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Medicare Advantage in Arizona Overview for 2022

For many seniors, Medicare Advantage plans in Arizona for 2022 can simplify the confusion that comes with making sure they have the appropriate health care coverage. A Medicare Advantage plan in Arizona combines Medicare Part A (hospital) Medicare Part B (outpatient and medical) coverage into one plan. Advantage plans frequently include Medicare Part D (prescription drug coverage), too.

Medicare Advantage in Arizona is enjoying a rise in popularity among Medicare beneficiaries. Private insurance companies provide the benefits and handle customer service. But it’s important to remember the following about a Medicare Advantage Plan in Arizona:

  • You’re still in the Medicare program
  • You still get Part A and Part B coverage
  • You still have the rights and protections of Medicare
  • You must continue paying your Part B premium

Read on to see if Medicare Advantage is the best choice for your health care needs.

What is Medicare Advantage in Arizona?

Medicare Advantage in Arizona is another way to receive your Medicare benefits. When you sign up for Medicare, you’re asked to choose how you want to receive coverage:

  • Original Medicare (Medicare Part A and Part B)
  • Medicare Advantage (called Medicare Part C)

The Centers for Medicare and Medicaid Services oversees both programs. If you choose Original Medicare, you can buy additional coverage through a Medicare Supplement plan (Medigap plan) to help with out of pocket costs. You’ll also need a Part D plan for prescription drug coverage.

If you choose an Arizona Medicare Advantage plan, you’ll get all of your benefits through one plan. Here’s how Medicare Advantage in Arizona works:

  • Most Advantage plans use an approved network of providers, but plans are required to cover emergency care outside of the network service area.
  • Most MA health plans include Part D coverage. These are called MAPD plans, or Medicare Advantage Prescription Drug plans.
  • Advantage plans usually include extra benefits such as wellness programs, over-the-counter medicine coverage, vision, and fitness programs.
  • MA plans have a cap on out-of-pocket spending. Once you reach that limit, you won’t pay anything for covered care.

What is the Best Medicare Advantage plan in Arizona for 2022?

Best network freedom: Medicare Advantage PPO

  • PPO’s Typically has a larger network
  • Doesn’t require specialist referrals
  • Monthly premiums range from $0 to $100.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • HMO plans typically offer low or no deductibles
  • Lower out-of-pocket expenses because it uses referral network
  • Premiums generally $0

Best for low income or health conditions: Medicare Advantage D-SNIP

  • Care plan targeted toward a specific chronic condition
  • Beneficiaries can have Medicare and Medicaid, which lowers out of pocket costs for copayments and premiums.

What Medicare Advantage plans are available in Arizona?

All 15 counties in Arizona offer Medicare Advantage plans, but the type and number of plans in each county are diverse. Here’s a general breakdown of what’s available in Arizona:

  • Local HMO: 10
  • Local PPO: 11
  • Regional PPO:2

What’s changing with Medicare Advantage in Arizona for 2022?

Enhancements to the Part C and D Programs Beneficiary Real Time Benefit Tool (RTBT)

  • Requires Part D plans to offer enrolles an RTBT to access patient-specific drug information, including cost and alternative drugs
  • Access information via online portal or computer applications
  • Lets enrollees know out of pocket costs before arriving at pharmacy

Permitting a Second, “Preferred,” Specialty Tier in Part D

  • Allows prescription drug plans to allocate drugs across the two tiers
  • Drugs on the “preferred” tier have lower coinsurance
  • Encourages beneficiaries to use lower-cost specialty drugs

Medicare Advantage (MA) and Part D Prescription Drug Program Quality Rating System

  • Updates method for determining star ratings
  • Updates method for determining quality bonus payments to Medicare Advantage companies

Establishing Pharmacy Performance Measures Reporting Requirements

  • Requires insurance companies selling Part D plans to report how they measure in-network pharmacy performance
  • Enhances transparency
  • Creates industry standards for all pharmacies

Implementing Several Opioid Provisions of the SUPPORT Act

  • Requires Part D plans to establish drug management programs
  • Requires notification when a plan suspends payment to a pharmacy due to suspected fraud
  • Requires drug plans to educate enrollees on opioid use risk, alternative treatments, and safe disposal of drugs

Codifying Existing Part C and D Program Policy for Supplemental Benefit Requirements

  • Writes existing policies into law
  • Clarifies definition of “supplemental benefit” and “primarily health related”
  • Allows reduced cost-sharing as a supplemental benefit

How much does Medicare Advantage in Arizona cost?

Monthly premiums for an Arizona Medicare Advantage plan will vary based on location and whether it’s an HMO or PPO. HMO premiums are typically lower than PPOs. The average price for an Arizona Advantage plan that includes drug coverage is $16.35.

When can you enroll in a Arizona Medicare Advantage plan?

Eligibility for a Medicare Advantage plan hinges on being enrolled in Medicare Parts A and B.

Following are the enrollment periods for Medicare Advantage:

Initial Enrollment Period

Your Initial Enrollment Period is a seven-month time span that starts three months before you’re first eligible for Medicare and ends three months after.

