Simply explained, Medicare Advantage is a program Medicare recipients can choose instead of Medicare Parts A and B. Medicare Part C allows private health insurance companies to provide all of the standard benefits of Medicare Parts A and B within a managed care plan like an HMO or PPO. Medicare Advantage Plans usually provide prescription drug insurance and some may include extras such as gym memberships or vision insurance.
Many of the companies have more than 1 plan which means that you can find the one that best works for you
More About Medicare Advantage Plans
Arizona Medicare Advantage Plans (also known as Medicare Part C) are Medicare plan options that are part of the Medicare program and are not the same as a Medicare Supplement. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. Medicare Advantage plans are available by county.
Arizona Medicare Advantage Plans that are available include:
- Medicare Health Maintenance Organization (HMOs)
- Generally, you must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some HMO plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option.
- In most cases, prescription drugs covered. If you want Medicare drug coverage, you must join an HMO plan that offers prescription drug coverage.
- In most cases, you need to choose a primary care doctor.
- In most cases, you must get a referral to see a specialist. Certain services, like yearly screening mammograms, do not require a referral.
- If your doctor or other health care provider leaves the plan’s network, your plan will notify you. You may choose another doctor in the plan’s network.
- If you get health care outside the plan’s network, you may have to pay the full cost.
- It is important that you follow the plan’s rules, like getting prior approval for a certain service when needed.
- Preferred Provider Organizations (PPO)
- PPO plans have network doctors, other health care providers, and hospitals, but you can also use out-of-network providers for covered services, usually for a higher cost. You are always covered for emergency and urgent care.
- Prescription drugs are covered, in most cases. If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage.
- You do not need to choose a primary care doctor.
- You do not have to get a referral to see a specialist, in most cases.
- Because certain providers are “preferred” (as the name suggests), you can save money by using them.
- Private Fee-for-Service (PFFS) Plans
- Medicare Special Needs Plans (SNP)
- Point of Service (HMO-POS)
Selecting Medicare Advantage Plans in Arizona
Consider these facts in deciding if a Medicare Advantage Plan for hospital and medical coverage is right for you:
- Most Medicare Advantage Plans cover costs & services not covered by Original Medicare.
- Medicare Advantage Plans may have lower deductibles & co-payments than Original Medicare.
- Medicare Advantage Plans usually have low premiums — $0 premium plans are available in Arizona.
- No health question asked. All Medicare beneficiaries, including people on Medicare due to a disability, are guaranteed acceptance regardless of health conditions (except End Stage Renal Disease).
- Special plans with lower or no out-of-pocket costs may be available for “Dual Eligibles” (people on both Medicare and AHCCCS).
With Medicare Advantage plans acceptance is guaranteed for all Medicare eligibles every year during the appropriate enrollment period regardless of health conditions. Dual Eligibles (people on both Medicare and AHCCCS) and those with certain chronic health conditions, have special enrollment periods. However, most Medicare Advantage plans require you to pay a co-pay each time you see a specialist, receive medical treatment, or visit a hospital. The maximum out-of-pocket expenses you are required to pay are capped on a per-year basis.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B, live in the plan’s service area, and be a U.S. citizen or lawfully present in the United States. You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party).
