- In 2019, there were five Medicare Advantage Plans available in Wyoming.
- 3% of the total Medicare population in Wyoming is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $8,215 per beneficiary in Wyoming, 19% lower than the national average.
- Available Medicare Advantage Plans range from one to three across Wyoming’s 23 counties.
Wyoming’s Medicare Advantage program differs from Original Medicare in several significant ways. You might need to choose a primary care doctor, for example, or may be required to get a referral to see a specialist. You’re usually limited to a fixed network of physicians and hospitals, and seeking care outside the network can be more expensive. All Medicare Advantage Plans must include at least as much coverage as you’d get from Medicare Parts A and B.
Medicare Advantage Plans in Wyoming
Types of Medicare Advantage Plans
Health Maintenance Organizations (HMO)
With an HMO plan, you’re usually required to pick a primary care provider and get referrals for specialist care. In most cases, you’ll get care from a network of hospitals’ doctors unless you choose a plan with a point-of-service (POS) option. If you go outside of the network, care can be more expensive, and you might even be responsible for the full cost of your bill. HMO plans usually cover prescription drugs.
Preferred Provider Organizations (PPO)
PPO plans are more flexible compared to HMOs. Generally, you don’t need a referral to see a specialist, and you aren’t required to choose a primary care doctor. You’re usually free to get care outside of the network if you choose, although services cost less if you get them from in-network physicians and hospitals. Most PPO plans include coverage for prescription drugs.
Private Fee-For-Service Plans (PFFS)
PFFS plans allow you to see any doctor or get care from any hospital that agrees to treat you and accepts the payment terms of your plan. Some PFFS plans have networks of doctors that have agreed to treat you even if they’ve never seen you as a patient before. Regardless of a plan’s terms, emergency care is always covered. Prescription drugs may or may not be covered. If they’re not, drug coverage can be added by joining a Medicare Part D plan.
Special Needs Plans (SNP)
SNP plans are geared toward people with specific conditions, diseases, and chronic illnesses. These plans include a benefits package that’s specifically tailored to the groups they serve. You’re typically required to have a primary care doctor or a care coordinator with this type of plan, and specialist referrals are often required. Most SNP plans require you to get care from providers in the network, except out-of-area dialysis for End-Stage Renal Disease (ESRD) and emergency treatment. SNP plans must include prescription drug coverage.
Enrollment eligibility for Medicare Advantage Plans In Wyoming
In Wyoming, you’re eligible to sign up for Medicare Advantage if you’re at least 65 years old or disabled, don’t have Medigap insurance, and are enrolled in or qualify to enroll in Original Medicare Parts A and B. Unlike Original Medicare, which lets you see any doctor that accepts it nationwide, Medicare Advantage Plans require you to live in the area that the plan’s network services.
The government allows you to join a Medicare Advantage Plan or switch to a different one during certain times of the year. These periods include:
- Initial enrollment period. You first qualify to sign up for Medicare Advantage and Medicare drug plans in the year you turn 65. The initial enrollment periods last for seven months, including three months before your 65th birthday, the month of your birthday, and the three months following it. If you’re already eligible for Medicare due to disability and turn 65, you can sign up, switch, or drop a plan completely.
- Open enrollment period. The first open enrollment period of the year runs from October 15th to December 7th. During this time, you can switch Medicare Advantage Plans, change from Original Medicare to Medicare Advantage, or switch from Medicare Advantage back to Original Medicare. You can also join a drug plan or drop drug coverage.
- Medicare Advantage enrollment period. This period, which runs from January 1st to March 31st, allows you to join a drug plan, switch to a Medicare Advantage Plan with or without drug coverage, and return to Original Medicare if you have a Medicare Advantage Plan. You can’t join a new Medicare Advantage Plan, join a drug plan, or change drug plans if you have Original Medicare, however.
Certain events may also qualify you for a Special Enrollment Period (SEP), during which you can make changes to your Medicare Advantage Plan and/or drug coverage. You may be eligible for an SEP if you move to a new address, you lose coverage, your plan changes its contract with Medicare, or you have a chance to get other coverage.
Prescription drug coverage
Medicare drug coverage is optional, and there are two ways to get it. You can either join a Medicare Advantage Plan that covers the drugs you need or sign up for a Medicare drug plan (Part D) to add coverage to your plan. You’ll need to have Original Medicare, a Medicare Savings Account plan, certain PFFS plans, or a Medicare Cost Plan to add drug coverage via Part D. If you choose not to add drug coverage at the time of initial enrollment, you’ll probably have to pay a late enrollment penalty if you join a plan later.
Medicare Advantage Resources in Wyoming
You may be unsure which Medicare Advantage Plan is best for your needs. Fortunately, several resources, agencies, and organizations in Wyoming can help with your decision. These free services provide a wealth of information about Medicare Advantage and other health insurance options, making it easier to choose what’s right for you.
Wyoming State Health Insurance Information Program
WSHIIP is a federally mandated, volunteer-run program aimed at helping seniors and others eligible for or enrolled in Medicare. Its staff counsels people on Medicare plans, prescription drug plan options, health insurance rights, and ways to pay for long-term care. The program is statewide and has more than 80 counselors available to serve every Wyoming county. Contact a WSHIIP Program Manager to find a representative near you.
Contact Information: Website | (800) 856-4398
Wyoming Insurance Department
The Wyoming Insurance Department handles questions and complaints related to Medicare, Medicaid, and other types of insurance. Some of the issues it helps with include illegal termination of policies, claim denials, delays in claim handling, and misrepresentation of policy coverage. It educates seniors about Medicare fraud and provides several guides to help people choose the right plan for Medigap insurance, long-term care insurance, Medicaid, and prescription drugs.
Contact Information: Website | (307) 777-7401
Wyoming Aging & Disability Resource Center
Wyoming’s ADRC website features an extensive searchable database of resources, services, and programs for elderly and disabled individuals. It can connect you with Medicare Advantage counselors, health care information, long-term care planning assistance, and much more. ADRC representatives are available if you need help finding Medicare services in your area.
Contact Information: Website | (800) 442-2766
Learn More From Our Sources
- Medicare | Medicare Advantage Plans | Last accessed June 2021
- Medicare | Health Maintenance Organization (HMO) Plans | Last accessed June 2021
- Medicare | Preferred Provider Organization (PPO) Plans | Last accessed June 2021
- Medicare | Private Fee-for-Service (PFFS) Plans | Last accessed June 2021
- Medicare | Special Needs Plans | Last accessed June 2021
- Medicare | Drug Coverage (Part D) | Last accessed June 2021
- Medicare | Joining a Health or Drug Plan | Last accessed June 2021
- Medicare | Special Circumstances (Special Enrollment Periods) | Last accessed June 2021
- Medicare | How Do Medicare Advantage Plans Work? | Last accessed June 2021