What is Medicare Advantage in Arizona?
Many Medicare beneficiaries choose a Medicare Advantage plan in Arizona for their health care coverage instead of Original Medicare, not as a replacement for Medicare Part A and Part B coverage.
Facts about Medicare Advantage in Arizona:
- Centers for Medicare and Medicaid Services require that all Medicare Advantage (Medicare Part C) plans provide at least the same coverage as Medicare Part A and Part B provide.
- Most Arizona Medicare Advantage plans have additional coverage that Original Medicare does not include.
- Enrollees in Medicare Advantage in Arizona must pay their Medicare Part B premium to be eligible for a Part C plan.
- Medicare Advantage is becoming more popular every year.
- Part C plans are sold by private health insurance providers.
- This insurance company is responsible for claims, customer service, administration, and other services involving Medicare benefits.
- Most Medicare Advantage plans require that beneficiaries use network providers for health care services, supplies, and medical facilities.
- Medicare Advantage Prescription Drug (MAPD) plans include prescription drug coverage.
- Some plans have extra benefits like vision, dental, hearing, wellness club memberships like SilverSneakers, over-the-counter drug allowances, transportation allowances, and meal delivery.
What is the best Medicare Advantage plan in Arizona in 2022?
Compare these Medicare Advantage plans in Arizona to find what fits your health care needs best:
Best for network freedom: Medicare Advantage PPO plans
- PPO plans provide a larger network of healthcare providers
- No referrals necessary
- PPO plan premiums go from $0 to $100.00 per month.
Best for lowest out of pocket costs: Medicare Advantage HMO plans
- HMO monthly premiums are typically $0
- HMOs use network providers and referrals which mean lower out of pocket expenses
Best for low income or health issues: Medicare Advantage D-SNP
- SNP or special needs plans are geared for people with limited income or chronic health conditions like end-stage renal disease
- Enrollees can have both Medicare and Medicaid for lower costs on copays, coinsurance, deductibles, and premiums.
What Medicare Advantage Plans are available in Arizona?
The number of Medicare Advantage plans in Arizona vary by county, but here’s a list of what the entire state offers:
- 40 Local HMOs
- 11 Local PPOs
- 02 Regional PPOs
How Much does Medicare Advantage cost in 2022?
In most states Medicare benificiaries can find an HMO with a zero monthly premium. Some states also offer a PPO with a zero monthly premium, although it is becoming less common.
In Arizona, costs vary from county to county, but the average premium for a Medicare Part C plan in the state is $12.25 per month. If you choose an MAPD plan, the average monthly cost is $16.35.
When can I make changes to my Medicare Advantage Plan?
Most enrollees make changes to there Medicare Advantage plan in Arizona during the Annual Election Period (AEP) which goes from October 15th to December 7th annually.
If you don’t qualify for special enrollment, you are locked into your Medicare Advantage plans for the 12 month period.
When can I enroll in a Medicare Advantage plan in Arizona for 2022?
Enrollment periods for Medicare Advantage plans:
Initial Enrollment Period (IEP)
When aging into Medicare:
Your IEP begins three months before your 65th birthday, includes the entire month of your birth date, and extends for three months beyond your birth month. This is a total of seven months when you can enroll in a Medicare Advantage plan.
Getting disability benefits:
Through qualification for Medicare because of disability, end-stage renal disease, or ALS, IEP starts three months before the 25th month of getting disability. It includes the 25th month, and ends three months later. During these seven months you can enroll in Medicare Part C.
Open Enrollment Period (OEP) or Annual Election Period (AEP)
During AEP you can enroll in a Medicare Advantage plan, switch to a different Part C plan, or go back to Original Medicare coverage.
During AEP you can also enroll in Medicare Part D prescription drug plans. AEP goes from October 15th to December 7th . Any changes you make take effect on January 1st.
Medicare Advantage Open Enrollment Period
During this period (January 1st to March 31st) you can change your Medicare coverage by switching from Part C to Original Medicare, or you can enroll in a new Medicare Advantage plan. Any changes begin on the first day of the month following the change.
Special Enrollment Periods
Under special circumstances, Medicare Advantage enrollees can make changes to their current insurance plans or enroll in a new Medicare Advantage or Part D plan.
