Any Arizona resident who is 65 or older can apply for enrollment in the federal Medicare program. This program provides Medicare plans in Arizona to retirement age citizens who need additional health care coverage. It is also sometimes referred to as “Traditional Medicare” or “Original Medicare”. The program has two basic parts to it: Medicare Part A, and Medicare Part B. The entire plan is pretty comprehensive; Part A covers most hospital visits, whereas Part B covers your outpatient needs. However, Traditional Medicare still has holes in its coverage plan which you will have to pay for if you don’t have any other form of health care coverage. This article will help you figure out additional coverage options to cover these healthcare “gaps”.
Coverage and Benefits for Medicare Plans Arizona
If you have at least 10 years of employment history (or 40 quarters), Medicare Part A is free to enroll. But if your employment history is shorter than the required minimum, you will be required to pay a premium. On top of that, part B will have premium costs associated with it regardless of how long you’ve been employed. For more information, you should contact your local Social Security Office.
If you qualify for Medicare, you will, at the very least, receive Part A benefits. This is the foundation of Medicare. if you try to reject your Part A benefits or refuse to pay for them, you won’t be eligible for any other aspect of Medicare coverage. Part B, on the other hand, is optional. However, aside from accidents, serious illness, and the last few years of your life, most of your medical care will only be covered by Part B benefits – such as regular check-ups, outpatient procedures, and Urgent Care.
Medicare Part C includes all of the benefits of Medicare Part A and B, and may include much more depending on your personal circumstances. Medicare Part C – also known as Medicare Advantage – is a way of supplementing your Medicare coverage with a private health insurance policy instead of government-sponsored Medicare. Unlike with Original Medicare, you cannot opt out of Part B coverage if you sign up for Medicare Advantage. With regard to prescription drugs, some Medicare Advantage plans cover these; but they are usually very expensive. Many senior citizens find that Medicare Part D, which is the government’s prescription drug coverage plan, helps them get the medication they need at a lower cost. Similarly to Medicare Advantage, purchasing Part B benefits is mandatory if you want to sign up for Part D drug prescription coverage.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Arizona Medicare Insurance Programs
There are nearly a million people in Arizona currently enjoying Medicare benefits (977,447). 38% of them, an estimated total of 371,430 people are getting their Medicare through Medicare Part C, otherwise known as a Medicare Advantage program. 16.6% are instead choosing to complement their Original Medicare with a Medigap policy. The other 45.4% of Arizona’s elderly might be supplementing their Medicare with a private plan, and employer’s benefits, or with absolutely no additional coverage at all. The latter is an extremely risky option, especially for anyone on a fixed income who cannot easily handle surprise medical bills.
Before going forward, make sure you are currently receiving Medicare benefits. You need to be successfully enrolled in the federal Medicare program in order to qualify for Arizona medicare supplemental insurance.
Why do People Who Live in Arizona Need Additional Coverage beyond Traditional Medicare?
To be clear, the additional coverage is not mandatory. It exists for your piece of mind, and to protect you financially from out-of-pocket expenses which often pop up from relying on Original Medicare alone to cover your health care needs. Below are some of the coverage gaps and their associated costs. If you aren’t careful, you could end up paying full price for:
|Medicare Part A Costs||Medicare Part B Costs|
There are several different supplemental health plans out there that you can choose from. Below, we’re going to go into more detail about the most popular two: Medigap insurance, and Medicare Advantage. It’s up to you to compare the two and figure out which is better for your personal situation.
Much to the lament of most Arizonans, there is indisputable evidence that healthcare costs are on the rise. unfortunately, most retirees didn’t foresee these skyrocketing expenses when they were budgeting for retirement. If left to chance, there will likely be a time during your golden years where the costs of your medical care vastly exceeded what you can afford, even with Medicare. That’s the reason why supplement insurance plans exist – to help you protect your finances.
Medicare supplement insurance was invented to help senior citizens protect their savings and live with dignity in the face of rising healthcare costs. The monthly premiums are well within reason for most people, and the coverage benefits you get will play a significant role in stretching out your savings. These simple, standardized plans are streamlined to make sure that you understand them, and to make sure they cover the benefits which Medicare doesn’t. They are issued by private companies, but unlike Medicare Advantage, your Original Medicare benefits are still handled by the government. Your Medicare supplement provider only intervenes in order to help you resolve disputes.
As much as Medicare does cover, the few gaps in coverage it has can be ruinous if you aren’t careful. Prolonged hospital visits, blood transfusions, and a lack of prescription drug coverage from Medicare Parts A & B can cost you tens of thousands of dollars without warning. In most cases, a Medigap supplement is the safest, easiest, most affordable way to protect your bank account from these unpleasant surprises.
If you decide to supplement your Original Medicare coverage, you really have only one of two options: Medicare Advantage, or a Medicare supplement insurance program (Medigap). In truth, there are pros and cons to each option. The more you learn about each one, the easier it will be for you to decide which plan best fits your needs.
