You’re eligible for Medicare, the government-run healthcare program for seniors, at age 65. The program is composed of Medicare Part A (hospital coverage) and Part B (outpatient coverage), also called Original Medicare. It won’t cover prescription drug costs and there isn’t a cap on out-of-pocket expenses.
Medicare Part C, or Medicare Advantage, is another option to get the coverage you need. Medicare Advantage (MA) plans are offered by private insurance companies and must provide the same coverage as Original Medicare. Many plans cover prescription drugs and limit your out-of-pocket expenses for services.
What You Need to Know
Medicare Advantage plans provide the same coverage as Original Medicare.
Many MA plans include Part D coverage for prescription drugs.
You can switch your Medicare Advantage plan during open enrollment periods.
What Types of Medicare Advantage Plans Are Available in Arizona?
Most MA plans work with a network of doctors and healthcare facilities to lower the cost of medical services. Plan types include:
- Health Maintenance Organization (HMO): These account for about two-thirds of all MA plans.1 You usually must designate a primary care physician (PCP) for regular medical care. Visiting an out-of-network doctor will cost you more out-of-pocket than staying in-network.
- Preferred Provider Organization (PPO): You don’t usually need to choose a PCP and you can visit any healthcare facility. Going to an in-network doctor often lowers your out-of-pocket costs.
- Special Needs Plans (SNP): You’re eligible for these plans if you have specific health conditions.2
- Chronic Condition SNP (C-SNP): These plans cover chronic medical conditions like diabetes or cancer.
- Institutional SNP (I-SNP): This plan provides care if you’re living in an institution like a nursing home, or if you need in-home nursing care.
- Dual-Eligible SNP (D-SNP): You must be eligible for both Medicare and Medicaid to enroll in this plan.
- Private Fee-for-Service (PFFS): You don’t need to choose a PCP for this plan. The plan decides how much it will pay healthcare providers for care, as well as how much you’ll pay.
- Medicare Medical Savings Accounts (MSA): These plans combine a high-deductible insurance plan with an MSA to help pay for out-of-pocket expenses.
Did You Know?
You’ll save money with a Medicare Advantage plan by staying in-network for services.
What Are Prescription Drug Options with Medicare Advantage in Arizona?
Unlike Original Medicare, most Medicare Advantage plans include Medicare Part D prescription drug coverage.
When choosing an MA plan, check the plan’s drug formulary, or list of covered medications, to make sure your prescriptions are included.
How Do You Choose Medicare Advantage Plans in Arizona?
Compare the costs and benefits of Medicare Advantage plans in your area to find the right one for you. Considerations include:
- Premiums: This is the monthly cost of your plan. You’ll also pay the Medicare Part B premium ($148.50 for most people in 2021). You might want to choose a zero-premium plan, but you may have higher out-of-pocket costs in other areas like copays.
- Deductible: This is the annual amount you’ll pay out-of-pocket before your plan starts paying for care.
- Coinsurance: Your portion of the cost of medical services, usually as a percentage of the total cost.
- Copay: The fixed price you’ll pay for specific medical services.
- Out-of-Pocket Maximum: The maximum amount you’ll pay out-of-pocket for care each year.
- Plan Benefits
- Vision: Covers services like eye exams or frames.
- Dental: Covers dental care such as routine checkups or teeth cleaning.
- Telehealth: Covers remote healthcare such as video office visits or consultations over the phone.
- Additional Perks: Your MA plan may include coverage for additional benefits like healthcare transportation or reimbursement for a gym membership.
Did You Know?
Most MA plans also offer vision and dental coverage.
When and How to Enroll in Medicare Advantage in Arizona?
You can first enroll in Medicare during your Initial Enrollment Period. This includes the three months before to the three months after you turn 65. If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period from January 1 to March 31 each year. Be aware, you may have late penalties on your Medicare premiums if you sign up after your Initial Enrollment Period.
You can enroll in Original Medicare through the Social Security Administration. Sign up online, over the phone, or at your local Social Security office.
Once enrolled in Original Medicare, you can choose a Medicare Advantage plan. Enrollment periods for MA plans include:3
- Initial Enrollment Period: You can pick an MA plan when you enroll in Original Medicare.
- Medicare Annual Election Period: Choose an MA plan during annual open enrollment from October 15 to December 7.
- Medicare Advantage Open Enrollment Period: Switch your current MA plan or go back to Original Medicare from January 1 to March 31 each year.
- Special Enrollment Period: Certain circumstances allow you to sign up for an MA plan outside of open enrollment periods, including:
- You’re no longer living within your plan’s service area.
- You receive coverage from an employer or union healthcare plan.
- You’re becoming ineligible for your existing coverage, such as becoming ineligible for Medicaid.
- Your plan is being terminated or leaving the Medicare program.
- You need an SNP after being diagnosed with a health condition.
How Much Do Medicare Advantage Plans Cost in Arizona?
Medicare Advantage plan costs vary based on several factors, including where you live. In Arizona, the average cost of a Medicare Advantage plan is $12.25 per month.4
Remember to consider all the costs associated with your plan, including monthly premiums and deductibles. Your monthly premium could cost between $0 and $120 per month in Tucson and Phoenix, but other costs will vary by plan.5
In Arizona, the average cost of a Medicare Advantage plan is $12.25 per month
What If You Want to Change Your Medicare Advantage Plan in Arizona?
It’s easiest to change your Medicare Advantage plan during one of the open enrollment periods. After enrolling in a new plan, your previous plan is automatically terminated at the start of your new coverage.
What Are Medicare Resources in Arizona?
- State Health Insurance Assistance Program (SHIP): This service provides free counseling on your Medicare options.6
- Arizona Department of Insurance and Financial Institutions: Access resources to help you find coverage and get your insurance questions answered.7
- Arizona Health Care Cost Containment System (AHCCCS): This is Arizona’s Medicaid program, which includes resources and coverage options for low-income seniors.8
Find out if a Medicare Advantage plan is a good fit for you by comparing plans now so you’re ready to enroll during your Initial Enrollment Period.