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Medicare in Arizona

Medicare in Arizona raising questions? Learn about costs, coverage, and more

Reviewed by: Selah Lee, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Arizona is health insurance available to all legal U.S. residents aged 65 and older. The federal government partially funds it through taxes.

  • Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). provides hospital and medical coverage. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Arizona combines Parts A and B and often bundles other services like Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies..

  • The price of Medicare in Arizona starts with standard costs but is adjusted based on details like your income and work history.

 

Arizona has been a popular settling spot among retirees for decades, dating back to 1954 when the nation’s first 55-and-older retirement community opened in Youngtown. And given its fantastic climate and favorable taxes, it hasn’t exactly fallen off since. [1]

Thanks to Medicare, The Grand Canyon State can claim solid health care, too. With a population that has traditionally skewed a bit older, there are many well-established ways to receive Medicare in Arizona. That doesn’t mean you should go into the process unprepared, however. Do you know about Medicare Advantage in Arizona? What Medicare plans are available? Is Medicare in Arizona different from other states?

Committing to a healthy lifestyle after 65 is a great way to make sure your best days don’t end when your working days do. To help, here’s our guide to Medicare in Arizona:

How Does Medicare Work in Arizona?

There are two main ways to receive Medicare in Arizona: Original Medicare (Parts A and B) and Medicare Advantage (Part C). Here’s a quick breakdown:

 

Original Medicare (Parts A and B)

Parts A and B provide some hospital, preventive and medically necessary services. Out-of-pocket costs can be high, and you’ll need separate coverage for prescription drugs, hearing, vision and dental. You can see any doctor that accepts Medicare.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

 

If you have Original Medicare, there are ways to get the coverage you need if Parts A and B aren’t enough, or if your costs are too high. One way is to add Medicare Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap) when you enroll.

Keep reading for more information on Medicare plans in Arizona, including enrollment periods, costs, and more.

What Is the Best Medicare Advantage Plan in Arizona?

Medicare Advantage in Arizona has traditionally been a popular choice in The Grand Canyon State with roughly 40% of Medicare enrollees since 2008. But figuring out which plan is best totally depends on your needs. To help with this answer, here are the four kinds of Medicare Advantage plans you can find in Arizona, and how they work:

  • Health Maintenance Organization (HMO): In an HMO, a primary care physician refers you to specialists within your provider network.
  • Preferred Provider Organization (PPO): PPOs still use primary care physicians but offer some flexibility to see out-of-network doctors and specialists.
  • Private Fee-for-Service (PFFS): PFFS plans pay your doctors and other providers separately for each service you receive.
  • Special Needs Plans (SNPs): SNPs cater to patients living with certain health conditions and/or other specific criteria. [2] D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.

How Much Does Medicare Cost in Arizona?

The cost of Medicare in Arizona starts with a few standard costs, but what you’ll actually pay comes down to your needs and which plan you choose. To help you start budgeting, here’s what you can expect to pay for Medicare plans in Arizona, starting with Original Medicare (Parts A and B) and Medicare Part D.

 

Medicare in AZ: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in AZ: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in AZ: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

What Are the Qualifications for Medicaid in Arizona?

There are several requirements to be eligible for Medicaid in Arizona. Typically, Medicaid benefits are for Arizonans that are legal U.S. citizens, residents, or legal aliens with low-income. Arizona has resources available for adults, pregnant women, kids, families, and seniors. [3]

How Do You Qualify for Medicare in Arizona?

To be eligible for Medicare in Arizona, you must be a legal U.S. citizen or resident aged 65 and older. Since it’s a federal program, that age limit is the same across the U.S.

But if you’re younger than 65, you may be eligible to start receiving Medicare if:

  • You’ve received Social Security benefits due to disability for 24 months
  • You’ve drawn Railroad Retirement Board (RRB) benefits for 24 months
  • You’re living with:
    • Amyotrophic Lateral Sclerosis (ALS)
    • End Stage Renal Disease (ESRD)

Eligible for Medicare in Arizona? When to Enroll.

You may qualify for Medicare when you’re 65, but that doesn’t mean you should wait for your birthday to enroll in a plan. Instead, your first chance to enroll begins three months before you turn 65. This is known as your Initial Enrollment Period (IEP). It’s also important to know about other Medicare enrollment periods. After initially enrolling, there are several chances to revise your plans as your needs change.

Here are the Medicare Enrollment Periods to know about:

  • Initial Enrollment Period (IEP): seven months around the month you turn 65.
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

What Are the 4 Types of Medicare?

We’ve given you an overview of Original Medicare (Parts A and B) and Medicare Advantage and even shown you what costs to expect from Medicare plans in Arizona. But how do they work together, and what are some of the other topics to know? Here’s what to expect from the four types of Medicare in Arizona.

