Medicare in Arkansas: How it Works and What's Covered

Medicare is the country's federal health insurance program for people 65 and older, people under 65 with qualifying disabilities, and individuals with end-stage renal disease. Medicare in Arkansas offers seniors and individuals with disabilities flexibility and choices for affordable, high-quality healthcare just like it does in ever other state.

Almost five million residents are enrolled in Medicare in Arkansas, including:

• 2,746,230 Prescription Drug Plan (Part D) enrollees
• 2,192,240 Medicare Advantage enrollees

Whether you're new to Medicare or you're preparing for an open enrollment period, it's common to have questions about qualifications, coverage, and how you can get the best medical care within your budget. This guide answers some of the most common questions about Medicare in Arkansas.

How Does Medicare Work in Arkansas?

Medicare provides eligible individuals with a variety of choices to find the best coverage options for their specific needs. These choices provide different levels of care and various out-of-pocket costs and monthly premiums. Like other states, Medicare in Arkansas is made up of four basic parts plus supplemental plan options.

• Part A: Hospital Coverage
• Part B: Medical/Doctor Coverage
• Part C: Medicare Advantage (provided by a private company and replaces Part A and Part B)
• Part D: Helps cover the cost of prescription drugs
• Medigap: Supplemental plans that help pay out-of-pocket costs for Original Medicare

You can receive Medicare benefits from Original Medicare (a combination of Part A and Part B) or a Medicare Advantage (Part C). Supplemental insurance (Medigap) and Part D (prescription coverage) may be needed alongside Original Medicare.

If you or your spouse worked at least 10 years and paid payroll taxes, there is no monthly premium for Part A. For enrollees that haven't worked long enough to receive Part A for free, the monthly premium is $458 or a lesser amount related to the time worked. Part B Medicare premiums are based on annual income. These premiums range from $144.60 per month (for single tax filers making under $87,000 or joint filers making $174,000 or less) to $491.60 per month (single filers making $500,000 and joint filers making $750,000).

Many eligible Medicare enrollees also have other health care coverage. If you already have health care coverage and you're eligible for Medicare, the plans can work together to help you avoid gaps in health coverage. These rules determine whether your Medicare coverage or employer coverage pays first.

Medicare pays first when:

• You have retiree insurance from your or your spouse's former job
• You're over 65 and you or your spouse is currently employed by an employer with less than 20 employees
• You're under 65 and disabled with health coverage from your or your family member's current employer with less than 100 employees

Your group plan pays first when:

• You're over 65 and you or your spouse is currently employed by an employer with more than 20 employees
• You're under 65 and disabled with health coverage from your or your family member's current employer with more than 100 employees
• You have Medicare because of your group health plan and have End-Stage Kidney Disease, your group health plan pays for the first 30 months, then Medicare begins to pay

It's important to note that the primary paying insurance policy only pays up to its coverage limit and the secondary paying policy only pays if there are additional costs to cover. The secondary policy may not cover all costs and the remaining expenses will be your responsibility.

What Does Medicare Cover in Arkansas?

Depending on the coverage options you choose, Medicare in Arkansas can pay for most or all healthcare-related expenses.

Part A: Hospital Coverage

• Hospitalization: Entire coverage for the first 60 days minus the $1,408 deductible, 60 to 90 days- complete coverage except $352 per day, 90 to 150 days - complete coverage except $704 per day. No coverage beyond 150 days.
• Post Hospital SNF Coverage: 100% coverage for the first 20 days if approved, 20 to 100 days- complete coverage except $176 per day. No coverage beyond 100 days.
• Home Health Care (following three-day hospitalization or SNF stay): 100% coverage as long as you meet the guidelines, and 80% of approved amount for durable medical equipment
• Hospice Care: Complete coverage for as long as a doctor certifies the need, costs for drugs and inpatient respite care are limited
• Bloodwork: Complete coverage after the first three pints

Part B: Medical Coverage

• Medical Expense (Physician services and medical supplies: 80% of approved amount
• Clinical Laboratory (diagnostic tests): 100% of approved
• Home Health Care: 100% of approved
• Outpatient Hospital Treatment: 80% of approved
• Durable Medical Equipment: 80% of approved
• Bloodwork: 80% of approved amount after $198 deductible and the first three pints

Part C: Medicare Advantage

Medicare Advantage Plans automatically cover essential Part A and Part B benefits, except hospice which is covered by Medicare Part A. Advantage plans also cover urgent and emergency care services. Many services also cover vision, hearing, health and wellness programs, dental care, and various other supplemental benefits. Medicare Advantage plans also provide prescription coverage.

Part D: Prescription Benefits

Original Medicare doesn't include prescription coverage. Part D provides prescription coverage to supplement Original Medicare. Medicare Part D plans have various monthly premiums, out-of-pocket costs, and deductibles. Certain coverage limits like quantity limits, step therapy, and prior authorization may also apply. It's essential to ensure a Medicare Part D plan will cover your prescriptions before you enroll.

Medigap

Medicare supplement coverage plans cover out-of-pocket costs for Medicare Part A and B. Medigap plans are sold by private insurers but are subject to federal rules.

Does Arkansas Medicare Cover Dental?

Like many aspects of Medicare, your dental coverage will depend on the plan you have and the care you need. Original Medicare doesn't cover typical dental expenses. The only exception is that Part A may cover certain medically necessary dental procedures if you're an inpatient at the hospital. Medicare Part A may also cover part of your hospital stay if you're an inpatient for a dental procedure, although the procedure itself is not covered.

Many Medicare Advantage plans include dental coverage. The procedures covered, copays, and deductible amounts will depend on the plan you choose.

How Do I Sign Up for Medicare in Arkansas?

Medicare enrollment happens at age 65 for most Americans. If you're already receiving Social Security or Railroad Retirement benefits, you'll be automatically enrolled. Similarly, automatic enrollment in Medicare occurs for people under 65 who have been receiving disability benefits for 24 months or have ESRF or ALS. 26% of Medicare enrollees in Arkansas are between the ages of 18 and 64.

If you're still working or not receiving retirement benefits, you may not be automatically enrolled in Medicare. If you are within three months of turning 65, or older, and not ready to draw your Social Security, you can apply for Medicare online. You can also go to your local Social Security office to apply for Medicare. If you're already enrolled in Medicare Part A, you can apply for Part B during a special enrollment period.

Is Medicare Advantage Available in Arkansas?

Yes, Medicare Advantage is available across all counties in Arkansas. There are 288 top-rated (by CMS) Medicare Advantage plans in Arkansas, and 49 Advantage prescription drug plans. The average monthly premium for a Medicare Advantage plan that includes prescription drug coverage in Arkansas is $22 per month.

Medicare Advantage enrollment is available when a person first becomes eligible for Medicare. Annual enrollment periods occur between October 15 through December 7 each year. You can enroll in Medicare Advantage or change your plan during these periods. During the Medicare Advantage Open Enrollment period (January 1 to March 31), you can switch to another Medicare Advantage plan or to Original Medicare. About 27% of Medicare enrollees in Arkansas are in Medicare Advantage plans.

Contact Us to Learn More About Medicare and Medicare Advantage in Arkansas

Medical coverage is one of the most important considerations for staying healthy as you age. Finding the coverage you need that fits within your budget is essential to ensure you don't face gaps in coverage. Different Medicare options are designed to provide choices based on your needs and supplemental coverage.

Preparing for Medicare coverage can be difficult. Additionally, coverage options and opportunities can change from one year to the next. If you have questions about Medicare or want to compare plans in your area, visit our website. We can help you learn about your options and find the best coverage for your needs.