Medicare in Wyoming

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Wyoming Medicare Plans

Medicare is a federal health insurance program designed for U.S. citizens and permanent legal residents of age 65 or older. Certain younger people also qualify for this plan, who have certain disabilities or people having end-stage renal diseases. The Medicare plan was especially launched in the year 1966 for the seniors, to provide them health coverage in the later stage of their life when they generally do not have coverage after retiring from their job. Besides, health insurance for seniors is quite expensive and thus to provide them cheap and affordable health coverage Medicare plans were launched just for them. Nearly 111,000 Wyoming residents are enrolled in Medicare plans and about 96% of medicare beneficiaries in the state opt for Original Medicare. medicare beneficiaries in Wyoming prefer Original medicare mainly because out of 23 counties in the state 15 counties in the state didn’t have Medicare Advantage plans available for purchase prior to 2019 but now the state has started offering Medicare Savings Account plan, a type of Medicare Advantage plan statewide in Wyoming. Administered and partially funded by the federal government, Medicare plans are certainly best options for the elderly citizens. Some of the Medicare plans options available for seniors in Wyoming include:

Original Medicare

Original Medicare in Wyoming just like any other U.S. states is the government-sponsored health insurance program offered to people of age 65 or older. Comprising of Part A, medical insurance and Part B, hospital insurance, Original Medicare is the most preferred Medicare plan for the residents of Wyoming with 96% of the residents enrolled in Original Medicare plan. This plan is available for all the U.S. citizens and permanent legal residents of age 65 or older residing here for at least five continuous years. The Original medicare is same throughout all the states including Wyoming.

Enrollment Period

Most of the Wyoming residents like other states get automatically enrolled in Medicare as soon as they become eligible. However, those who are not automatically enrolled can sign up for Original Medicare during their seven-month Initial Enrollment Period. The IEP typically commence three months before the month individuals turn 65, includes the month they turn 65 and ends three months after that month. If individuals are qualifying for Medicare due to disability and are receiving government disability benefits, then their IEP is the seven-month period that starts from their 22nd month of receiving disability benefits and continues through the 28th month.

Coverage

Medicare beneficiaries in Wyoming receive the following hospital insurance coverage under Medicare Part A:

  • Hospital care
  • Nursing home care
  • Skilled nursing facility care
  • Hospice care
  • Limited home health services

Medicare beneficiaries in Wyoming receive the following medical insurance coverage under Medicare Part B:

  • Doctor visits
  • Durable medical equipment
  • Clinical research
  • Inpatient, outpatient, and partial hospitalization for mental health treatment
  • Obtaining a second opinion before surgery
  • Limited outpatient prescription drugs
  • Ambulance services

Cost

Most of the Medicare beneficiaries in Wyoming just like any other state don’t have to pay a monthly premium for their Medicare Part A coverage is they or their spouse have worked for at least 10 years and paid their Medicare taxes. However, people who have not paid Medicare taxes while working will not be eligible for premium free Part A and need to pay up to $458 each month for the year 2020. Medicare enrollees in Wyoming are required to pay a monthly premium for Part B coverage. In 2020, the standard Part B premium amount is $144.60 or higher, as it mainly depends upon one’s income. Individuals can find out their exact amount that they will need to pay for Part B in 2020 from the Social Security.

Medicare Part C or Advantage Plans in Wyoming

Medicare Part C or Advantage is a type of Medicare plan offered by private insurance carriers having contract with Medicare to provide beneficiaries with the Original Medicare benefits. This plan is considered as an alternative way of getting Original Medicare benefits. Since not all Medicare Advantage plans are available in each county of Wyoming, beneficiaries need to look out for the plan available in their area along with its costs and benefits. According to the federal law, Medicare Part C plans should offer similar coverage as of Original medicare except for the Hospice care, which is still covered only under Medicare Part A. Some of the Medicare Advantage plans available in Wyoming also provide additional coverage too such as routine dental and vision care and prescription drug coverage.

Eligibility

Medicare beneficiaries in Wyoming are eligible to enroll in a Medicare Advantage plan if they fulfill the following conditions:

  • Individuals having Medicare Part A and Part B coverage
  • People living in the service area of the Medicare Advantage plan, which they are considering to buy
  • Beneficiaries not having end-stage renal disease

Enrollment Period

Individuals eligible for Medicare Advantage plan can enroll or make changes to their coverage during the following periods:

Initial Coverage Election Period – ICEP is the duration when the individuals first become eligible to enroll in Medicare Advantage plan. Individuals who enroll in Original Medicare when they first become eligible for it can also enroll in a Medicare Advantage plan during the same period. However, for most of the Medicare beneficiaries the ICEP is the seven month duration that starts three months before they turn 65 include their birth month and ends three months after it.

Annual Election Period – This is the period that occurs every year from October 15 to December 7. During this period Medicare beneficiaries are allowed to switch from Original Medicare to Medicare Advantage plan and vice versa.

Open Enrollment Period – Medicare Advantage Open Enrollment Period occurs every year from January 1 to March 31. During this period, individuals can disenroll from Medicare Advantage and return to Original Medicare and can also switch from one Medicare Advantage plan to other.

Special Election Period – Medicare beneficiaries in Wyoming can enroll in a Medicare Advantage plan or change Medicare Advantage plans during this period, which is outside their Annual Election Period. They are allowed to change if they have experienced certain life or insurance coverage changes that have make them eligible for a Special Election Period.

