- In 2019, there were 50 Medicare Advantage Plans available in Kansas.
- 16% of the total Medicare population in Kansas is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,146 per beneficiary in Kansas, which is 1% higher than the national average.
- Available Medicare Advantage Plans range from three to 40 across Kansas’s 105 counties.
You have several options when you enroll in a Medicare Advantage Plan. Apart from plans with benefits similar to Part A and B Original Medicare, some include features and characteristics more like private health insurance. Others focus on specific needs. Plans commonly have geographic and other restrictions, so your choice depends on where you live and your health.
Medicare Advantage Plans in Kansas
Types of Medicare Advantage Plans
The Kansas Medicare Advantage Program is an alternative to Original Medicare Part A and B. Several plans are offered. Some require you to use doctors and medical specialists from a preferred provider list. Others give freedom of choice, although copays may be higher. All plans must offer, at a minimum, the same cover as Part A and Part B Original Medicare.
Health Maintenance Organizations (HMO)
The HMO plan is one of the more popular and affordable options. Treatment is coordinated through a primary care physician selected from the insurer’s physicians’ network. An HMO is a managed care plan, and in most instances, you must get a referral before visiting a specialist. Prescription drugs are normally covered, and copays are limited. Prior approval is needed for certain services. Out-of-network treatment isn’t covered.
Preferred Provider Organizations (PPO)
A PPO plan has a network of preferred providers who offer lower fees and copays. With a PPO plan, you aren’t restricted to the preferred provider network, and you don’t have to choose a primary care physician. You don’t need a referral for a specialist and a PPO plan usually includes prescription drugs. Premiums tend to be slightly higher, but the advantage is you can choose your preferred doctor.
Private Fee-for-Service Plans (PFFS)
PFFS plans are the least restrictive, and you can go to any doctor or medical facility of your choice, provided they are enrolled in Medicare and willing to accept a payment plan from your PFFS plan. If the plan doesn’t include prescription drugs, you can elect to purchase a Medicare Part D Plan for drugs. Plan premiums are typically higher. Medicare PFFS plans publish a schedule of what the plan pays for specific services, and copays are unlimited.
Special Needs Plans (SNP)
An SNP plan is a Medicare Advantage Plan limited to people who have a recognized chronic condition or who live in a nursing home, require home nursing, or are eligible for both Medicare and Medicaid. SNP plans must include the same coverage as Medicare Part A and Part B, and benefits are tailored to provide care for the specific condition. Prescription drug cover is always included.
Enrollment and Eligibility for Medicare Advantage Plans in Kansas
To be eligible for Medicare in Kansas, you must meet one of the following:
- Be at least 65 years old
- Have permanent kidney failure
- Have a qualifying disability
These conditions apply to all Medicare plans. Before you can join a Medicare Advantage Plan, you must be registered for Medicare Part A and Part B.
Medicare Advantage Plans have four enrollment periods:
- Initial Enrollment Period: You can enroll for a Medicare Advantage Plan during the seven-month period starting three months before you turn 65. Membership is effective the first day of the month you turn 65, or if you join after 65, on the first day of the month after you apply. If not registered by Social Security for Medicare Part A and Part B, you must register first before you apply for a Medicare Advantage Plan.
- Open Enrollment Period: Between October 15 and December 7 every year, you may switch to or from Original Medicare to a Medicare Advantage Plan or to another Medicare Advantage Plan. Coverage starts on January 1.
- Medicare Advantage Open Enrollment Period: From January 1 to March 31, if you have a Medicare Advantage Plan, you can switch to another plan or go back to Original Medicare. You can’t join a Medicare Advantage Plan from Original Medicare.
- Special Enrollment Period: If you move, change employment, or lose existing cover, you can purchase a Medicare Advantage Plan.
Prescription drug coverage
HMO, PPO, and PFFS Medicare Advantage Plans may not have drug coverage, so you need to check before enrolling. Special Needs Plans include, at a minimum, the same drugs as provided by Medicare Part D. If you have a PFFS plan without medication coverage, you may buy a separate Medicare Part D drug plan. This option isn’t available with other Medicare Advantage Plans, so if you need regular prescription drugs, make certain the plan covers them. You can buy Medicare Part D drug coverage if you have Original Medicare Part A and/or Part B.
Medicare Advantage Resources in Kansas
With so many Medicare Advantage Plans available, choosing the best plan for your needs requires a degree of care. Fortunately, there are several agencies offering impartial advice on Medicare and other aging matters. Some are state agencies, while others are nonprofit organizations run by volunteers. These agencies can help you evaluate different options available in your county, compare benefits and costs, and choose the plan that’s best for your needs.
Kansas Department for Aging and Disability Services: Commission on Aging
The Kansas Department for Aging and Disability Services operates the Senior Health Insurance Counseling for Kansas service throughout the state. Trained counselors offer free advice regarding Medicare, disability, long-term care, and health insurance. SHICK volunteer counselors are impartial and don’t work for any insurance company. Their purpose is to provide relevant information to help you make an informed health insurance decision.
Contact Information: Website | 800-860-5260
Kansas Insurance Department
The Kansas Insurance Department is an independent state agency set up to regulate companies selling insurance products in Kansas. The KID ensures insurance companies are solvent and the policies legally compliant. The agency helps consumers by publishing a Medicare Shopper Supplement Guide that explains Kansas Medicare supplemental insurance and how to obtain it. There’s an online shopping guide so you can compare plans available in your area.
Contact Information: Website | 785-296-3071
Central Plains Area Agency on Aging
The Central Plains Area Agency on Aging, located in Wichita, offers counseling and guidance services to the aged and disabled living in and around Wichita. While offering help and advice to all aged people, the agency places particular attention on helping low-income, minority, non-English speaking residents. The agency’s friendly counselors can explain Medicare and other care options open to aged and disabled people in the area.
Contact Information: Website | 855-200-2372
North East Kansas: Area Agency on Aging
Based in Hiawatha, the North East Kansas Area Agency on Aging serves residents in the northeastern region of the state. Funded by local entities, state, and federal government, the agency aims to be a single-entry point to senior services for elders and their families. It answers questions about health insurance, Social Security, and assisted living services. Case managers are on hand to assess needs and help arrange appropriate services.
Contact Information: Website | 785-742-7152
Area Agency on Aging Kansas City
The Kansas City Area Agency on Aging is a department of the Unified Government of Wyandotte County and Kansas City, KS. It offers reliable and unbiased information and counseling on a range of topics affecting seniors. These include Medicare, home services, caregivers, health insurance counseling, and independent living. Special attention is given to seniors with social and economic needs.
Contact Information: Website | 913-573-8531
Learn More From Our Sources
- Medicare.gov | Medicare Advantage Plans Last accessed May 2021
- Medicare.gov | Health Maintenance Organization (HMO) Last accessed May 2021
- Medicare.gov | Private Fee-for-Service (PFFS) Plans Last accessed May 2021
- Medicare.gov | Special Needs Plans (SNP) Last accessed May 2021
- Medicare.gov | Who can join a Medicare Advantage Plan Last accessed May 2021
- Medicare.gov | Special Enrollment Periods Last accessed May 2021
- Medicare.gov | How to get prescription drug coverage Last accessed May 2021
- Social Security Administration | Medicare Last accessed May 2021
- Medicare Plans Patient Resource Center | Compare Medicare Advantage Plans Last accessed May 2021
- Medicare Plans Patient Resource Center | Medicare Advantage PPO Plans Last accessed May 2021