Medicare Advantage Plans in Wyoming
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Updated: Jul 06, 2021
Medicare Advantage (or Medicare Part C) is healthcare for seniors managed by private companies. These companies must legally offer the same benefits of Original Medicare's Part A and Part B. Medicare Advantage plans, however, may include additional benefits that aren't generally available under Original Medicare, such as vision, hearing, and dental.
Most Medicare Advantage plans also provide prescription drug coverage, although not all of them do. Seniors interested in selecting a Medicare Advantage plan should carefully read over the plan documents to determine what is and what isn't covered.
- 1 In 2019, there were 5 Medicare Advantage plans available in Wyoming.
- 2 3% of the total Medicare population in Wyoming is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $8,215 per beneficiary in Wyoming, which is 19% lower than the national average.
- 4 Available Medicare Advantage plans range from one to three across Wyoming’s 23 counties.
There are four different types of Medicare Advantage plans from which Wyoming residents can choose. Some of these plans require its members to use only in-house healthcare providers, while others let their members select doctors, specialists, and hospitals from outside the network. Most of these plans offer prescription medication coverage, but not all of them do. Additionally, seniors can only enroll in plans that are offered in their geographical area.
Medicare Advantage Plans in Wyoming
Types of Medicare Advantage Plans
Before a Wyoming senior decides between remaining on Original Medicare or enrolling in a Medicare Advantage plan, they should ask themselves the following questions:
- Do I want a plan that includes prescription drug coverage?
- Am I willing to only see healthcare providers inside my plan’s network?
- How high a premium do I want to pay?
Seniors searching through Wyoming’s Medicare Advantage program may find plans categorized as an HMO, PPO, PFFS, or SNP.
Health Maintenance Organizations (HMOs)
Most of these plans require members to see in-network healthcare providers, select a primary care physician and get referrals to see specialists. (Emergencies and out-of-network dialysis are exceptions to this limitation.) Medicare Advantage HMO plans may offer additional benefits like dental, vision, and hearing, usually at an extra cost. Most HMO plans also include drug coverage, and these plans may require members to pay the Medicare Part B premium and, if applicable, the Part A premium as well.
Preferred Provider Organizations (PPO)
Residents of Wyoming who enroll in a Medicare Advantage PPO plan have more coverage options. They may not need to remain with an in-network healthcare provider, but they usually have to pay an additional fee if they choose someone outside the plan’s network. Members also don’t need to select a primary
care physician or, in most cases, get referrals to see a specialist. These plans may offer more benefits than Original Medicare, but you may need to pay for them. Most PPO plans offer prescription drug coverage, but some don’t. Your best option is to check with the plan provider.
Private Fee-For-Service Plans (PFFS)
PFFS plans offer members more flexibility in deciding who provides their medical care, but there are some financial downsides. PFFS plans usually contract with a network of healthcare providers, and they offer services to members of that PFFS plan. Members may go outside the network to other healthcare providers. However, these providers can look at the terms of payment of the member’s plan, and if they don’t accept those terms, they can refuse service. (Normally, this happens before a visit.) As with the HMO program options, there are exceptions for emergencies, out-of-network dialysis, and out-of-network urgent care. PFFS plans may provide prescription drug coverage, but if not, you can enroll in a stand-alone Medicare Part D plan.
Special Needs Plans (SNP)
Special Needs Plans are designed for Wyoming residents with specific healthcare problems or who require skilled nursing care. Each plan is connected to specialists who are equipped to handle a member’s condition or problem. Members of these plans can only see in-network providers and must choose a primary care physician and get referrals to see specialists. Again, exceptions are made for emergencies and out-of-network ESRD dialysis. An SNP plan is legally required to provide its members with prescription drug coverage.
Enrollment and Eligibility for Medicare Advantage Plans in Wyoming
Participation in Original Medicare or enrollment in a Medicare Advantage plan requires an individual to meet the following criteria:
- The senior must be at least 65 years of age.
