- In 2019, there were 58 Medicare Advantage Plans available in Arizona.
- 38% of the total Medicare population in Arizona was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $9,201 per beneficiary in Arizona, which is 9% lower than the national average.
- Available Medicare Advantage Plans range from two to 56 across Arizona’s 15 counties.
While Original Medicare provides the same coverage to every enrollee, Medicare Advantage Plans offer varying benefits, rules, and cost-sharing responsibilities. Out-of-pocket costs depend on your plan’s monthly premium, whether your plan has a yearly deductible, and whether you obtain care from in-network providers.
Medicare Advantage Plans in Arizona
Types of Medicare Advantage Plans
Arizona’s Medicare Advantage program offers a variety of different plans. These plans, which private health insurance providers manage, vary in costs, benefits, and eligibility requirements. Understanding how each plan works can help you determine which one provides the coverage you need.
Health Maintenance Organizations (HMO)
HMOs, which are among the most popular and lowest priced Medicare Advantage Plans, require that you obtain health care services through the plan’s provider network. If you go outside of the plan’s network for care, you may pay the full cost, with the exception of emergency care and out-of-area dialysis. In some cases, plans may provide some coverage for out-of-network providers, but it generally costs significantly less to get care in-network. HMOs usually require you to choose a primary care doctor and get a referral to see a specialist.
Preferred Provider Organizations (PPO)
PPOs are another popular option for those enrolled in Medicare Advantage. While these plans have in-network providers, which you should visit for the most affordable care, most provide some coverage for providers outside of their network. Unlike HMOs, you usually don’t have to choose a primary care doctor, and you can usually set up an appointment to see a specialist without first getting a referral.
Private Fee-For-Service Plans (PFFS)
PFFS plans contract with doctors, specialists, and hospitals who agree to always treat members. Unlike HMO and PPO plans, which generally cover a percentage of the cost for services, PFFS plans determine how much you pay the health care provider and how much the plan pays. If your PFFS plan has a network, you can see any of the providers within the network. You have the freedom to choose an out-of-network health care provider, although your cost-sharing responsibility may be higher. You don’t need to choose a primary care doctor or get a referral to see a specialist in most cases.
Special Needs Plans (SNP)
SNPs have provider networks, drug formularies, and benefits that are geared to specific groups of people, such as those who have a chronic disease like diabetes or those who live in a nursing home. In most cases, you must get services from in-network providers, except for emergency medical services. Your SNP may require you to choose a primary care doctor or to have a care coordinator who helps you obtain necessary services, and you usually need a referral to see a specialist.
Enrollment and eligibility for Medicare Advantage Plans in Arizona
To enroll in a Medicare Advantage Plan, you must be enrolled in or qualify for Original Medicare Parts A and B and not have Medigap. Original Medicare eligibility is limited to those over age 65 or who are permanently disabled. The plans available to you depend on where you live, so you must reside within the service area of the plan you choose. If you live in Arizona for part of the year and in another state for the rest of the year, make sure the plan you choose in Arizona provides out-of-network coverage.
Enrollment into Medicare Advantage is limited to certain periods that open up annually or due to a qualifying event.
- The Initial Enrollment Period opens up three months before your 65th birthday and closes three months after your birth month.
- The Open Enrollment Period runs annually from October 15th to December 7th and is the time in which you can join, switch, or drop a health care plan. Any changes you make to your coverage take effect on January 1st.
- The Medicare Advantage Open Enrollment Period begins on January 1st and goes through March 31st. At this time, you can switch Medicare Advantage Plans or go back to Original Medicare.
Outside of these scheduled enrollment periods, special enrollment periods open up when certain events happen in your life.
- You move to another region and lose your coverage or have more options available to you.
- Medicare terminates your plan’s contract.
- You become eligible for Medicaid.
Prescription drug coverage
Most Medicare Advantage Plans, including all SNPs and most HMOs, PPOs, and PFFS plans, have prescription drug coverage, which helps pay for any medications that your doctor prescribes. Original Medicare members can purchase a separate Part D plan. If you have a PFFS plan without drug coverage, you are permitted to buy a separate Medicare Part D plan. Part D prescription drug coverage can’t be added to HMO or PPO plans. If you want this coverage, sign up for a plan that offers it when you initially enroll in Medicare to avoid late enrollment penalties.
Medicare Advantage Resources in Arizona
Several agencies can help you find the best Medicare Advantage policy for your needs and budget. In Arizona, you can get help through the State Health Insurance Assistance Program (SHIP), which is one of the Medicare programs funded by the state. You may connect with counselors through your local Area Agency on Aging or by contacting the state’s Department of Insurance.
Arizona Department of Economic Security | Division of Aging and Adult Services
The DES Division of Aging and Adult Services oversees two programs that serve Medicare-eligible residents in the state, including the SHIP and Senior Medicare Patrol. These programs can help you find available Medicare Advantage Plans in your region, compare benefits and costs, and enroll in Medicare Advantage or switch your plan. Trained volunteers can help you recognize and report Medicare fraud, abuse, and waste. Through the website, you can get general information about Medicare and find local resources and help centers.
Contact Information: Website | 602-542-4446
State Health Insurance Assistance Program
SHIP is a statewide program that provides free, unbiased advice for those weighing their Medicare options. It’s staffed primarily by trained volunteers who aren’t affiliated with any insurance providers. While these counselors aren’t licensed to sell you a policy, they can answer your questions about the benefits and cost-sharing obligations of various plans, help you understand and reconcile your medical bills, and dispute denied claims or canceled coverage.
Contact Information: Website | 800-432-4040
Area Agency on Aging, Region 1
The local Area Agency on Aging has a Benefits Assistance Program for Medicare beneficiaries. It’s made up of SHIP and SMP and provides you with an up-to-date directory of local SHIP counseling locations and education on avoiding being a victim of health care fraud. The AAA may be able to help you save money on health care expenses by assisting with Medicare appeals and helping you determine your eligibility for income-based programs. The Agency maintains the Benefits Assistance & Medicare Online Library, which features detailed information on Medicare rules and benefits.
Contact Information: Website | 602-280-1059
Arizona Department of Insurance and Financial Institutions
The Arizona Department of Insurance and Financial Institutions provides information relevant to older adults in the state, helping you make informed decisions regarding your Medicare coverage. Through its website, you can learn more about Medicare prescription drug plans, Medigap policies, and insurance companies licensed to sell Medicare products in the state.
Contact Information: Website | 602-364-3100
Learn More from Our Sources
- Medicare | What’s Medicare?
- Medicare | Costs for Medicare Advantage Plans
- Medicare | How Do Medicare Advantage Plans Work?
- Medicare | Health Maintenance Organization (HMO)
- Medicare | Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Medicare | Special Needs Plans (SNP)
- Medicare | Who Can Join a Medicare Advantage Plan?
- Medicare | Joining a Health or Drug Plan
- Medicare | Special Circumstances (Special Enrollment Periods)
- Medicare | Drug Coverage (Part D)
- Medicare | Part D Late Enrollment Penalty