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Medicare in Arizona

Nearly four in ten Medicare beneficiaries in Arizona have Medicare Advantage plans

Key takeaways

Medicare enrollment in Arizona

As of September 2020, there were 1,361,860 residents with Medicare in Arizona. That’s a little more than 18 percent of the state’s population.
For most people, Medicare enrollment goes along with turning 65. But disability that lasts at least two years also triggers Medicare eligibility, as does a diagnosis of kidney failure or ALS. In Arizona, 13 percent of Medicare beneficiaries are under 65 — and enrolled due to a disability, kidney failure, or ALS — while 87 percent were eligible due to their age. Nationwide, 15 percent of all Medicare beneficiaries are eligible due to a disability, but there is quite a bit of state-by-state fluctuation: In Kentucky, Arkansas, Alabama, and Mississippi, 22 percent of Medicare beneficiaries were disabled as of 2017, while in Hawaii it was just 9 percent.

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Original Medicare in Arizona

Original Medicare, which includes Medicare Part A (hospital coverage) and Medicare Part B (outpatient/medical coverage) is a federal program that does not vary from state to state. So overall Medicare eligibility in Arizona and Medicare enrollment in Arizona both work the same way they do in every state. For people who aren’t yet receiving Social Security benefits and thus aren’t automatically enrolled when they turn 65, the Medicare application in Arizona is available through the Social Security Administration, as is the case nationwide.

But the availability and pricing of private Medicare coverage, including Medicare Advantage plans, Medigap plans, and Medicare Part D plans, does vary from one state to another.

Medicare Advantage in Arizona

In most areas of the country, Medicare beneficiaries can choose whether they want to use Original Medicare (coverage provided directly by the federal government) or enroll in a private Medicare Advantage plan. Medicare Advantage plans cover all of the benefits provided by Medicare Parts A and B (although the out-of-pocket costs will differ, as will access to medical providers), and most also include Part D coverage for prescription drugs.

Medicare Advantage plans also tend to include extra benefits, such as dental and vision coverage, and care management programs that can help beneficiaries manage chronic conditions.

38 percent of Arizona Medicare beneficiaries had Medicare Advantage coverage as of 2018, compared with an average of 34 percent nationwide. Most of the rest of the state’s Medicare beneficiaries had coverage under Original Medicare, but there are also some enrollees in Arizona who have Medicare Cost plans. Nationwide, enrollment in Medicare Advantage plans has been steadily increasing. Total enrollment in private Medicare plans, including Medicare Advantage and Medicare Cost plans, stood at 583,139 as of September 2020, which was nearly 43 percent of the state’s total Medicare population.

There are Medicare Advantage plans for sale in all 15 counties in Arizona for 2021, but plan availability varies considerably from one part of the state to another. In Navajo County, there are nine plans available, and in Apache County, there are 12. But residents in Maricopa County can select from among 69 different Medicare Advantage plans.

Medicare Advantage enrollment is available when a person is initially eligible for Medicare, and there’s also an annual enrollment window. Each fall, the Medicare annual election period, from October 15 to December 7, gives Medicare beneficiaries the option to switch between Medicare Advantage and Original Medicare. And people who are already enrolled in Medicare Advantage plans also have access to a Medicare Advantage open enrollment period (January 1 to March 31) during which they can switch to a new Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medigap in Arizona

Original Medicare beneficiaries who want help paying some or all of their out-of-pocket costs can purchase Medigap plans (also known as Medicare supplement plans). Medigap plans are issued by private insurers but are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The standardization makes it fairly easy to compare plans – plans can differ in price and in things like customer service, but the benefits offered by Plan A, Plan C, Plan F, etc. are the same regardless of which insurer offers the coverage.

325,876 Arizonans were enrolled in Medigap plans as of 2018, according to data collected by AHIP. There are 69 insurers licensed to sell Medigap plans in Arizona. According to an analysis conducted by Business Insider, the average cost for Medigap Plan F (the most popular plan) in Arizona in 2016 was about $143/month.

