Both Medicare Part C (aka Medicare Advantage) and Part D came about due to the passage of the Medicare Modernization Act (MMA) in 2003. The legislation was designed to give America's seniors a greater level of choice when it came to their healthcare. This page explains Medicare Advantage plans in Arizona and how to compare your options.
What Is Medicare Advantage?
Medicare Advantage plans must provide the same benefits you get with Original Medicare, which includes Part A, hospital insurance, and Part B, medical insurance. Original Medicare does not include prescription drug coverage, though. For that, you need Medicare Part D.
Although the law only requires them to offer the same coverage as Original Medicare, most MA plans provide additional benefits.
Prescription drug coverage is a common add-on and is available in around 90 percent of Medicare Advantage plans. Known as Medicare Advantage Prescription Drug plans (MA-PD), these all-in-one policies combine your Parts A, B, and D benefits into a single plan.
Other common Advantage plan benefits include:
- Fitness programs
- Hearing aids
- Routine dental care
- Routine vision care
Please note that not all MA plans offer the same types of benefits.
Types of Medicare Advantages Plans in Arizona
There are four main types of Medicare Advantage plans in Arizona. They include:
- Health maintenance organizations: HMO plans have a provider network of doctors, labs, hospitals, clinics, and more. They also require plan members to choose a primary care physician, who provides specialist referrals and coordinates patient care. Most HMO plans won't pay for care received from an out-of-network provider unless it was an emergency.
- Preferred provider organizations: PPOs also have a provider network. However, if you're willing to pay a higher out-of-pocket cost, PPO plans cover care received from an out-of-network provider.
- Private Fee-for-Service: PFFS plans set a price point for all services, with plan members paying any additional costs. PFFS plans also have a network, but like a PPO, they allow you to see an out-of-network provider if you're willing to pay more.
- Special needs plans: SNPs are limited to beneficiaries who meet certain criteria, such as having a chronic condition, being eligible for both Medicare and Medicaid (i.e. dual eligibility), or living in an institution such as a nursing home.
How to Compare Medicare Advantage Plans in Arizona
You should look at three metrics when comparing Medicare Advantage plans in Arizona: Costs, coverage, and provider network.
How much does the plan cost?
Your out-of-pocket costs under a Medicare Advantage plan may include:
- Yearly deductible
- Monthly premium
- Copayments or coinsurance
To understand the full cost of the plan, you must look at all three metrics. These costs can vary widely, depending on the plan and provider you choose.
The average monthly premium for a Medicare Advantage plan in 2023 is $18 (it jumps up to around $65 when you take out the $0 premium plans). However, even if your Advantage plan has a monthly premium, you are still responsible for the Medicare Part B premium ($164.90 in 2023).
What does the plan cover?
When comparing costs, it's important to look at coverage, too, to ensure you're comparing apples to apples.
Medicare Advantage plan benefits vary widely. After prescription drug coverage, the most common additional benefit is coverage for eye exams and/or prescription lenses. Next is fitness benefits, which around 72 percent of MA enrollees get. Around 67 percent of Medicare Advantage beneficiaries get routine dental care as part of their coverage.
Even if the MA plan has a monthly premium, it could still cost you less out-of-pocket if it means you don't have to buy a standalone prescription drug plan or ancillary insurance that covers vision or dental.
Finally, don't forget to look at the drug formulary on a Medicare Advantage Prescription Drug plan. This is the list of covered prescription medications and if it doesn't include yours, then you should keep looking until you find a plan that does. Please note that you cannot have both a standalone Part D plan and an MA-PD plan.
Does the network include your providers?
Provider networks may include any entity you'd rely on for healthcare, not just doctors and nurse practitioners. A provider network may include:
- Clinics and urgent care centers
- Durable medical equipment providers
- Nursing homes
How to Choose a Medicare Plan in Arizona
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Arizona. Enter your location information (zip code and county) and estimated coverage start date to review the Medicare plan options in your area.
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