There are several different Medicare Advantage plans available in Arizona.
Medicare Advantage plans may be Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS), Special Needs Plans (SNP) or Medicare Medical Savings Accounts (MSA).
Not all types of Medicare Advantage plans may be available in your area, so check with the plan to see if they offer coverage where you live.
Premiums, deductibles, and benefits can vary, so choose a plan that fits your individual needs.
Check to make sure your providers are in-network before signing with a plan.
Medicare Advantage plans offer Medicare Part A and B coverage and additional benefits such as prescription drug coverage, vision, dental, and more.
Plan availability, cost and benefits all vary depending on where you live in Arizona.
This article will take a closer look at Medicare Advantage coverage options in Arizona, including costs, eligibility, and more.
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If you live in Arizona and are considering a Medicare Advantage plan, you have several choices.
All Medicare Advantage plans must offer Medicare Part A and Part B coverage that is at least equal to Original Medicare. All Medicare Advantage plans are through Medicare-approved private health insurance companies. Medicare Advantage plans are also called Part C plans and offer broader coverage benefits than Original Medicare plans.
Additional coverage under Medicare Advantage plans can include:
- Prescription drugs
- Over-the-counter drugs
There are advantages and limitations for each type of Medicare Advantage plan. The one that fits you depends on your healthcare needs and what works for your budget. The type of plan you choose determines your coverage, benefits, and costs.
There are four common options for Medicare Advantage plans:
- Health Maintenance Organizations (HMO) – HMO plans may have provider network restrictions (doctors, hospitals, pharmacies, etc.). Going out of network may cost you more since the plan wouldn’t pay for out-of-network services other than in emergencies. But you may have $0 premiums, deductibles and copays with some plans.
- Preferred Provider Organization (PPO) – PPO plans may offer greater flexibility with provider networks. You generally won’t need a primary care provider or referrals for specialists with a PPO type plan. If you go to an out-of-network provider, costs may be higher, but they would generally be covered, unlike an HMO plan.
- Private Fee-For-Service (PFFS) – PFFS plans offer different coverage benefits but may be more expensive depending on your healthcare needs annually. The plan pays providers based on set payment terms, and you pay your portion of the cost of service (copayment). Providers can choose not to accept PFFS plan payment rates, so it’s essential to learn more about prices and the provider network before joining a PFFS plan.
- Special Needs Plan (SNP) – SNP plans are only offered to those who qualify. For example, if you have specific health conditions (chronic heart failure, lung disease, cancer, end-stage renal disease, etc.) or meet other criteria such as you’re eligible for both Medicare and Medicaid (dual eligible), you are eligible for SNP plans. The Medicare Advantage plan will be specifically designed to suit your healthcare needs.
A less common Medicare Advantage option is Medical Savings Account plans. These plans have higher deductibles with a healthcare savings account to pay for approved Medicare expenses.
You can check with a GoHealth insurance agent on available options for Medicare Advantage plans that suit your needs.
Medicare.gov also has a helpful plan comparison tool. You can enter your zip code and find plans in your area, coverage options and cost.
Costs for Arizona Medicare Advantage plans can vary depending on the benefits you’re interested in, where you live in Arizona, and the type of plan you choose. For example, costs may be higher if a plan provides dental, vision, prescription drug, and further coverage with a more flexible provider network.
You must switch from Original Medicare (Parts A and B) in order to enroll in Medicare Advantage, but if you do, you’ll still need to pay the standard Original Medicare premiums. Medicare Advantage plans feature unique deductibles, copays, and other out-of-pocket costs (diagnostic, lab fees, supplies, ambulance, etc.), ranging from $0 to several hundreds of dollars.
Your drug copays can depend on the drug and if the plan covers it. We’ll discuss this in more detail in the section below on Medicare Advantage plans with prescription drug coverage.
Review these tips from GoHealth before signing up for a plan.
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If you’re eligible for Medicare and have Original Medicare (Parts A and B), you’re eligible for Medicare Advantage. To be eligible for a specific Medicare Advantage plan, it must be available where you live. If you live in multiple locations throughout the year, be sure to check if the plan covers all locations.
There are several opportunities to enroll in a Medicare Advantage plan. You can enroll in Medicare Advantage during your Initial Enrollment Period (IEP) if you first sign up for Original Medicare. Your IEP starts three months before your 65th birthday and extends to three months after your birth month. Remember, you cannot have both an Original Medicare plan and a Medicare Advantage plan.
You also can switch from Original Medicare to Medicare Advantage during Medicare’s Open Enrollment Period. Also known as the Annual Enrollment Period, it’s from October 15 to December 7 each year.
You can also change Medicare Advantage plans annually during the Medicare Advantage Open Enrollment Period from January 1 to March 31. During this period, you also can go back to Original Medicare and add a Part D drug plan.
You can also enroll under special circumstances at other times during the year if:
- You move, and your plan doesn’t offer coverage in your new location.
- Your living situation changes (like moving into a long-term care or skilled nursing care facility).
- Your plan is terminated.
- Your eligibility changes (employer-based, dual eligibility, etc.).
- You want to switch to a five-star plan.
It’s important to feel confident and comfortable with whichever plan you choose since you’ll have the plan for at least a year.
Some tips that might help when choosing between plans:
- Have lists of all your medications to review.
- Know your costs and benefits with your current plan to compare.
- Check whether the plan requires prior authorization or referrals for services.
- Check the plan’s star rating.
A majority of Medicare Advantage plans offer prescription drug coverage. These are called Medicare Advantage Prescription Drug plans. They offer Part A, B, and drug coverage as a convenient way to get complete coverage in one plan. Plans have different formularies which provide a list of covered drugs in cost tiers. Most plans have four to five tiers or levels for drug coverage. Generic drugs fall in the lowest or Tier 1 and specialty drugs fall in the highest tier.
Plans may have different drug premiums, deductibles and copays. It is essential to compare costs and make sure all your drugs are covered. You may have to pay higher drug copays with non-preferred generics or brand name drugs that are not part of the plan’s formulary of covered drugs.
Your plan may also require prior authorization (approval) to cover certain drugs or have other requirements before the plan covers a drug. For example, step therapy requires you to try lower-tier drugs before covering a higher-tier drug.
For more information on different Medicare Advantage plans and how they compare, you can reach a GoHealth insurance expert.
You can also check with:
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