October 6, 2016
If you’re an Arkansas resident with Original Medicare (Part A and Part B), you may have Medicare plan options available as well. Medicare coverage comes in multiple parts, and some types of coverage, including prescription drug coverage, are only available through private insurance companies contracted with the Medicare program.
Original Medicare for Arkansas beneficiaries
Original Medicare is the “original,” government-run program that provides health coverage for adults 65 and older and some individuals with disabilities. Generally, Original Medicare works the same in the entire country, and Arkansas beneficiaries will have the same costs, benefits, and rules as other states. Original Medicare beneficiaries can see any provider that accepts Medicare, both in state and out of state. Coverage outside the United States, however, is limited and will only pay for Medicare covered services.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient services, including hospital and skilled nursing stays, limited home health care, and hospice care. Part A also covers medications that are administered as part of your inpatient treatment in a Medicare approved facility. Part A coverage doesn’t include a private hospital room, round-the-clock nursing, or personal items like toothpaste or shampoo.
Part B covers outpatient services, such as physical examinations, preventive screenings, lab tests, mental health services, durable medical equipment, and participation in certain clinical research studies.
Original Medicare, Part A and Part B, doesn’t include coverage for:
- Routine eye care, including eye exams to prescribe (non-cataract) glasses or contacts
- Routine dental care, including cleanings, x-rays, and fillings
- Cosmetic surgery
- Hearing aids
- Prescription medications (except in limited inpatient or outpatient settings)
Some of the above items and services may be covered through a Medicare Advantage plan. If you have Original Medicare, you’ll pay for these expenses out of pocket.
In Arkansas, as in the rest of the United States, you’re eligible for Medicare if you’re 65 or older and either a U.S. citizen or a permanent legal resident. You can also qualify for Medicare before 65 if you receive disability benefits, have end-stage renal disease (ESRD), or Lou Gehrig’s disease.
Beneficiaries can enroll in Original Medicare, Parts A and/or B, during the following periods:
- Initial Enrollment Period:This is the seven-month period when you’re first eligible, beginning three months before you turn 65, including the month you turn 65, and ending three months later.
- General Enrollment Period:Beneficiaries who don’t sign up during the Initial Enrollment Period can sign up during the annual enrollment that occurs from January 1 to March 31 every year and the effective date would be July 1. You may have to pay a penalty for Part A and/or Part B for not signing up when you were first eligible.
- Special Enrollment Period:You may qualify for a Special Enrollment Period outside of regular enrollment periods if you delayed Part A and/or Part B because you had other health coverage (such as through a group plan). You won’t have to pay a late enrollment penalty if you sign up during a Special Enrollment Period. You can sign up when your group coverage ends or when you stop working, whichever comes first.
If you aren’t automatically enrolled, there are several ways to sign up for Medicare:
- Online on the Social Security website. You can enroll at the time you apply for retirement benefits or submit an application for Medicare only.
- By phone at 1-800-772-1213. If you are a TTY user, call 1-800- 325-0778. Social Security phone lines are open Monday through Friday, from 7AM to 7PM. If you worked for a railroad, you can contact the Railroad Retirement Board (RRB) to apply for Medicare. Call 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM, to speak to an RRB representative. If you are a TTY user, call 1-312-751-4701.
- In person at a local Social Security office. To find Social Security locations in Arkansas, use the Social Security Office Locator.
Medicare plan options and Medicare Supplement plans in Arkansas
Once you are eligible for Medicare Part A and/or enrolled in Medicare Part B, you are also eligible for Medicare Part D coverage. Medicare beneficiaries in Arkansas may also be eligible for Medicare Advantage and Medicare Supplement plans. These types of coverage’s are only available through private insurance companies contracted with Medicare. The specific available plans will depend on the area you live.
Here is an overview of the main types of private Medicare insurance:
- Medicare Advantage (Part C):Medicare Advantage is an alternative way to receive your Original Medicare benefits (except for hospice care, which Part A still provides). Some plans offer additional benefits, like vision and dental. You continue paying your Part B premium.
- Medicare Part D (prescription drug coverage):Part D is optional prescription drug coverage. If you have Original Medicare, you can get your Part D coverage through a stand-alone Medicare Prescription Drug Plan. The best time to enroll in a Medicare Prescription Drug Plan is generally during your Initial Enrollment Period (described above).
- Medicare Advantage Prescription Drug plans:These plans provide your Original Medicare health benefits (Part C) and prescription drug benefits (Part D) under a single plan.
- Medicare Supplement (Medigap) plans:Medigap plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Original Medicare.
Arkansas resources for Medicare beneficiaries
Beneficiaries in Arkansas may find the following resources, listed on Medicare.gov, helpful:
- Arkansas Senior Health Insurance Information Program(SHIIP): Find general information on Medicare, long-term care options, and useful contacts. Contact SHIIP at 1-800-224-6330 or 1-501-371-2782. Representatives are available Monday through Friday, 8:00AM to 4:30PM ET.
- Arkansas Division of Aging and Adult Services: Learn about state services for older adults. Contact the department at 1-501-682-2441.
- Arkansas Senior Medicare Patrol: Learn about the most common Medicare scams and steps you can take to prevent fraud. Call the Senior Medicare Patrol at 1-501-320-6457 or toll-free at 1-866-726-2916.
- Arkansas Medicaid: If you’re a beneficiary with limited income, you may qualify for help with Medicare costs. Learn about eligibility requirements and how to apply. Consumers can call the Arkansas Medicaid office at 1-800-482-5431 (in-state toll-free) or 682-8501 (local and out-of-state), Monday to Friday, 8AM to 4:30PM ET.
Learn more about how Medicare plans work in Arkansas, including:
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.