What is Kansas Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare. While Original Medicare is provided by the federal government, Medicare Advantage plans are offered by private, Medicare-approved insurance companies in Kansas.

By law, these plans must provide at least the same level of coverage as Original Medicare Part A and Part B. However, most Kansas plans go further, offering:

  • Prescription Drug Coverage (Part D) built directly into the plan.

  • Annual Out-of-Pocket Maximums to protect you from high medical bills (Original Medicare has no cap).

  • Extra Benefits such as gym memberships (SilverSneakers), dental exams, and routine vision care.

Types of Plans Available in Kansas

Kansas residents typically choose between two main types of Medicare Advantage networks:

1. Health Maintenance Organization (HMO)

With an HMO, you generally must get your care from doctors and hospitals within the plan’s network. You usually need a referral from a primary care doctor to see a specialist. These often feature the lowest monthly premiums.

2. Preferred Provider Organization (PPO)

PPO plans offer more flexibility. You can see any doctor who accepts Medicare, but you will pay significantly less if you stay "in-network." You generally do not need a referral to see a specialist.

Using Star Ratings to Compare Plans

The Centers for Medicare & Medicaid Services (CMS) uses a 5-Star Quality Rating System to measure how well Kansas plans perform. Ratings are updated annually and are based on:

  • Preventive Care: How often members get screenings and vaccines.

  • Chronic Condition Management: How well the plan helps members manage long-term illnesses.

  • Member Experience: Surveys on customer service and ease of getting care.

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Enrollment Windows in Kansas

You can only join, switch, or drop a Medicare Advantage plan during specific times of the year:

  • Initial Enrollment Period (IEP): A 7-month window when you first become eligible for Medicare (usually around your 65th birthday).

  • Annual Enrollment Period (AEP): Every year from October 15 to December 7, you can switch plans or move from Original Medicare to Advantage.

  • Medicare Advantage Open Enrollment (MA OEP): From January 1 to March 31, if you are already in an Advantage plan, you can make one switch to another Advantage plan or return to Original Medicare.

How to Choose a Kansas Medicare Advantage Plan

To find the right fit, ask these three questions:

  1. Are my doctors in-network? Use the plan's provider directory to ensure your preferred Kansas physicians and hospitals are covered.

  2. Are my prescriptions covered? Check the plan's "Formulary" (drug list) to see how your specific medications are tiered and priced.

  3. What is the Max Out-of-Pocket? Compare the safety net. If you have a major health event, what is the most you will have to pay in a single year?

Frequently Asked Questions: Kansas Medicare Advantage

1. Is Medicare Advantage the same as a Medicare Supplement?

No. While both are offered by private companies in Kansas, they work differently:

  • Medicare Advantage (Part C) is an "all-in-one" alternative that replaces how you receive your Original Medicare benefits, often including drug coverage and extra perks.

  • Medicare Supplement (Medigap) works alongside Original Medicare to pay for out-of-pocket costs like the 20% coinsurance.

  • Note: You cannot have both at the same time.

2. How can a plan have a $0 monthly premium?

Many Kansas residents have access to $0 premium plans. These insurers receive a fixed amount from the federal government to manage your care. If the plan manages care efficiently, they pass those savings to you in the form of lower premiums and extra benefits.

  • Important: Even with a $0 premium plan, you must continue to pay your monthly Medicare Part B premium.

3. Do I lose my Medicare benefits if I join an Advantage plan?

No. You are still in the Medicare program and you still have all your Medicare rights and protections. You are simply choosing to receive your Part A (Hospital) and Part B (Medical) benefits through a private provider network rather than the federal government.

4. Can I see any doctor in Kansas with an Advantage plan?

It depends on the plan type.

  • HMO plans generally require you to stay within a specific network of Kansas doctors and hospitals.

  • PPO plans allow you to see out-of-network providers, though you will typically pay a higher copayment or coinsurance for doing so.

5. What is a "Maximum Out-of-Pocket" (MOOP)?

One of the biggest advantages of Part C in Kansas is the MOOP. Unlike Original Medicare, which has no limit on what you could spend in a year, Medicare Advantage plans have a mandatory "safety net" cap. Once you spend that amount on covered medical services, the plan pays 100% for the rest of the year.

6. Do these plans cover my prescription drugs?

Most Kansas Medicare Advantage plans are MAPD (Medicare Advantage Prescription Drug) plans, meaning Part D coverage is included at no extra premium. However, always check the plan’s "Formulary" to ensure your specific medications are covered.

7. What happens if I move to a different county in Kansas?

Medicare Advantage plans are service-area specific. If you move to a new county (for example, from Sedgwick to Johnson County), your current plan may not be available. This usually triggers a Special Enrollment Period, allowing you to switch to a plan available in your new zip code.

Kansas Medicare Advantage

Phone/text:

913-232-2006 

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Serving ALL of Kansas including:  De Soto, Edgerton, Fairway, Gardner, Lake Quivira, Leawood, Lenexa, Merriam, Mission, Mission Hills and Mission Woods, Olathe, Overland Park, Prairie Village, Roeland Park, Shawnee, Spring Hill, Topeka, Westwood, & Westwood Hiils, Wichita