Examples of special situations:
- Leaving your current plan’s service area
- Returning to the United States to live
- Moving into or out of a skilled nursing or long-term care facility
- Leaving prison
- Not eligible for Medicaid or becoming dual eligible for Medicare and Medicaid
- Medicare ends your current plan or doesn’t renew it
- Ending a Medigap plan and enrolling in a Medicare Advantage plan
Five-star Special Enrollment Period
If a plan in your service area has a Five star rating you have eligibility to switch over to that plan using a special enrollment period.
Special Enrollment Period when you are in the “Extra Help” program
As a beneficiary of Extra Help or Medicaid, you can make changes to Medicare Advantage Part C or Part D one time during the following periods:
- January – March
- April – June
- July – September
Are Medicare Advantage Plans bad in Arizona?
Medicare Advantage provides comprehensive, high-quality that are very popular in the United States.
The following numbers show how Medicare Advantage plans are gaining popularity:
- Number of people enrolled in Medicare Advantage in Arizona: 570,322 (in 2020).
- Number of lives enrolled according to the type of plan: (In 2018)
- Local HMOs: 348,945
- Local PPOs: 35,338
- Regional PPOs: 7,541
- Percentage of Medicare beneficiaries enrolled in Medicare Advantage in Arizona:
1,356,544 people are enrolled in Medicare and 42 percent of them have Medicare Advantage health plans.
- Number of people enrolled in Medicare Advantage nationwide:
Over 26 million people have Medicare Advantage coverage in the United States in 2021.
- Percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide: 42 percent of Medicare beneficiaries have through Medicare Advantage.
Frequently Asked Questions about Medicare Advantage in Arizona:
What's the downside to Medicare Advantage plans?
- Depending on the type of plan, there may be network restrictions. This may limit choice of physicians, hospitals, or facilities. HMOs have more limits and require referrals from your primary care physician to see specialists.
- MA plans can be financially less predictable than Medicare Supplement (Medigap) plans. Even though they have lower premiums, you may have more out of pocket costs.
- MA plans require more member involvement. Beneficiaries must confirm they stay in the network, pay copays and Medicare bills like the Part B premium. They must also research and make changes to their plans annually.
- MA plans have less long-term stability than Medigap plans because they change benefits, networks, covered drugs, and premiums. Medicare Supplement plans are standardized and don’t change.
What are 4 types of Medicare Advantage plans in Arizona?
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNP)
What are the top 3 Medicare Advantage plans?
Nationwide, the three insurance companies with the highest enrollment are:
- United Healthcare
- Blue Cross Blue Shield
What are the special needs plans?
Special Needs Plans (SNPs) are a special type of Medicare Advantage plan that provides benefits for people with limited income or chronic illnesses.
Does Medicare Advantage cover drugs?
Most Medicare Advantage plans have prescription drug coverage combined with medical coverage in one plan. Be sure to discuss coverage options with your insurance agent before committing to a plan.
Do Medicare Advantage plans use the SilverSneakers program in Arizona?
Because fitness club memberships are very popular benefits, many plans do include them in their coverage. Discuss your coverage options with your insurance agent to ensure you get the benefits you want.
Arizona Medicare Resources
Arizona Medicare State Links:
Arizona Medicare Plan Statistics
These are some highlights of enrollment statistics for Medicare Advantage plans in Arizona:
- Beneficiaries with a Medicare Advantage plan in Arizona: Over 460,000
- Percentage of Arizonans who enroll in Arizona Medicare Advantage plans instead of Original Medicare: About 39%
- Percentage who enroll in an HMO Medicare Advantage plan: 91%
It’s likely that many beneficiaries choose an HMO Medicare Advantage plan in Arizona because most come with a modest or even a $0 premium.
This list shows the top Arizona counties by population:
- Maricopa County, AZ: 4,307,033
- Pima County, AZ: 1,022,769
- Pinal County, AZ: 430,237
- Yavapai County, AZ: 228,168
- Yuma County, AZ: 207,534
Ready to Learn More?
Medicare can be very confusing, if you need help on plan selection or getting more detailed information, please reach out to us for additional help, we are here to guide you!