Medicare Advantage Plans in Arizona

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Many plans offer additional benefits such as dental, vision, hearing, telehealth services, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first be enrolled in Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but individuals with disabilities or conditions like ALS or ESRD may qualify earlier.

Key enrollment periods include:

• Initial Enrollment Period (IEP)
• General Enrollment Period (GEP)
• Special Enrollment Periods (SEP)

Delaying enrollment may result in penalties or a loss of premium-free coverage.

What Types of Medicare Advantage Plans Are Available in Arizona?

Arizona residents have access to a range of Medicare Advantage plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and usually a designated primary care physician (PCP). Out-of-network care generally results in higher costs.
• Preferred Provider Organizations (PPOs): Offer flexibility to see both in- and out-of-network providers, usually without needing a PCP or referrals.
• Private Fee-for-Service (PFFS) Plans: Let you use any provider who agrees to the plan’s terms. No PCP is required.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions such as diabetes or cancer.
  • I-SNPs: For individuals in nursing facilities or who need skilled in-home care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid. These plans often include drug coverage, dental, and care coordination with low or no cost.
• Medical Savings Accounts (MSAs): Pair a high-deductible plan with an insurer-funded medical savings account to help pay for qualified healthcare expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most Medicare Advantage plans in Arizona include Part D drug coverage. Plans that don’t—like MSAs or some PFFS plans—require separate Part D enrollment (if allowed).

If your plan lacks drug coverage:

• You may enroll in a standalone Part D plan, depending on plan eligibility.
• You may face a penalty for delaying prescription drug coverage without creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Understand Medicare Advantage costs before selecting a plan:

• Premiums: Many Arizona plans offer $0 premiums, though you still pay the standard Part B premium. Higher premiums may offer more coverage.
• Deductibles, Coinsurance & Copays: Costs vary. You may have fixed copays for visits and coinsurance for other services.
• Out-of-Pocket Maximums: Caps how much you’ll pay per year for covered services. Once reached, the plan pays 100% of costs.
• Extra Benefits: MA plans may offer dental, vision, telehealth, gym memberships, and transportation assistance.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: Begins 3 months before and ends 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Switch, join, or drop MA plans.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Part B after missing initial deadlines.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): For switching MA plans or returning to Original Medicare.
• Special Enrollment Periods: Available for circumstances such as:
  • Moving out of your plan’s service area
  • Losing employer or union healthcare coverage
  • Becoming ineligible for Medicaid
  • Plan termination or exit from the Medicare program
  • Diagnosis of a condition qualifying you for an SNP

What If You Want to Change Your Medicare Advantage Plan?

You can change your plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

When you enroll in a new plan, your old plan is automatically canceled when the new one takes effect.

What Are Medicare Resources in Arizona?

Arizona offers several helpful programs:

• Arizona SHIP (State Health Insurance Assistance Program): Offers free Medicare counseling and plan comparison assistance.
• Arizona SMP (Senior Medicare Patrol): Educates beneficiaries on preventing and reporting Medicare fraud.
• Arizona Department of Insurance and Financial Institutions: Assists with Medicare-related complaints.
• Arizona Health Care Cost Containment System (AHCCCS): Arizona’s Medicaid program offering assistance to low-income seniors. Call 1-855-432-7587 or visit their website.

Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also called Medigap, help cover deductibles, copayments, and other costs not covered by Original Medicare.

• You must have Medicare Parts A and B to enroll.
• The best time to apply is during your six-month Medigap Open Enrollment Period, which begins when you sign up for Part B.
• Outside this window, insurers may require medical underwriting.
• Medigap plans do not include drug coverage—you’ll need a separate Part D plan.

There are 10 standardized plans available. Medicare Supplement Plan G had the highest enrollment in 2023 and, along with Plan N, is among the fastest-growing. Plan F is no longer available to new Medicare enrollees.

Learn more about Medicare Supplement plans in Arizona.

Next Steps

If a Medicare Advantage plan in Arizona suits your needs, begin comparing plan options available in your ZIP code. Review provider networks, drug coverage, out-of-pocket costs, and extra benefits. Enroll during the appropriate enrollment window to avoid penalties and ensure full coverage.