October 6, 2016
Medicare beneficiaries living in Arizona may have multiple Medicare plan options available, depending on where they live.
If you are eligible for Medicare, you can get your health coverage in two main ways: through Original Medicare or through the Medicare Advantage (Medicare Part C) program. Read below about these and other types of Medicare insurance.
Original Medicare, Part A and Part B, is a traditional, federally-administered health insurance program in Arizona (as in all states). Part A covers inpatient services, including hospital and skilled nursing facility care, short-term home health care, and hospice care. Part B covers outpatient medical services, including doctors’ visits, preventive care, and durable medical equipment. Restrictions apply to both Part A and Part B coverage, as do certain costs such as premiums, deductibles, and coinsurance.
Original Medicare includes limited prescription drug coverage, and doesn’t cover most prescription medications you would take at home. It also doesn’t cover certain long-term nursing home care, personal care, routine vision services, or routine dental services.
If you have Original Medicare, your benefits will generally be the same regardless of where you live. You can see any provider that accepts Medicare.
Most people become eligible for Medicare when they turn 65. If you are already receiving Social Security or Railroad Retirement Board (RRB) benefits before turning 65, you will automatically get Medicare the first day of the month that you turn 65. Otherwise, you can enroll in Medicare during your Initial Enrollment Period (IEP), the seven-month period that begins three months before you turn 65, includes the month you turn 65, and ends three months later.
In some cases, you may be eligible for Medicare before age 65. If you receive disability benefits from the Social Security Administration or the Railroad Retirement board for 24 months in a row, you’ll be enrolled in Medicare automatically. If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS), you’ll be enrolled in Medicare during the first month that you receive disability benefits. If you have end-stage renal disease (ESRD), you might qualify for Medicare before age 65, but you need to contact the Social Security Administration to sign up (see below).
Medicare beneficiaries in Arizona, as in other states, can enroll in Medicare through the Social Security Administration. You can sign up:
If you don’t sign up during your IEP, you can enroll in Part A and/or Part B during the General Enrollment Period that takes place annually from January 1 to March 31. Keep in mind that you may have to pay a late enrollment penalty for not signing up in Part A and/or Part B when you were first eligible.
If you have other health insurance, such as through an employer group plan, you may choose to delay Part B enrollment, since it comes with a monthly premium. Most people get Part A with no monthly premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes during that time. If you’re still working and have employer coverage, however, you may not want to pay for additional coverage you don’t need. If you decide to delay Part B, you can sign up during a Special Enrollment Period (SEP) when your group coverage ends, without paying the Part B late enrollment penalty. Talk to your employer’s benefits administrator about how your insurance would work with Medicare.
Medicare beneficiaries in Arizona also have many Medicare plan options available besides Original Medicare.
As an Arizona resident, your available Medicare plan options will depend on where you live.
Medicare Advantage plans are offered by private, Medicare-approved insurance companies and give you an alternate way to receive your Original Medicare benefits. All plans cover the same Part A and Part B benefits. Some plans may have extra benefits, such as routine vision, routine dental, or wellness programs. Depending on the type of Medicare Advantage plan, you may be restricted to seeing providers in a network or pay more to go outside the plan’s network. Costs and any additional benefits will vary depending on your plan. No matter which Medicare Advantage plan you enroll in, you will have to keep paying the Part B premium, in addition to any premium your plan requires. Hospice care is still covered under Part A when you have a Medicare Advantage plan.
Unlike with Original Medicare, you generally don’t need to enroll in a separate plan to get prescription drug coverage in Medicare Advantage. Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug (MAPD) plans.
Original Medicare includes only limited prescription drug coverage normally during an inpatient Medicare-approved hospital stay. If you have Original Medicare, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan to help pay for your prescriptions.
Your out-of-pocket costs for a Medicare Part D Prescription Drug Plan will depend on the medications you take, the plan you enroll in, and how the plan categorizes those drugs into different payment tiers. Each Medicare Part D Prescription Drug Plan has a formulary, or list of drugs the plan covers, organized into payment tiers. The formulary may change at any time. You will receive notice from your plan when necessary.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Medicare beneficiaries in Arizona may find the following list of state resources helpful.
Learn more about how Medicare plans work in Arizona, including:
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.