Types of Medicare Advantage Plans in Wyoming

Medicare Advantage plans were not available in most of the counties of Wyoming prior to 2019 but now Medicare Savings Account plan, a type of Medicare Advantage plan is available in the state. Though, some of the counties of Wyoming do offer majority of the Medicare Advantage plans that are commonly available in other states of the U.S. Some of the Medicare Part C plan available here include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point-of-Service (POS)
  • Private Fee-for-Service
  • Medical Savings Account
  • Special Needs Plan

Medicare Advantage Prescription Drug Plan

Medicare Advantage Prescription Drug is a type of Medicare plan, which combines health and prescription drug coverage into a single plan. This plan is offered by medicare contracted private insurance companies and is considered as an alternative way to receive Medicare coverage. The Medicare Advantage Prescription Drug plans are required to cover everything that are covered under Original Medicare with the only exception of Hospice care. Besides prescription drug coverage, these plans also include other benefits like routine dental and vision care, hearing care and access to wellness programs.

Plan Formulary

Medicare Advantage Prescription Drug plan available in Wyoming has a documented list of prescription medications, which it covers, called a formulary. Every plan has its own formulary and include both brand name prescription drugs as well as generic drugs. The formulary has to include at least 2 drugs in all the commonly prescribed categories and classes to ensure that people with different medical conditions can get the drugs they need. Though, every plan has to cover at least 2 drugs from each category but the plans are free to choose the 2 drugs as per their choice. Medicare Advantage Prescription Drug plan formulary has at least two drugs from following popular categories:

  • Antipsychotics
  • Antidepressants
  • Anticonvulsants
  • Antiiretrovirals
  • Immunosuppressants
  • Antineoplastics

Costs

Since, Medicare Advantage Prescription Drug plans are offered by Medicare-approved private insurance companies, so the plan costs may vary from one insurance carrier to other. Generally this plan comes with a monthly premium but some of the areas in Wisconsin may offer plan at premium as low as $0 a month. Individuals enrolled in this plan should remember that even if they have $0 premium then also they are liable to pay their Part B premium. Beneficiaries of this plan are also responsible to pay for some additional costs like co-payments, coinsurance and deductibles.

Medicare Part D or Prescription Drug Plans

Medicare beneficiaries in Wisconsin, who are receiving health coverage through Original Medicare receive coverage for health benefits only. Since, Original Medicare doesn’t provide prescription drug coverage except in cases of an inpatient hospital stay, or in a clinic setting, where a prescription drugs are administered by a professional health-care provider, beneficiaries need to enroll in a stand-alone Medicare Part D or Prescription drug plan to obtain prescription drug coverage. Stand-alone Medicare Part D Prescription Drug Plans work in conjunction with the Original Medicare coverage. Medicare Part D prescription drug coverage are offered by private insurance companies having contract with Medicare. Individuals who are eligible to enroll in Medicare Part D should seriously consider to enroll in this plan to lower their drug costs.

Eligibility

Individuals interested in Medicare Part D plan have to meet the following eligibility requirements in order to enroll for this plan:

  • Individuals who are of age 65 or older.
  • Individuals below 65 having disability that qualifies them to receive Social Security or Railroad Retirement Disability benefits.
  • Individuals need to have either Medicare Part A or Part B or both to become eligible for Part D plan.
  • Individuals diagnosed with end-stage renal disease.

Plan Formulary

Every Medicare Prescription Drug plan available in Wyoming has its own list of covered medications called a formulary. The plan’s formulary not only list the name of drugs included in the plan but also list the amount which the insured has to pay for each covered drug and if any restriction are imposed on the insured ability to avail the drug. Medicare has also mandated to include some of the drugs in in all of the Part D plans and these plans have to cover substantially all of the prescription drugs on the following six protected categories:

  • Antipsychotics
  • Antiretrovirals
  • Immunosuppresants
  • Antidepressants
  • Antineoplastic (anticancer) drugs
  • Antiretroviral drugs
  • Anticonvulsants

Enrollment Period

Medicare beneficiaries in Wyoming should enroll in Medicare Part D plan when they first become eligible for the Medicare plan i.e. during the Initial Enrollment Period. IEP is the seven month duration starting three months prior the beneficiaries become eligible for Medicare, include the month in which beneficiary become eligible and continues for three months after it. Individuals unable to enroll during their period can enroll during the Annual Election Period or Open Enrollment Period that starts from from October 15 and ends on December 7 every year.

Medicare Supplement Plans in Wyoming

Since Original Medicare comes with some out-of-pocket costs like deductibles, coinsurance and co-payments, Medicare beneficiaries in Wyoming rely upon Medicare Supplement or Medigap plans in Wyoming to find help in paying these out-of-pocket costs. Wyoming is among the 47 states having ten standardized Supplement plans available for beneficiaries. Though, not every Supplement plan is available throughout the state and people looking for Medigap plans must check the plan available in their area.

Different Choices of Medicare Supplement Plans in Wyoming

Medicare Supplement plans in Wyoming just like any other states are available in ten standardized types, where each plan is labeled with a letter such as A, B, C, D, F, G, K,L, M, and N. Plan of the same letter offers the similar benefits irrespective of the insurance company offering the plan and the service area in which the plan is available. In 2020, Medicare Supplement plans offering coverage for Part B deductible will begin and the two Supplements plans offering this benefits are Plan C and Plan F. However, beneficiaries who became eligible for Medicare benefits on or after January 1, 2020 will not be able to enroll in these plans and those who already have these plans will be able to keep their coverage.

Enrollment Period

Medicare beneficiaries in Wyoming can enroll in Medicare Supplement plans during their Open Enrollment Period, which starts the month on which the beneficiaries become both 65 years of age or older and they enrolled in Medicare Part B. During this period, insurance company allows beneficiaries to enroll in the Medicare Supplement plans without medical underwriting. Individuals enrolling during this period cannot be denied coverage or charged more due to any previous or current health problem. Though, beneficiaries can enroll after this period too, but the insurance company may require medical underwriting and individuals can be denied coverage or charged higher rates based on their health problem.

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