Original Medicare (Parts A and B)

Original Medicare plans in Arizona consist of two main Parts: A and B. Each work separately for Medicare enrolled to provide basic coverage.

  • Part A: helps cover your hospital stays, which may include inpatient services at nursing homes, skilled nursing facilities, some home health, and hospice care.
  • Part B: Provides coverage for your preventive and medically necessary services

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Medicare Prescription Drug Plan (Part D)

Medicare Part D is stand-alone drug coverage. Part D can be added to Original Medicare separately. Some Medicare Advantage plans in Arizona include prescription coverage.

What is Medicare Supplement Insurance (Medigap)?

Medigap is another resource for Medicare beneficiaries. If you need help with the high out-of-pocket costs that can come with Original Medicare in Arizona, Medicare Supplement Insurance offers several options that can help cover copayments, coinsurance, and deductibles. If you buy a Medigap policy, you will pay for it separately from Original Medicare.

What Is the Best Medicare Plan to Have?

Just like with Medicare Advantage in Arizona, trying to figure out which plans are best is completely personal. It depends on your needs, budget, and more. Plus, there are a lot of plan options to choose from, whether you’re mixing and matching Original Medicare with Medigap and Part D, or wading through the Medicare Advantage plans you can choose from.

Here are some tools from GoHealth to help figure out which Medicare plans in Arizona may work for you:

  • Pros and Cons: Learn how to choose between Original Medicare and other Medicare insurance plans and decide which option is right for you.
  • Enrollment Checklist: Gather information like doctor names, prescription drugs, and any information needed for your health coverage.
  • Medicare Star Rating System: See how plans stack up against each other.
  • Pro Tips: Check here for pointers and ways to make the decision making process simpler.
  • Call GoHealth: Still have questions about Medicare plans in Arizona? The licensed insurance agents at GoHealth will walk through your options and offer the impartial answers you need. Call us at 1-855-792-0088 TTY: 771.

What Is the Downside to Medicare Advantage Plans?

Fact is, Medicare Advantage in Arizona won’t work for everyone. If you’re deciding between that and Original Medicare, here are the main characteristics people often consider:

  • Original Medicare often has higher out-of-pocket costs but there are no network restrictions. This means more flexibility to see any doctor that accepts Medicare.
  • Medicare Advantage offers a smaller network of doctors you can see, but costs are often lower. Medicare Advantage plans often include services not offered by Original Medicare, including prescription drugs (Part D).

If you still have questions about Medicare plans in Arizona, the licensed insurance agents at GoHealth can help. As impartial resources, they’ll show you your options and answer your questions. Give GoHealth a call today to see what Medicare plans in Arizona will work for you.

Medicare in Arizona by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,199,206 people are enrolled in Medicare in Arizona. The total number of beneficiaries enrolled in Medicare Advantage in Arizona is 524,666. The previous year, 497,316 enrolled in Medicare Advantage. Medicare Advantage participation in Arizona went from 43.05% to 43.75% year over year. If you’d like to see a deeper dive into how Medicare in Arizona breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Arizona
1,199,206
Beneficiaries with Part A & Part B
524,666
Medicare Advantage Beneficiaries
43.75%
Medicare Advantage Participation Rate
53.10%
% Female
46.90%
% Male
0.9
Average HCC Score
$9,625.62
Actual Per Capita Costs
10.36%
% Eligible for Medicaid
28.39%
% of Beneficiaries with an Emergency Department Visit
15.88%
Hospital Readmission Rate
82.48%
% Non-Hispanic White
2.33%
% African American
7.97%
% Hispanic
7.22%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Arizona Medicare Resources & Contacts

Beneficiaries spend an average of $9,625.62 each year on Medicare in Arizona. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Arizona-based resources, like these, may be able to help:

Arizona Department of Economic Security

1-602-771-2800

https://des.az.gov/

What should I know about the Arizona Department of Economic Security?

Connect with employment, senior and other benefits in your area, report fraud

Arizona Health Care Cost Containment System (AHCCCS)

1-855-432-7587
M-F, 8 am to 5 pm

https://www.azahcccs.gov/

What should I know about AHCCCS?

This is Arizona’s Medicaid system for low-income adults and kids

Arizona Department of Health Services

1-602-542-1025
COVID-19 info: 1-844-542-8201

https://www.azdhs.gov/

What should I know about the Arizona Department of Health Services?

Find info and resources that promote healthy living for seniors

Arizona State Health Insurance Assistance Program (SHIP)

1-602-542-6439

https://des.az.gov/services/older-adults/medicare-assistance

What should I know about the Arizona State Health Insurance Assistance Program (SHIP)?

Apply for financial assistance and learn how to guard against fraud on your account

Nationwide Resources

Speak with an insurance agent that is licensed in Arizona about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in AZ, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

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