease (SNPs might still be an option)
Kansas seniors receiving Social Security or Railroad Retirement Board benefits are enrolled in Medicare Parts A and B automatically when they turn 65 and must switch to Medicare Advantage during one of four available enrollment periods.
Enrollment periods have varying rules and either offer an opportunity to enroll in Kansas’ Medicare Advantage program for the first time or make changes in existing plans.
- Initial coverage election periods allow anyone to join for the first time and covers a seven-month period that includes the three months prior to an enrollees’ 65th birthday month and the three months after.
- Annual election periods allow current Medicare recipients to switch to Medicare Advantage and current Medicare Advantage recipients to switch plans. The periods run between October 15 and December 7.
- Annual open enrollment periods allow current Medicare Advantage recipients to change plans or switch back to Original Medicare. These periods run between January 1 and March 31.
- General enrollment periods allow those with Medicare Part A who enrolled in Part B during the open enrollment period to switch to a Medicare Advantage plan. The periods run from April 1 to June 30.
Prescription Drug Coverage
Medicare Advantage plans in Kansas that include prescription drug coverage are called Medicare Advantage Prescription Drug plans, or MA-PDs. Some MA-PDs bundle everything into one premium, but others have a separate premium for drug coverage. Beneficiaries who enroll in HMO or PPO plans without prescription drug coverage can’t enroll in a stand-alone Medicare Part D plan, or they’ll lose their Medicare Advantage plan and be automatically switched back to Original Medicare. PFFS plans without a prescription drug plan do allow members to join a separate Medicare Part D plan, and SNPs are required by law to include drug coverage.
Medicare Advantage Resources in Kansas
Medicare Advantage provides a range of valuable benefits to seniors in need of health insurance coverage, often over and above what’s offered under Original Medicare. Kansas’ Medicare Advantage program has several plans and options to choose from, which can make it confusing for some seniors to navigate the enrollment process. To encourage participation, Kansas has several state and local programs that offer personalized Medicare counseling to qualifying recipients, and they’re usually free of charge.
Kansas Department for Aging and Disability Services
The Kansas Department for Aging and Disability Services’ Commission on Aging oversees the Senior Health Insurance Counseling for Kansas (SHICK) program, which is a free service for older Kansans who have questions about Medicare and other insurance issues. Trained volunteers offer personalized counseling on Medicare, Medicare Advantage, Medicare Supplement Insurance, and long-term care. Counselors don’t work for an insurance company and only provide education and assistance, so Medicare-eligible seniors can make informed decisions about what’s best for them. Seniors can schedule counseling by calling KDADS or their nearest SHICK office.
Contact Information: Website | 800-860-5260
Kansas Area Agencies on Aging
Kansas Area Agencies on Aging oversees 11 Aging and Disability Resource Centers around the state. Each agency has SHICK program counselors who offer free, confidential one-on-one counseling on Medicare, Medicare Advantage, Medicare Supplement Insurance, long-term care, and other insurance issues. They also help low- income Medicare beneficiaries apply for reduced cost medications through the Prescription Drug Program. Seniors in need of assistance can make an appointment by calling the statewide call center or local ADRCs.
Contact Information: Website | 785-267-1336 or 855-200-2372
K-State Sedgwick County Aging and Medicare
Kansas State University’s Sedgwick County Aging and Medicare program has SHICK counselors available Monday through Friday, from 8:30 a.m. to 3:30 p.m., to provide one-on-one, unbiased counseling and assistance with Medicare, Medicare Advantage, Medicare Supplemental Insurance, long-term care insurance, and other health insurance issues. Staff members also offer presentations and classes on aging, including Medicare Options Classes that provide basic information on Original Medicare, Medicare Advantage Plans, Medigap supplemental insurance plans, and Medicare prescription drug coverage. Seniors can check online for class schedules or call the extension office.
Contact Information: Website | 316- 660-0117 or 316-660-0126
South Central Kansas Area Agency on Aging
The South Central Kansas Area Agency on Aging serves 10 counties in south-central Kansas as the local ADRC and operates the SHICK program. Its trained SHICK counselors answer Medicare questions and offer free advice about Medicare, Medicare Advantage, Medigap, long-term care, and other health insurance subjects. SCKAAA also offers free publications and help with the Prescription Drug Program, a privately funded program for low-income Medicare beneficiaries needing help paying for medications.
Contact Information: Website | 800-362-0264
Northwest Kansas Area Agency on Aging
The Northwest Kansas Area Agency on Aging serves 18 counties in northwest Kansas and operates the local SHICK program. If offers free, personalized Medicare counseling sessions but doesn’t recommend specific policies, agents, or companies. Topics counselors cover include Medicare Advantage plans, Medigap, Medicare fraud, Medicare Prescription Drug plans, Medicare Savings Programs, the Extra Help Program for prescription drugs, Medicaid, and other health insurance options.
Contact Information: Website | 800-432-7422
- Sources [-]
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/Pubs/pdf/11135-prescription-drug-coverage-with-ma-mcp.pdf Last accessed April 2021
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.
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.