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Medicare Supplements in Phoenix AZ – 2015 Medicare Advantage Plans Available in Arizona

Original Medicare is the national health insurance provided to people aged 65 and over, as well as people under 65 with certain disabilities and chronic conditions. Since its scope of coverage is limited, people interested in purchasing additional health insurance can choose a Medicare Advantage plan (Medicare Part C or MA) or alternatively one of the Medicare supplements in Phoenix AZ (Medigaps).

Why you need additional coverage

The coverage provided by Original Medicare Parts A and B (hospital and medical insurance) is not comprehensive and it comes with certain expenses.

That is to say, policyholders are responsible for the payment of certain health care costs out-of -pocket. This includes the $1,260 deductible for every inpatient (hospital) stay, as well as 20% of the cost of most outpatient treatments and doctor visits.

As a result, bills can pile up quickly, especially in cases of major surgery or expensive outpatient treatments (e.g. cancer chemotherapy). This is why the majority of US citizens choose some kind of additional coverage as a way to prevent excessive out-of-pocket costs.

Medicare Advantage main points

Medicare Advantage is provided through private companies contracted by Medicare. It serves as a substitute for Original Medicare benefits. Medical Advantage beneficiaries continue to be enrolled in Medicare, but they receive their coverage through their MA plan.

Plan beneficiaries usually have a primary physician assigned to them. For specialist visits, the specialist must also be in the network. A referral from the primary physician is also required. MA plans may charge a premium in addition to the Part B premium. Some MA plans have $0 premiums while others have high monthly premiums, depending on the benefits.

Unlike Original Medicare, MA plans have an annual out-of-pocket limit. Once you have paid deductibles and copays up to the annual out-of-pocket limit, the plan will cover 100% of your medical bills for the rest of the year.

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All MA Plans cover emergency care and most of them include prescription drug coverage (Part D). With some MA plans, the coverage can also extend to eye, dental and hearing services. Plans offering a wider scope of coverage generally charge higher out-of-pocket costs.

Each Medicare Advantage Plan can price its services differently and determine its coinsurance percentages and terms. Some plans charge yearly deductibles and most plans charge copayments for certain benefits and services.

Medicare advantage plans in Arizona are county specific and if you change residence, you may have to enroll in a different plan. In this case, there is a special election period allowing users to switch plans outside the open enrollment period (October 15th – December 7th).

What are the different types of Medicare Advantage Plans in Arizona?

MA coverage is provided through the following plans:

Health Maintenance Organization (HMO)

These plans provide coverage through a network of doctors and hospitals, for a flat monthly rate and no deductibles. The choice of care is usually restricted to doctors or hospitals in the plan’s network, except in cases of emergency.

Preferred Provider Organization (PPO)

PPO plans offer a network of doctors and hospitals that beneficiaries can choose from. Healthcare outside the network is also an option, but your out-of-pocket costs will be higher.

Private Fee-for-Service (PFFS)

Similarly to Original Medicare, users can receive care by any doctor or hospital that accepts Medicare payments. PFFS plans determine how much they will pay and the beneficiary pays the rest.

Special Needs Plans (SNPs)

SNPs provide customized care (in terms of benefits, provider choices, and drug formularies) for people with specific diseases of characteristics.

HMO Point-of-Service (HMOPOS)

These plans provide certain services out-of-network for a higher copayment or coinsurance.

Medical Savings Account (MSA)

MSA plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account which beneficiaries can use to pay for healthcare services.

Medicare Advantage and Prescription drug coverage

Most MA plans include prescription drug coverage (Part D). These plans are known as Medicare Advantage Prescription Drug plans (or MAPDs).

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If you are enrolled in an MA plan that doesn’t provide it, such as PFF or MSA, you can join a Medicare Prescription Drug Plan.

If your MA plan does include drug coverage and you join a Medicare Prescription Drug Plan, you’ll be removed from the MA plan and returned to Original Medicare.

Things to consider when choosing Medicare supplements in Phoenix Az

The best place to check and compare plans is the plan finder on Medicare.gov. Here are the main things you should pay attention to:

  • Quality ratings – Medicare gives star ratings for the health plan quality (1-5 stars), based on its overall performance, customer satisfaction and quality of care. 4 and 5-star rated plans receive extra money from the government that can be spent on your benefits.
  • Co-pays and deductibles – get informed about the expenses you will have to cover for doctor’s visits or inpatient stays, as well as the annual out-of-pocket limit. Plans with higher premiums have lower out-of-pocket limits.
  • Participating doctors and hospitals – MA plans usually have provider networks and may not cover your expenses if you use out-of-network care. Ask your doctors what MA plans they take part in and which ones they recommend.
  • Dental and eye care coverage are included in many MA plans. Look for encircled D or V in the plan listing to see if it has this kind of coverage.
  • Coverage away from home – in most plans, this is restricted to emergency care. To see if your plan offers coverage while travelling, contact your provider directly.

Medicare Advantage Plans Available in Arizona

Each MA plan in Arizona has a specific set of benefits and costs (premiums, out of pocket limits, deductibles, gap coverage and prescription drug coverage).

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Plans offering Prescription drug coverage, $0 monthly premium:

  • AARP MedicareComplete
  • Aetna Medicare Value Plan (HMOs)
  • CareMore Heart (HMO SNPs)
  • HumanaChoice H6609-133 (PPO)

Highest monthly premium, gap coverage:

  • Humana Gold Choice H8145-103 (PFFS)
  • HumanaChoice R5826-014 (Regional PPO)
  • HumanaChoice H6609-133 (PPO)
  • Humana Gold Plus H2649-030 (HMO-POS)
  • Blue Medicare Advantage Premier
  • Phoenix Advantage Select (HMOs)

Lowest maximum out-of-pocket costs, gap coverage:

  • Humana Gold Choice H8145-103 (PFFS)
  • Blue Medicare Advantage Classic
  • Phoenix Advantage
  • Phoenix Advantage Select (HMOs)
  • CareMore Breathe
  • CareMore Diabetes (HMO SNPs)

Don’t forget to read the Annual Notice of Change sent by your plan provider in September, even if you’re satisfied with your current choice. Plans frequently change their drug formularies and your drugs may not be on the plan’s preferred list next year. There’s also a chance that your plan will not be offered in your area anymore.



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