- In 2019, there were 40 Medicare Advantage Plans available in Arkansas.
- 22% of the total Medicare population in Arkansas was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,044 per beneficiary in Arkansas, which is 1% lower than the national average.
- Available Medicare Advantage Plans range from 10 to 37 across Arkansas’ 75 counties.
Medicare pays a fixed amount toward your coverage to the private insurance companies that provide Medicare Advantage Plans in Arkansas. These companies must follow Medicare’s coverage rules. You’ll find 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, but not all plans are available everywhere and some limit enrollees based on specific conditions.
Medicare Advantage Plans in Arkansas
Types of Medicare Advantage Plans
Arkansas’ Medicare Advantage program most commonly offers HMOs and PPOs, so you’ll find a range of these plans. You’ll also find some PFFS plans and a few SNPs tied to specific conditions. While numerous insurance companies offer Medicare Advantage Plans in Arkansas, providers may not service every county.
Health Maintenance Organizations (HMO)
In an HMO, you usually need to get your health care from providers within the plan’s network, and if you use out-of-network providers, you usually pay all costs yourself. Most HMOs include prescription drug coverage, require you to choose a primary care physician (PCP), and require a referral from this doctor to see a specialist. HMO plans typically have the lowest premiums and low or no deductibles but also have some of the strictest network rules.
Preferred Provider Organizations (PPO)
PPO plans also have network providers, but these plans will pay part of the cost if you see providers outside the network. You still pay less seeing in-network providers, but networks tend to be larger, offering better selections than some plans. PPOs usually include prescription drug coverage, but these plans don’t require you to choose a PCP or require referrals for specialists. PPOs are more flexible but tend to have higher premiums and require deductibles.
Private Fee-For-Service Plans (PFFS)
PFFS plans decide how much it pays doctors, hospitals, and other health care providers and how much you’ll pay. PFFS plans may have a network of providers, and you can see any of them, or you may be able to see any provider who accepts the plan’s payment terms. If there’s a network, it’s cheaper to see network providers. Prescription drugs may/may not be covered, and you don’t need to choose a PPC or get referrals.
Special Needs Plans (SNP)
SNPs are coordinated care plans that provide targeted care to enrollees with very specific needs. If you don’t meet these needs, you can’t enroll. The three types of SNPs include Chronic Condition SNP (C-SNP) for individuals with severe or disabling chronic conditions, Dual Eligible SNP (D-SNP) for individuals eligible for Medicare and Medicaid, and Institutional SNP (I-SNP) for individuals in nursing homes or similar institutions. SNPs have network providers and must provide prescription drug coverage.
Enrollment and eligibility for Medicare Advantage Plans in Arkansas
You’re eligible for Medicare Advantage in Arkansas when you turn 65, or sometimes younger with a disability, even with end-stage renal disease. You must have Original Medicare Parts A without a Medigap plan. If you’re receiving Social Security benefits, you automatically get Original Medicare and must switch to Medicare Advantage.
- Initial coverage election period. You have a seven-month enrollment period to join Medicare Advantage when you first become eligible for Medicare, which includes your birth month in the year you turn 65 years old, plus the three months before and the three months after.
- Open enrollment period. During this annual open enrollment period that runs from October 15 to December 7, you can changeover from Original Medicare to Medicare Advantage, go back to Original Medicare, or move from one Medicare Advantage Plan to another.
- Medicare Advantage enrollment period. The annual Medicare Advantage enrollment period from January 1 to March 31 is strictly for switching to another Medicare Advantage Plan with/without drug coverage if you already have a Medicare Advantage Plan. You can also transition from Medicare Advantage Plans to Original Medicare but not vice versa.
Prescription drug coverage
Prescription drug coverage, called Medicare Part D, helps pay for prescription medications. Some Medicare Advantage Plans include prescription drug benefits along with Medicare Parts A and B and are referred to as MA-PDs. Most HMOs and PPOs include prescription drugs, but if your plan doesn’t, and you add a stand-alone Part D, you’ll automatically be unenrolled from your Medicare Advantage Plan and switched back to Original Medicare. You can add separate Part D coverage to PFFS plans that don’t cover prescriptions without losing your Medicare Advantage Plan. SNPs are required by law to include prescription drug coverage.
Medicare Advantage Resources in Arkansas
If you’re nearing age 65, you’ll want to explore your health insurance coverage options to ensure you have appropriate medical benefits as you age. Arkansas’ Medicare Advantage program provides the medical coverage you need, but signing up can be confusing. You’ll find state and local programs with knowledgeable staff who will help you fill out Medicare Advantage applications and answer your Medicare-related questions. These services are usually free for qualifying Medicare recipients.
Arkansas Association of Area Agencies on Aging
The Arkansas Association of Area Agencies on Aging oversees eight regional AAA offices that provide care coordination free of charge. You’re connected with a Care Coordinator trained to provide you with information and application assistance, which includes help filling out Social Security, Medicaid, and/or Medicare applications. Coordinators answer any questions you have about health care services and benefits available in your area.
Contact Information: Website | 833-707-1187
Arkansas Senior Health Insurance Information Program (AR SHIIP)
AR SHIIP is administered by the Arkansas Insurance Department, which oversees offices in five regions around the state. It connects you, your family, and caregivers with certified counselors who offer one-on-one assistance in person or over the phone on Medicare, Medicare Advantage Plans, Medicare Part D, and Medicare Supplements. Services are free, so find an AR SHIIP office near you.
Contact Information: Website | 800-224-6330
CareLink’s trained staff will help you evaluate your Medicare or Medicare Advantage Plan for free to ensure you have the best coverage for the coming year and potentially save you $100s. Its staff also assists you with your Medicare Part D options because health needs and health insurance plans change every year. You must make an appointment for your review during an open enrollment period.
Contact Information: Website | 800-482-6359
Learn More From Our Sources
- Medicare | How do Medicare Advantage Plans work?
- Medicare | Health Maintenance Organization (HMO)
- Medicare | Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Centers for Medicare & Medicaid Services | Special Needs Plans
- Medicare | Who can join a Medicare Advantage Plan?
- Medicare | Getting Medicare if you have a disability
- Medicare | I have End-Stage Renal Disease (ESRD)
- Medicare | Special circumstances (Special Enrollment Periods
- Medicare | Joining a health or drug plan
- Medicare | How to get prescription drug coverage