About 15 percent of Arizona's population uses Medicare.
Medicare is a federally-funded health insurance program in the US meant to service senior citizens aged 65 or older, although some people younger than this may qualify if they have certain diseases and conditions. Original Medicare comes in two parts--A and B--and covers hospitalizations, preventive services, hospice care and home health. Part C, more commonly called Medicare Advantage, gives customers a chance to combine their original Medicare benefits with additional ones. Arizona's Medicare Advantage plans are bought from private companies, which offer different plans in different areas.
Types of Medicare Advantage Plans
Medicare Advantage Plans can be offered in several different ways. You may be able to find them as health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, special needs policies targeted at those with specific health problems, private fee-for-service (PFFS) plans and policies that work with medical savings accounts. In Arizona, most insurance companies that sell Medicare Advantage offer HMO, PPO and PFFS policies. HMO plans require you to get all medical treatment from providers that are part of your network, while PPOs generally allow you to go outside the network if you pay higher fees. PFFS plans allow you to go to any provider who agrees to the plan's payment terms.
Premiums and Co-Pays
Traditional Part A Medicare is often free of premiums, but since Medicare Advantage comes from private companies, you will probably need to pay a monthly premium for services. Arizona Medicare Advantage plans will also require you to pay annual out-of-pocket costs, deductibles and co-pays for some services. These will change depending on the company from which you receive your MA plan and the specific plan you purchase. In 2011, Humana's Gold Plus HMO-POS H0397-010 plan for the Phoenix area has no annual deductible, but does have a monthly premium of $59 and an annual out-of-pocket cost of $6,700, while the same company's HMO H0307-008 plan has annual out-of-pocket costs of $5,000, no deductible and monthly premiums of only $35.
Benefits
The benefits for Medicare Advantage plans are also decided by the insurance company, although the federal government does mandate that MA plans must include all the benefits of original Medicare, save for hospice. Many MA plans in Arizona offer prescription drug benefits along with Part A and Part B coverage. Some also add vision, hearing and wellness programs, as well as long-term care benefits.
Medicare Advantage Companies
Medicare Advantage (MA) plans can only be sold by companies authorized to do so by the federal Centers for Medicare and Medicaid Services. If a company does not abide by the federal rules, it can be sanctioned and removed from the approved provider list. As of 2011, Human, Cigna, Abrazo Advantage, United Healthcare, Banner MediSun, Secure Horizon, CareMore, Evercare and the Senior Care Action Network were among the companies allowed to provide MA plans in Arizona. Health Net, which was formerly allowed to sell MA, was sanctioned by Medicare in November 2010 and banned from enrolling new members.
Tags: Medicare Advantage, Advantage plans, Advantage Plans, annual out-of-pocket, annual out-of-pocket costs, Arizona Medicare
