If you are a Medicare beneficiary living in Wyoming, you have a variety of Medicare choices available. You may be able to choose to receive your Medicare benefits through Medicare Advantage (Part C), an alternative way of receiving Original Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. Since not all Medicare Advantage plans are available in every county, the specific benefits and costs available will depend on where you reside.
How Medicare Advantage works in Wyoming
Private insurance companies contracted with Medicare to offer Medicare Advantage plans to beneficiaries who live within the plan’s service area. If you are enrolled in a Medicare Advantage plan, you’re covered under the Medicare program, but you will interact with the insurance company of your Medicare Advantage plan. You’ll need to continue paying your Part B premium and the Medicare Advantage plan’s premium, if any.
All Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare (except hospice care, which is still covered under Medicare Part A). However, many plans also cover benefits not included in Original Medicare, such as routine vision, hearing, dental, or prescription drug coverage.
Medicare Advantage plan costs in Wyoming vary, depending on the insurance company and the type of benefits covered. Some plans may cost less than Original Medicare, but not every plan is offered in every county of Wyoming.
Medicare beneficiaries are eligible to enroll in a Medicare Advantage plan in Wyoming if they:
- Have Medicare Part A and Part B;
- Live in the service area of the Medicare Advantage plan they’re considering; and
- Do not have end-stage renal disease (kidney failure), which is covered by Original Medicare.
Eligible individuals can enroll in a Medicare Advantage plan or make changes to their coverage during the following periods:
- Initial Coverage Election Period (ICEP):This is the period when a person is first eligible to enroll in a Medicare Advantage plan. If you enroll in Original Medicare (Part A and Part B) the first time you’re eligible, you can enroll in a Medicare Advantage plan during the same time period. For many, the ICEP is the seven-month period that starts three months before the month you turn age 65. The ICEP then runs through your birth month, and for the three months after your birth month.
- Medicare Advantage and Prescription Drug Plan Annual Election Period: This is the Fall Open Enrollment period that occurs each year from October 15 to December 7. During this period, you can switch from Original Medicare to a Medicare Advantage plan (and vice versa). You may also add, drop or change your prescription drug coverage provided by a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
- Medicare Advantage Open Enrollment Period: This period occurs from January 1 to March 31 every year. During this period, individuals can disenroll from Medicare Advantage and return to Original Medicare, and if they choose, add a stand-alone Medicare Part D Prescription Drug plan to work alongside their Part A and Part B coverage. During this period you can also switch from on Medicare Advantage plan to another.
- Special Election Period: Individuals can enroll in a Medicare Advantage plan or change Medicare Advantage plans outside the Annual Election Period if they have experienced certain life or insurance coverage changes that make them eligible for a Special Election Period. For example, if you were enrolled in a Medicare Advantage plan, and you moved permanently outside the service area of the plan, you would be eligible for a Special Election Period so that you could either enroll in another Medicare Advantage plan where you moved or opt to return to Original Medicare (Part A and Part B) coverage. If you had Part D prescription drug coverage before you moved, you could use this Special Election Period to sign up for a stand-alone Medicare Part D Prescription Drug plan available where you recently moved.
Types of Medicare Advantage plans in Wyoming
Wyoming beneficiaries have several options when it comes to Medicare Advantage plans. Here are some of the most common types of Medicare Advantage plans:
- Health Maintenance Organization (HMO): These plans typically require members to use providers in the plan’s network in order to receive benefits. There are exceptions to this rule: if you require emergency care or if the plan pre-approves out-of-network care, your care will be covered by the plan. In an HMO Medicare Advantage Plan, you’ll select a primary care physician who coordinates your health care, and you generally need a referral to see a specialist.
- Preferred Provider Organization (PPO)*: In a PPO Medicare Advantage plan members have different levels of coverage, depending upon whether they use providers who participate in the plan’s network. Generally, your out-of-pocket expenses are lower when you use providers who participate in the plan’s network. You won’t usually have a primary care doctor and don’t need referrals to see specialists in a PPO Medicare Advantage plan.
- Health Maintenance Organization Point-of-Service (HMO-POS): This plan combines elements of HMO and PPO plans. Members have the option of seeing out-of-network providers and paying a higher out-of-pocket cost for services but they still have health coverage for services they receive from providers who do not participate in the plan’s network. Typically you will still select a primary care doctor, but you might not need a referral to see a specialist and have coverage for the specialist’s services.
- Private Fee-for-Service (PFFS): This type of plan (not Medicare) sets payment terms. Usually, members can use any provider that agrees to the plan’s payment terms and conditions. PFFS members are responsible only for the plan’s cost-sharing expenses, but some providers may charge up to 15% above the Medicare-approved amount.
- Special Needs Plan (SNP): These plans restrict membership to individuals who meet specific eligibility requirements. Each Special Needs Plan identifies a specific group of Medicare beneficiaries within their plan service area. These individuals may be persons who have a certain chronic health condition, such as congestive heart failure or diabetes, or individual whose health status requires they live in institutions such as nursing homes, or they may be individuals who receive both Medicare and Medicaid benefits. Special Needs Plans often provide certain benefits, programs, and services designed to assist people who have these specific circumstances and conditions. All Special Needs Plans include prescription drug coverage.
- Medical Savings Account (MSA): This type of plan combines a high-deductible Medicare Advantage plan with a medical savings account. Medicare contributes some money into the MSA savings account each year, which you can use to pay for medical expenses. You’ll pay the full cost for all health care until you reach the plan deductible. Medical Savings Account plans don’t include prescription drug coverage, so if you desire prescription drug coverage and a Medical Savings Account plan, you might consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan, also.
- Medicare Advantage Prescription Drug Plan: Instead of enrolling in a stand-alone Medicare Part D Prescription Drug Plan, you receive your Part D prescription drug coverage and your health benefits from a single plan.
Many Medicare Advantage plans include prescription drug coverage. If your Medicare Advantage plan doesn’t include prescription drug coverage and you desire this benefit, you can change to a Medicare Advantage Prescription Drug during the Annual Election Period.
Comparing Medicare Advantage plans available in Wyoming
As a Medicare beneficiary in Wyoming, you may find it useful to compare all Medicare Advantage plans available in your area.
The availability and costs of Medicare Advantage plans generally vary depending on where in Wyoming you live, the insurance company offering the plan, and specific plan details. You may find that some Medicare Advantage plans in Wyoming offer premiums as low as $0. Be sure you consider other costs as well, such as copayments and deductibles, and that you continue paying your Medicare Part B premium no matter which Medicare Advantage plan you choose.
The Medicare Advantage plans available where you live in Wyoming may include networks of participating providers. If so, your use of the doctors, hospitals and other health-care providers who participate in the plan’s network has a significant impact on your ability to receive the full benefits of the Medicare Advantage plan. If you currently have doctors and other health-care providers you want to retain, check to see if they participate in the Medicare Advantage plan before you make a final decision to enroll in it.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B. Consider whether a Medicare Advantage Prescription Drug plan would be a good choice to meet your medical and prescription drug coverage needs. If a Medicare Advantage plan offers other extra benefits, such as preventive vision or dental care, consider whether these are important to your coverage needs. With all these options available in Wyoming, you can see why it’s a good idea to compare plans.
To start comparing Medicare Advantage plans in Wyoming, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further refine your search and cost estimates.
To learn more about Medicare in Wyoming, please refer to the following articles:
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.