  • Eligible due to age: the month you turn 65
  • Eligible due to disability: the 25th month of receiving disability payments
  • Eligible due to Amyotrophic Lateral Sclerosis (ALS): the first month you receive disability benefits
  • For everyone, the IEP is a one-time event.

Open Enrollment Period – AKA Annual Election Period

  • Oct. 15 – Dec. 7
  • Can sign up for, switch, or leave a Medicare Advantage plan
  • Those with end-stage renal disease can join Medicare Advantage during open enrollment.

Medicare Advantage Open Enrollment Period

  • Jan. 1 – March 31
  • Can switch MA plans or leave an MA plan and return to Original Medicare
  • Can enroll in a Part D prescription drug plan if you left Medicare Advantage and returned to Original Medicare

Special Enrollment Periods

  • Periods outside the normal enrollment periods to join Medicare Part B
  • Not tied to a specific time frame
  • Based on circumstances, such as losing job-based health insurance, moving out of plan’s service area, or the insurance company opts out of its contract with Medicare
  • Must sign up for Part B before enrolling in Medicare Advantage

A call to one of our insurance agents will help determine whether you meet the criteria for special enrollment.

5-star Special Enrollment Period

  • Can leave your Advantage plan and change to a plan with a 5 star rating

Special Enrollment Periods if you get “Extra Help”

  • Qualify for Medicare and Medicaid: You can join, drop, or change MA plans once a quarter for the first three quarters of the year. (You cannot use this special enrollment option October through December.)
  • Qualify for help for drug coverage: You can join, drop, or change drug coverage options.
  • State Pharmaceutical Assistance Program: You can join a Medicare Part D drug plan or a Medicare Advantage plan with Part D coverage included if you’re enrolled in or lose coverage through SPAP.

When can I make changes to my Medicare Advantage plan?

The best time to make changes to your MA plan is during the Annual Election Period. The AEP is also called the Open Enrollment Period or Fall Enrollment Period. It runs Oct. 15 through Dec. 7.

When you join a Medicare Advantage plan in Arizona, you’re locked into the plan for the next calendar year.

The AEP provides the most flexibility to:

  • Change Advantage plans
  • Move from Original Medicare to Medicare Advantage
  • Change from Medicare Advantage back to Original Medicare

If you make any changes, the effective date of coverage for your new plan is Jan. 1.

Are Medicare Advantage plans in Arizona “bad”?

Medicare Advantage plans are a good fit for many Arizona Medicare beneficiaries. Nationally, enrollment in MA insurance plans continues a steady growth, increasing by 9.6% over last year. At the same time, enrollment in Original Medicare declined by 2.6%. We think the future looks bright for Medicare Advantage in Arizona.

  • Number enrolled in Medicare Advantage in Arizona: 394,600
  • Number enrolled by plan:
    Local HMO: 348,945
    Local PPO: 35,338
    Regional PPO: 7,541
  • Medicare beneficiaries enrolled in Medicare Advantage in Arizona: 38%
  • Number enrolled in Medicare Advantage nationwide: 19.838 million
  • Medicare beneficiaries enrolled in Medicare Advantage nationwide: 34%

Common Questions on Medicare Advantage in Arizona?

Are there disadvantages to Medicare Advantage?

Medicare Advantage has many benefits, but there are things you should consider before choosing it for your Medicare coverage.

  • Network limitations: All MA plans work within a network. This limits your choice of doctors, hospitals and other medical facilities. Many plans require specialist referrals from a primary care physician.
  • Financial unpredictability: MA insurance plans have substantially lower premiums than Medigap plans, but you’ll have more out-of-pocket expenses each time you visit a healthcare provider. Over time, these costs can add up to a significant amount.
  • Requires active engagement: It’s your responsibility to stay on top of plan changes and ensure that you’re staying in network, paying copays, and getting proper authorization for services.
  • Less long-term stability: Insurers make annual changes to benefits, network providers, and covered drugs. Additionally, premiums can change, and you’ll need to reevaluate your healthcare needs and coverage options each year. With a Medigap plan, your benefits won’t change from year to year.

What are the four types of Medicare Advantage policies available in Arizona?

  • PPO plans (Preferred Provider Organization)
  • HMO plans (Health Maintenance Organization)
  • PFFS plans (Private Fee-for-service)
  • SNPs (Special Needs Plans)

Who are the top three Medicare Advantage plan providers?

Here are the top three companies based on national enrollment:

  • United Healthcare 26%
  • Humana 18%
  • BCBS 15%

What are Medicare SNPs?

Special Needs Plans (SNP) are MA plans designed for specific groups:

  • Those who have a chronic condition (C-SNP)
  • Those who qualify for Medicare and Medicaid (dual eligible or D-SNP)
  • Those who live in an institution (such as nursing center) or require care at home (I-SNP)

SNPs vary by county and are not available everywhere.

Do Medicare Advantage plans include prescription drug coverage?

The majority of Advantage plans include drug coverage.

Do Medicare Advantage plans cover the SilverSneakers program in AZ?

SilverSneakers is a favorite program among seniors. Fortunately, many Advantage plans include this benefit. Other plans might offer something similar. But MA coverage options change frequently, so be sure and check your plan each year to find out whether this is still a benefit.

Related Topics

Arizona State Links

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.   

Key Take Aways
  • In Arizona, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.