Option 1: An Arizona Medicare Supplement Plan
These are also known as “Medigap policies” for short. Medigap policies are specifically tailored to cover the gaps in Traditional Medicare – hence the “gap” part of “Medigap”. The federal government has endorsed 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N. Plans E, H, and I are no longer available as of 2010. They were phased out due to the Medicare Modernization Act. Every single Medigap plan offers the exact same benefits across all 50 states. But, based on your area, they will differ by cost and by insurance company. Below is a comprehensive comparison list of all 10 plans:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$105||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$91||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$105||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$162||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$85||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$97||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$158||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$75||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$60||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$106||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Option 2: An Arizona Medicare Advantage Plan
Medicare Advantage (Medicare Part C) is another Medicare supplement option which is fairly popular. But if you abandon Original Medicare for a Medicare Advantage (MA) plan, your health care will no longer be managed by the US government. A private insurance company will take over. However, you will still have at least the same benefits that Traditional Medicare offers, because your provider is legally required to offer the same deal that you would have access to on the federal level. Some MA plans offer additional benefits as well.
Some of these benefits could include prescription drug plans, vision, or dental (or a combination of benefits). Many MA beneficiaries prefer Part C for the convenience, even though it is highly likely that your plan will force you to enter a very restrictive network. The doctors you are used to seeing might not be available to you after you switch. This is a very important factor to keep in mind when making important decisions about your health care needs.
Medicare Advantage plans use exclusive Health Maintenance Organizations and Preferred Provider Organizations to give you efficient, affordable care.
What is the Difference Between Medicare Advantage and Supplement in Arizona?
The differences between Medicare Advantage and Medigap are many, and they can sometimes be complicated. But we will do our best to simplify them for you as much as possible. With a Medigap insurance policy, there are three potential premium payments to consider: Medicare Part A, Medicare Part B, and the monthly premium for your Medigap plan. Some Medicare Supplement Plans only pay the Part A deductible, and incorporate that cost into your monthly premium. Comprehensive plans, like Plan F, pay both A and B premiums; the only money you owe is your Medigap premium. Between Original Medicare and your Medigap supplement, there are very few additional costs which you will be responsible for. However, you should still sign up for Part D prescription coverage since Medigap policies no longer offer such benefits.
As we’ve said, Medicare supplement policies are managed by a private health insurance company. The company you choose depends on where you live and which businesses are operating in your area. But no matter where you are – whether you’re in Arizona or Maine or anywhere in between – the plans are all the same. These plans are standardized to make sure you get the medical care you deserve no matter where you go.
Then there’s Medicare Advantage (Medicare Part C). With a Medicare supplement policy, a private company works with the government to cover your medical costs. Medicare Advantage, on the other hand, takes Uncle Sam out of the picture entirely. Legally, these insurance policies must provide the exact same coverage you would get from Original Medicare. Many of them also provide additional benefits, but not all of them. It all depends on where you live, your medical needs, and how expensive your medical care is.
Medicare Advantage plans are a little less stable than Original Medicare or a Medicare + Medigap plan. Free market prices determine how much your Medicare Advantage plan provider will charge you. They also have wider legal wiggle room to reduce your coverage or cancel your policy as long as they can justify their actions within the rule of law. Despite this, some seniors still manage to save money on their health care costs with Medicare Part C do to their unique circumstances.
We hope that this comprehensive overview has been useful. But we completely understand if you have more questions. Our chart below outlines some of the most popular questions we get from people, along with short, concise answers which should resolve any confusion.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||A federal government subsidy takes care of most or all of the cost of your monthly premium. Whatever it doesn’t cover, you are responsible for||Nearly all of your medical expenses are covered with monthly premium payments|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||It all depends on your location and the nature of healthcare in your area. Some part C plans have expensive premiums, while others may charge you $0 if your government subsidy is generous enough||The Medigap plan you choose will require a modest yet affordable monthly premium|
|What will the plan cover?||You are entitled to the same medical coverage benefits with a Part C plan that you would get if you sign up for Medicare Parts A & B. Some Medicare Advantage plans offer benefits beyond fat – for a fee, of course||Some Medigap plans only cover a few of the more expensive gaps in Medicare coverage; others, like Plan F, completely protect you from your coverage gaps. It all depends on the plan you choose|
|Is it easy to budget my health care expenses?||The more often you require medical care, the more often you will have to pay out-of-pocket expenses – which can make budgeting difficult||Other than you are known monthly premium, there are very few out-of-pocket costs associated with a Medigap policy|
|Is my plan guaranteed? Or can it be cancelled?||A Medicare Advantage insurance provider is legally allowed to review your policy annually and decide whether to cancel coverage, change your premiums, or maintain the status quo||Medigap policies are guaranteed in all but two scenarios: if you fail to make your payments or if the company goes bankrupt, you will lose coverage|
|Do I have to clear a pre-approval or pre-certification process?||Yes, and it will be harder to pass the approval process if you are in less than ideal health||Qualifying for Original Medicare automatically qualifies you for a Medigap policy|
|Am I limited to specific doctors or hospitals?||Private health insurance companies use restrictive doctor and hospital networks in order to keep costs low; Medicare Advantage is no exception||Medigap insurance is accepted everywhere Medicare is, so your options are virtually limitless|
|What type of plan is best for me?||Newly-retired, relatively healthy city-dwellers tend to save more with a Medicare Advantage plan than other supplements; but this isn’t always the case||If you’re looking for comprehensive coverage, if you need a good amount of medical care, or if you live in a low population area, the Medicare Supplement Plan maybe a better choice|
Additional Arizona Resources and Information
It’s perfectly natural to still have questions regarding AZ Medigap and Medicare Advantage. For this reason, we’ve included a handy directory of contact information you can use to learn more. It’s important to be as well-informed as possible when making such important decisions.
Important Medicare Terms for Arizona
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.