- They need to be American citizens or to have spent at least the past five years as a permanent resident.
- They must have worked enough eligible hours to receive Social Security.
- Anyone who wants to enroll in a Medicare Advantage plan must first have enrolled in Original Medicare’s Part A and Part B.
- Residents who have been receiving Social Security disability benefits or who suffer from ALS or ESRD are also eligible.
- Wyoming seniors who wish to enroll in a Medicare Advantage plan may only enroll in a plan available in the county in which they reside.
Enrollment in a Medicare Advantage plan can only happen during specific periods:
- Three months before a Wyoming resident turns 65, the month of his or her birthday and the following three months is when seniors can initially enroll in Medicare.
- Yearly Medicare enrollment occurs October 15-December 7. During this time, an eligible Wyoming resident can leave Original Medicare, enroll in a Medicare Advantage plan, return to Original Medicare, or move between Medicare Advantage plans.
- Medicare Advantage open enrollment transpires between January 1-March 31. Wyoming residents can move between Medicare Advantage plans or return to Original Medicare.
- Finally, there is a general enrollment between April 1-June 30. During this period, anyone who has recently signed up for Medicare Part B can instead select a Medicare Advantage plan.
Prescription Drug Coverage
Before you select a Medicare Advantage plan, you need to consider your prescription medication needs. While most plans offer this coverage, some don’t, and there are specific rules about how you obtain this coverage.
- Most HMOs and PPOs provide prescription drug coverage, which is usually bundled into a Medicare Advantage Prescription Drug Plan (MA-PD). The drug coverage cost may be included in the plan’s premium, or members pay a separate premium. Not all HMOs and PPOs, however, provide drug coverage
- HMO and PPO plans without prescription drug coverage don’t allow their members to join a separate Medicare Part D plan. Anyone who attempts to enroll in Part D will lose their membership in the Medicare Advantage plan and go back to Original Medicare.
- PFFS plans that do not provide Part D coverage do allow their members to enroll in a stand-alone prescription drug coverage plan.
- SNPs must provide prescription drug coverage.
Medicare Advantage Resources in Wyoming
Not everyone interested in enrolling in a Medicare Advantage plan feels well-informed about their choice. After all, Original Medicare is just one plan, but there can be several types of Medicare Advantage plans, which may offer varying benefits like drug coverage or dental, hearing, and vision. Wyoming seniors can ask neighbors, friends, or family, but their knowledge of Medicare Advantage plans may be equally limited. That’s why Wyoming offers several resources for seniors to help them navigate their way through these options.
Wyoming State Health Insurance Information Program (SHIP)
A federally mandated program, SHIP exists to help seniors understand their healthcare insurance rights. This free service relies on trained consultants who can advise seniors on Original Medicare, Medicare Advantage plans, long-term care, and Medicare supplements. All counselors are unbiased and up-to-date on state offerings.
Contact Information: Website | 800-856-4398
Wyoming Senior Citizens, Inc. (WISC)
This is a private, not-for-profit organization designed to help seniors in the state with a variety of issues, including continuing to live independently. It’s Senior Medical Patrols (SMPs) aims to prevent and improve reporting efforts for Medicare fraud and abuse through education programs, outreach, and counseling.
Contact Information: Website | 800-856-4398
Wyoming RX plan
This free prescription drug assistance plan aims to help Wyoming residents with the costs of prescription drugs, especially those who are low-income or economically challenged. By providing significant savings on brand and generic drugs, seniors without Medicare prescription drug coverage can afford needed medications.
Contact Information: Website | 888-918-8915
- Sources [-]
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp | Last accessed June 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 | Last accessed June 2021
http://www.wyomingseniors.com/services/wyoming-state-health-insurance-information-program | Last accessed June 2021
http://www.wyomingseniors.com/ | Last accessed June 2021
http://www.wyomingseniors.com/services/senior-medicare-patrol | Last accessed June 2021
https://wyomingrxcard.com/ | Last accessed June 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.