Medicare Advantage Plans in Arizona
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: November 5, 2020
Arizona seniors can opt to enroll in Medicare Advantage instead of Original Medicare and potentially receive more benefits. Medicare Advantage, also called Medicare Part C, includes Medicare Part A (hospital insurance) and Part B (medical insurance), just like Original Medicare. However, many plans also often include prescription drug coverage, plus extras, such as rides to medical appointments, wellness programs, and dental, vision, and hearing care. Medicare Advantage plans in Arizona are offered by government-approved private insurance companies, instead of the federal government. The benefits and the out-of-pocket costs vary by company and plan.
- 1 In 2019, there were 58 Medicare Advantage plans available in Arizona.
- 2 38% of the total Medicare population in Arizona is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $9,201 per beneficiary in Arizona, which is 9% lower than the national average.
- 4 Available Medicare Advantage plans range from 2 to 56 across Arizona’s 15 counties.
Private insurance companies approved by the U.S. Centers for Medicare & Medicaid Services offer various types of Medicare Advantage plans in Arizona. The exact availability of these plans depends on the health insurance provider and geographic location of the beneficiary. Options may include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service plans, and Special Needs Plans. Medicare pays these companies a fixed amount toward each beneficiary’s coverage, which must follow Medicare’s coverage rules and provide plan members with the same rights and protections as they’d have under Original Medicare.
Medicare Advantage Plans in Arizona
Types of Medicare Advantage Plans
Arizona’s Medicare Advantage program offers a range of plan types, including numerous HMOs and PPOs, the two most popular types of managed-care plans. There are also some PFFS plans and several SNPs in certain counties, including Dual-Eligible SNPs and Chronic Condition SNPs. There are specific eligibility and enrollment requirements for all Medicare Advantage plan types, but there are state and local organizations available to answer questions and provide information about the program.
Health Maintenance Organizations (HMO)
HMO plans require members to receive all their medical care from a network of doctors, hospitals, and other healthcare providers. Members must choose a primary care physician, who makes all their treatment decisions and provides referrals to specialists if necessary. HMOs are usually the most affordable Medicare Advantage plans and have low or no deductibles, but to control these costs, HMOs only cover care received from in-network providers. Plan members who seek healthcare from non-network providers are responsible for the entire cost of their care, except in emergency or critical care situations and some dialysis situations.
Preferred Provider Organizations (PPO)
PPO plans usually have higher costs and deductibles than HMOs, but plan members have more flexibility in the healthcare providers they choose to see. PPOs have a network of preferred providers, and plan members get the lowest copay and coinsurance rates when they see providers within this network. Unlike HMOs, members can also see non-network providers and part of the cost will still be covered. PPO plan members also aren’t required to choose a PCP or get referrals before seeing a specialist.
Private Fee-For-Service Plans (PFFS)
PFFS plans allow members to seek healthcare services from any doctor, hospital, or provider and offer the greatest flexibility of all plan types. While these plans may have a network, and in-network costs are generally lower, members are free to see any healthcare provider who agrees to the plan’s conditions and payment terms and still receive coverage. The insurance company decides how much it pays providers and how much its members pay for the services received, so PFFSs tend to have higher premiums than other Medicare Advantage plans.
Special Needs Plans (SNP)
SNPs can be HMOs or PPOs, but they all restrict membership to beneficiaries who have one or more chronic or disabling conditions (Chronic Condition SNPs), are eligible for both Medicare and Medicaid (Dual Eligibility SNPs), or reside in a long-term facility (Institutional SNPs). Eligible members must receive all their care from providers within the plans’ networks, which vary in size and the geographic locations served. SNPs are higher in cost but provide focused care management. Arizona has several D-SNPs and a limited number of C-SNPs, including one for chronic heart failure and diabetes for residents of Maricopa and Pinal counties.
Enrollment & Eligibility for Medicare Advantage Plans in Arizona
Arizona seniors who are eligible for Medicare Parts A and B are also eligible to enroll in Arizona’s Medicare Advantage program when they turn 65, or at a younger age if they have a qualifying disability. Qualified beneficiaries must be U.S. citizens or permanent residents and live in an area where Medicare Advantage plans are sold. They can’t be enrolled in Medigap or have end-stage renal disease, except when an SNP is an option.
Seniors turning 65 who receive Social Security or Railroad Retirement Board benefits are automatically enrolled in Medicare Parts A and B. They can then join or switch to a Medicare Advantage plan during the right enrollment period.
Individuals receiving disability insurance must do so for 24 months in order to qualify for Medicare.
Arizona’s Medicare Advantage program has specific enrollment periods for first-time applicants and existing members needing to make changes.
