With more than 70 Medicare plans available in Arizona, selecting your best options can be a daunting task. This page provides an overview of the three primary options: Original Medicare, Medicare Advantage and Medicaid.
Original Medicare is made up of two parts: Part A covers hospital insurance, and Part B covers medical expenses such as doctor visits, lab work and some medical equipment.
The good news about Original Medicare is that it is pretty simple and typically covers about 80% of Part A and Part B expenses. The not so good news about Original Medicare is that you are responsible for the remainder of your medical expenses including prescription.
If you select Original Medicare you will probably want to select an additional private insurance plan to provide Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Medigap plans fill the “gaps” in hospital and medical costs that Original Medicare does not cover. Medigap offers 10 different levels of supplementary insurance in groups called Medigap A, B, C, D, F, G, K, L, M or N. Each sequential level provides higher coverage in exchange for a higher cost.
The good news about Medicare Advantage plans is that they can be a low-cost, or in some cases no-cost alternative to Original Medicare. The not so good news is that, in Arizona, selecting the best plan can be complicated (because there are more than 70 plans). The most common are HMO and PPO Plans.
- An HMO, or Health Maintenance Organization is a group of doctors, hospitals, and other health care providers who agree to give health care to Medicare beneficiaries for a fee that Medicare pays to them. In an HMO, you usually must get all your care from the providers that are part of the plan and you need a referral from a primary care physician to go to specialists.
- A PPO, or Preferred Provider Organization is a managed care plan that provides you with services from doctors, hospitals and other providers that belong to a network. You have the option of receiving services from providers outside the network at additional cost. You do not need a referral from a primary care physician to go to a specialist.
Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug Plan (MAPD).
The good news for Medicaid recipients is that the program generally pays for all of their covered medical expenses. The not so good news is that recipients must have household incomes at or below the Federal Poverty Threshold which, for 2018, is:
Monthly Income Limit as of 02/01/2019
Individual Applicant ………………….$1,040
Applicant + Spouse …………………….$1,409
Medicaid plans are offered by private insurance companies and generally include Part A (Hospital Insurance) and Part B (Medical Insurance). In addition, they usually cover Part D (Prescriptions) and may also offer additional coverage for vision, hearing and dental expenses.
In addition to low-cost or no-cost Medicaid, families at or below the Federal Poverty Threshold may also qualify for Supplemental Nutrition Assistance (SNAP), formerly the Food Stamp Program. Read more about SNAP.
Need A Little Help?
On this page we have attempted to share a little information about the most utilized Medicare options. If you find this information confusing, you are not alone. Our MPS staff and volunteers can help.