Medicare in Arkansas

Medicare is a health insurance program run by the federal government which provides coverage for seniors 65 years of age and older. However, some who have a long-term disability may qualify for Medicare before they reach the age of 65. Original Medicare consists of two main parts: Part A and Part B. Medicare Part A is also known as hospital insurance. It covers hospital stays, long-term nursing care facilities and home health care. Part B is known as medical insurance. It covers day-to-day preventative or routine medical services including doctors and medical equipment. Additionally, Medicare Part D is sold by private insurance companies and can help cover the cost of prescription drugs. This can be partnered with Original Medicare for supplemental coverage.

Medicare Part C, which is also known as a Medicare Advantage Plan, is another option for covering healthcare costs. It combines the coverage of Part A and Part B, but also includes prescription drug coverage as well as additional benefits not covered by Original Medicare. This creates a comprehensive option which is becoming more appealing to seniors, due to having a singular plan and cost. Part C plans are sold by private companies that have been approved by the government and adhere to the standard Medicare requirements.

In 2023, around 665,000 people, or 22% of the state’s population, were eligible for Medicare in Arkansas. This represents a 1.65% increase over last year, which is lower than the 2.66% increase that was seen nationally. The rate of enrollment into Medicare has increased in the state by 18.28%, representing a rate increase that is much higher than the national average of 9.75%. Of those eligible for Original Medicare in Arkansas, 43% were enrolled in a Medicare Advantage program which represents a 6% increase over 2022 — 3% higher than the national average.

This guide gives seniors in Arkansas comprehensive information on Medicare coverage options, Medicare Advantage, top plans, prescription drug coverage, Medigap and resources. It also explains how to customize coverage and access financial aid.

Options for Medicare Coverage in Arkansas

While Original Medicare has been the trusted source of basic coverage for many seniors in Arkansas, some people require more coverage than the program offers. Seniors have several options that allow them to create custom coverage by selecting policies sold by private insurance companies serving the state while enjoying federal subsidies that make premiums more affordable. 

Original Medicare (Parts A & B)

Original Medicare is managed by the federal government and is accepted by any U.S. provider that takes Medicare patients. In Arkansas, eligible residents can choose from several options including add-ons such as Part D and Medigap through Medicare-approved insurers. 

In 2023, Part A premiums start at $0 and Part B at $164.90 monthly. The annual deductibles are $1,600 for Part A and $226 for Part B. After the Part B deductible is met, Medicare covers 80%, with beneficiaries paying the remaining 20%. For Part A, you may pay the deductible more than once a year as there’s no limit to benefit periods.Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage Plans offer an alternative to Original Medicare (Part A and B), adding features such as dental and vision care. Administered by government-approved private companies, these plans usually require using network providers for nonemergency care. They often combine Original Medicare and Part D benefits, capping annual out-of-pocket costs. Types include HMO, PPO, PFFS, and SNP, with varying eligibility, premiums, and copayments. It’s important for beneficiaries to carefully compare plan features to choose the most suitable coverage for their needs. 

Who Should Consider Medicare Advantage

An Advantage plan might be a good choice for someone who:

• Is in overall good health and may be eligible for lower premiums
• Wants comprehensive coverage not provided by Original Medicare
• Needs to have more control over out-of-pocket expenses
• Wishes to enroll in dental or vision coverage

The Top 10 Medicare Advantage Plans in Arkansas

Arkansas seniors have a lot of Advantage plans to choose from. The following table provides information on the most popular insurance providers as of August 2023 based on enrollment data, monthly cost range and satisfaction ratings. More information on Medicare Part C is available on the Medicare Advantage Plans in Arkansas page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Arkansas

Enrolling in Medicare can be a complex process, especially for those who wish to sign up for an Advantage plan. Several programs and agencies in Arkansas offer free assistance to seniors, from helping them learn more about their benefits to assisting with enrollment paperwork, preventing fraud and determining if seniors qualify for financial assistance to help with their out-of-pocket expenses or long-term care.