If you’re an Arizona Medicare beneficiary requiring more thorough coverage than what’s available under Original Medicare, Part A and Part B, you may want to consider enrolling in a Medicare Advantage plan. Benefit details depend on the specific health insurance plan you choose and where in Arizona you live.
How Medicare Advantage works in Arizona
As in other states, Medicare Advantage in Arizona is available from private, Medicare-approved health insurance companies. Medicare Advantage plans are required by law to offer at least the same benefits as Original Medicare, Part A and Part B (except hospice care, which Part A covers). Medicare Advantage beneficiaries are covered through their individual health plans and not directly through Original Medicare (except for hospice care).
Arizona Medicare Advantage plans are available through private insurance companies that contract with Medicare. They often come with additional benefits, like routine vision, hearing, and dental coverage, depending on the plan. Most Medicare Advantage plans include prescription drug benefits.
To qualify for a Medicare Advantage plan, you need to:
- Be enrolled in Original Medicare, both Part A and Part B.
- Live in the coverage area of the plan you want to enroll in.
- Not have end-stage renal disease (ESRD). There are exceptions, so if you have ESRD and want to sign up for a Medicare Advantage plan, you can ask your plan, or Medicare, about exceptions. Medicare’s contact information is at the end of this article.
You can enroll in a Medicare Advantage plan during your Initial Coverage Election Period (ICEP):
- If you sign up for Medicare Part A and Part B when you first qualify for Medicare, you can enroll in Medicare Advantage at that time as well. Your ICEP is usually a seven-month period that starts three months before the month where you turn 65, and runs through your birth month, and continues for the three months after that.
- If you delay enrollment in Medicare Part B (for example, if you’re covered through an employer’s plan), your ICEP is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your ICEP would be April 1 to June 30.
If you don’t sign up for Medicare Advantage during your ICEP, you can enroll in a Medicare Advantage plan during the Annual Election Period. It runs from October 15 to December 7 each year. You can add, switch, or drop Medicare Advantage plans during the Annual Election Period; your new coverage will start on January 1 of the following year.
Medicare has special provisions to help you deal with certain situations. Some examples of these situations include moving to a new address, losing your current health coverage, qualifying for a different type of coverage, and experiencing changes in your current plan that affect your health benefits. You can switch health plans during Special Enrollment Periods if your situation qualifies you to do so.
Arizona Medicare Advantage beneficiaries who decide to opt out of Medicare Advantage and switch back to Original Medicare, Part A and Part B, can do so during the Medicare Advantage Open Enrollment Period, which occurs annually from January 1 to March 31 each year. You also can add a stand-alone Medicare Part D Prescription Drug Plan or another Medicare Advantage plan during this time.
Types of Medicare Advantage plans in Arizona
Arizona Medicare Advantage beneficiaries may have a number of options when it comes to choosing the type of Medicare Advantage plan that might suit their health and prescription drug needs:
- A Medicare Advantage Health Maintenance Organization (HMO)is one such option to consider. Under an HMO plan, you’re typically required to visit doctors, health-care providers, and hospitals in the plan’s network. You may also need a referral from your primary care physician to get coverage for various health services. An HMO Point-of-Service (HMO-POS) plan is similar to an HMO plan, but it allows you to go out of network for certain health services, generally at a higher out-of-pocket cost.
- As an Arizona Medicare beneficiary, you may be able to sign up for a Preferred Provider Organization (PPO)* plan. This type of plan allows you to select your own doctors, health-care providers, and hospitals, but you may end up paying more for this more flexible kind of coverage.
- Medicare Special Needs Plan (SNPs)are geared toward Medicare Advantage beneficiaries with specific health needs, such as patients living with HIV/AIDS or patients with diabetes, people living in nursing homes, or beneficiaries who also qualify for Medicaid. This type of health plan offers coverage generally tailored to suit the health needs of those specific beneficiaries.
- Under a Medicare Advantage Private Fee-for-Service (PFFS) plan, the plan itself decides how much it will pay for your doctor, health-care provider, and hospital visits. The Private Fee-for-Service plan also determines your out-of-pocket share for each health service.
- Medicare Advantage beneficiaries can also opt for a Medical Savings Account (MSA) plan. These policies generally combine a high deductible with a savings account that beneficiaries can use to pay for their health care expenses.
Most Medicare Advantage plans also include prescription drug coverage. These policies, known as Medicare Advantage Prescription Drug plans, combine health and prescription drug coverage into one plan.
If you choose to enroll in a Medicare Advantage plan, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium to keep your Medicare coverage.
Comparing Medicare Advantage plans in Arizona
There may be a number of Medicare Advantage plans available to Arizona residents; your costs may vary depending on the plan you choose. Each plan’s policies may change on an annual basis, so it’s usually a good idea to compare available Arizona Medicare Advantage plans based on where you live and your individual health needs.
Also remember that premiums for Medicare Advantage plans offering similar benefits can vary between among plans in Arizona. In addition, some Medicare Advantage plans may offer premiums as low as $0, while others may charge higher amounts, depending on the type of coverage they provide. Be aware that you must continue paying your Medicare Part B premium no matter which Medicare Advantage plan you choose.
Another important decision you have to make is whether or not you want prescription drug coverage with your Medicare Advantage policy, and which medications you need it to cover.
To start comparing plans in your part of Arizona, just enter your zip code in the form on this page.
You can reach a Medicare representative 24 hours a day, seven days a week (except federal holidays) at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.