- Initial coverage election periods begin the three months immediately before a first-time joiner’s 65th birthday month and end three months after their birthday month.
- Annual election periods lasting from October 15 to December 7 are limited to current Medicare recipients switching to Medicare Advantage and current Medicare Advantage members making plan changes.
- Annual open enrollment periods running from January 1 to March 31 are limited to current Medicare Advantage recipients switching plans or back to Original Medicare.
- General enrollment periods lasting from April 1 to June 30 are limited to Medicare recipients who already had Part A, enrolled in Part B for the first time during annual open enrollment and want to switch to a Medicare Advantage plan.
During the Open Enrollment Period the following can occur:
- Anyone who has (or is signing up for) Medicare Parts A or B can join or drop a Part D prescription drug plan.
- Anyone with Original Medicare (Parts A & B) can switch to a Medicare Advantage plan.
- Anyone with Medicare Advantage can drop it and switch back to just Original Medicare (Parts A & B).
- Anyone with Medicare Advantage can switch to a new Medicare Advantage plan.
- Anyone with a Part D prescription drug plan can switch to a new Part D prescription drug plan.
Prescription Drug Coverage
Except for SNPs, which are legally required to include prescription drug coverage, Medicare Advantage plans in Arizona may or may not include drug coverage. Many HMO, PPO, and PFFS plans do include prescription drug coverage, sometimes called Medicare Advantage Prescription Drug (MA-PD) plans, and may require a separate premium. Beneficiaries enrolled in HMOs or PPOs that don’t include drug coverage can’t sign up for a stand-alone Medicare Part D plan, or they’ll lose their Medicare Advantage plan and be switched back to Original Medicare. PFFS plans without prescription drug coverage allow members to purchase separate Medicare Part D plans.
Medicare Advantage Resources in Arizona
Having the right medical coverage is important, but some Medicare-eligible seniors become overwhelmed with the complex application and enrollment process for Medicare Advantage. Several Arizona organizations at the state and local levels provide personalized Medicare counseling to answer questions and provide guidance. These programs are usually free and help qualified recipients navigate coverage, benefits, premiums, deductibles, copayments, coinsurance, and other elements of Arizona’s Medicare Advantage program, so they can make informed decisions about their healthcare coverage.
Arizona Department of Economic Security
The Arizona Department of Economic Security’s Division of Aging and Adult Services operates the State Health Insurance Program to help seniors with Medicare application and benefits questions. This free health benefits counseling service is federally funded by the Administration for Community Living. It helps Medicare-eligible individuals, their families, and caregivers make informed decisions about Medicare and Medicare Advantage plans. It can also provide information to low-income Medicare recipients on how to get help paying for monthly premiums and finding assistance with Medicare prescription drug costs and doctor and hospital visits.
Contact Information: Website | 602-542-6439 or 800-432-4040
Western Area Council of Governments
The Western Area Council of Governments is the Regional Council on Aging and Area Agency on Aging for Region IV. It serves seniors aged 60 and over, family caregivers, and adults with disabilities in Yuma, Mohave, and La Paz counties. WACOG provides Medicare counseling and enrollment assistance through SHIP and its Benefits Enrollment Center. Counselors answer questions about Medicare Parts A, B, C, and D, and Medigap, and help seniors find Medicare Advantage and Medicare Part D plans that meet their needs. Seniors can call to make a counseling appointment.
Contact Information: Website | 800-782-1886
Chiricahua Community Health Centers
Chiricahua Community Health Centers offer free Medicare counseling throughout Cochise County and have certified application counselors available at all eight of its clinics. Chiricahua’s enrollment specialists are licensed through the Arizona Department of Insurance and are HIPAA- and CMS-certified. Application assistance is offered free of charge to everyone whether or not they’re clinic patients. Chiricahua doesn’t receive any type of commission for the Medicare-related services it provides, and it doesn’t sell Medicare or Medicare Advantage plans.
Contact Information: Website | 520-459-3011
Area Agency on Aging, Region One
Area Agency on Aging, Region One is a private, nonprofit organization that offers services for Maricopa County seniors aged 60 or over, adults aged 59 and younger with disabilities and long-term care needs, and family caregivers. AAA staff provide information about Original Medicare and Medicare Advantage plans and assistance with Medicare prescription drug coverage and Medicare claims and appeals. The Phoenix-located agency also delivers community presentations on various Medicare topics and provides an online Medicare resource library. Medicare-eligible individuals can speak to a benefits assistance counselor by calling 602-280-1059 or make an appointment for in-person counseling through the 24-hour senior helpline.
Contact Information: Website | 888-783-7500
- Sources [-]
https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/Pubs/pdf/11135-prescription-drug-coverage-with-ma-mcp.pdf Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.