Original Medicare is a federal program available to beneficiaries in every state, but additional benefits or enhancements to Original Medicare insurance through a Medigap, Medicare Advantage or Prescription Drug plan may be subject to state regulations.
Medicare Coverage in Arizona
As of 2019, an estimated 1.3 million residents of Arizona receive Medicare benefits. Of this number, approximately 39% choose Medicare Advantage plans as a way of receiving their Medicare insurance benefits. Medicare Advantage plans can include Part D benefits, but Part D benefits can also be purchased as a standalone plan. When taking a look at Part D enrollment as of 2019, half of the eligible recipients in Arizona choose a standalone Part D plan rather than receive the benefit through a Medicare Advantage plan.
Arizona allows for five different types of Medicare Advantage plans:
Health Maintenance Organization (HMO)
A fixed group of health care providers, which includes primary care doctors and hospitals, are contracted to provide Medicare benefits to recipients. Unless the requirement is waived for specific reasons, recipients in an HMO plan must use this network of providers for their care.
Preferred Provider Organization (PPO)
Although a PPO uses a network of contracted providers much like an HMO does, recipients can see out-of-network providers for an additional fee rather than applying for a waiver that may require specific circumstances for approval. Recipients do not need referrals for most specialists in a PPO.
Private Fee for Service (PFFS)
Recipients who choose a PFFS can go to any provider of their choice, but the insurance provider determines what their cost-sharing obligations are rather than using the Medicare standard. These plans may offer extra benefits not covered by Original Medicare.
Medicare Savings Account (MSA)
Two distinguishing features of an MSA plan include plans that have a high deductible, meaning a deductible that is more than $2000, and a savings account that holds a set yearly deposit from Medicare which remains in the account if not used by the end of the year. This money can be used to pay for health care services before deductibles are met.
Special Needs Plan (SNP)
This plan works like an HMO but restricts enrollment to recipients who are dual eligible for Medicare and Medicaid. Recipients must also be long-term care residents or have disabling or chronic health conditions.
Medicare Supplement plans, also known as Medigap plans, are offered through private insurance carriers which can differ from state to state. Some states have limited numbers of insurers and regulate Medigap plans differently from the national standard. In Arizona, approximately 60 insurers are contracted with Medicare to offer Medigap benefits, and Medigap in Arizona follows the national standard of using letter names to distinguish each plan’s benefits from one another.
Getting Help with Paying for Medicare Coverage in Arizona
The Arizona Health Care Cost Containment System (AHCCCS) governs the dual eligibility program for Medicare insurance recipients who qualify for Medicaid services. Each state determines the standards that must be met for a Medicare recipient to qualify as a dual eligibility enrollee.
In Arizona, applicants must:
- Be a resident of the state.
- Be a United States citizen or an immigrant with a qualifying status.
- Has or applies for a Social Security number.
- Is eligible for and entitled to Medicare Part A.
- Receives all eligible income from any source available to the applicant.
- Be under the income limit at the time of application.
Income limits in each state can change each year. As of February 1st, 2019, single applicants must have a gross monthly income below $1,401 for all their Medicare premiums, copayments and deductibles to be paid. Single applicants whose gross monthly income is above $1,041 but below $1,406 can still qualify to have their Part B premium paid by Medicaid. Married couples can qualify for all premiums, copayments and deductibles to be paid if they are below $1,420 in gross monthly income; if they exceed this limit but are still below $1,903, they can qualify to have the Part B premium paid by Medicaid.