Unlike Medicare Advantage and Medicare Part D plans, there is no annual open enrollment period for Medigap plans. Instead, federal regulations allow for a six-month guaranteed-issue window that begins when a person is 65 and enrolled in Medicare Part B. After a person’s enrollment period ends (and unless the person qualifies for one of the limited guaranteed-issue rights), Medigap insurers can use medical underwriting to determine whether an applicant is eligible for coverage, and if so, at what price.

Federal rules do not grant a guaranteed issue open enrollment period for Medigap if the applicant is under 65 and enrolling in Medicare as a result of a disability. The majority of the states have implemented rules ensuring at least some access to Medigap plans for enrollees who are under the age of 65, but Arizona is not among them.

In 2009, the Arizona Department of Insurance announced that out of 53 insurers offering Medigap plans, five were offering coverage to disabled beneficiaries under the age of 65. But as of 2020, there were 69 insurers licensed to sell Medigap plans in the state, and none of them were offering coverage to people under the age of 65 (note that Medicare’s plan finder tool indicates that one of these insurers — Guarantee Trust Life — does offer Medigap coverage to people under age 65 in Arizona, despite the fact that the Arizona Department of Insurance guide indicates that they do not).

People under age 65 who have Medicare in Arizona do have the option to enroll in a Medicare Advantage plan (as of 2021, this includes beneficiaries with end-stage renal disease; prior to 2021, people with ESRD could not join most Medicare Advantage plans, but that is no longer the case. Medicare Advantage plans do not vary their premiums based on medical history, and they do have built-in out-of-pocket caps, so they may appeal to some disabled Medicare beneficiaries who would otherwise have Original Medicare without any caps on out-of-pocket costs.

Disabled Medicare beneficiaries qualify for a Medigap open enrollment period once they turn 65. At that point, they can enroll in any Medigap plan available in their area, without medical underwriting.

Medicare Part D in Arizona

Original Medicare does not cover prescription drugs. Some beneficiaries have employer-sponsored coverage to supplement their Medicare, and others have supplemental Medicaid, both of which can provide prescription coverage. But enrollees without either of those options need to obtain coverage under a Medicare Medicare Part D plan. Part C coverage can be purchased on its own, as a stand-alone plan, or as part of a Medicare Advantage plan that includes Part D prescription drug coverage.

For 2021, insurers in Arizona are offering 32 stand-alone Part D plan options with premiums ranging from about $7 to $106/month.

478,065 Arizona Medicare beneficiaries had stand-alone Part D plans as of September 2020, and another 553,704 had Part D coverage as part of their Medicare Advantage plans.

The annual Medicare open enrollment period (October 15 to December 7) is an opportunity for Medicare beneficiaries to change their Part D coverage if they choose to do so. Any changes made during this window will take effect on January 1 of the coming year. Beneficiaries are encouraged to compare all of the available plans each year, as the plan options may have changed since last year, as might have the enrollee’s prescription needs.

Average per-beneficiary spending for Medicare in Arizona

In 2018, per-beneficiary spending averaged $9,201 for Original Medicare in Arizona (the data were standardized to account for regional differences in payment rates, but did not include costs for Medicare Advantage enrollees).

Nationwide per beneficiary Original Medicare spending that year averaged $10,096, so Medicare spending in Arizona was about 9 percent lower than the national average. Louisiana had the highest average per-beneficiary Original Medicare costs, at $11,932, while Hawaii had the lowest, at just $6,971.

How does Medicaid provide financial assistance to Medicare beneficiaries in Arizona?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Arizona includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Medicare in Arizona: Resources and information for beneficiaries and their caregivers

You can contact the Arizona State Health Insurance Assistance Program (SHIP), with questions related to Medicare coverage in Arizona or for help with Medicare enrollment in Arizona.

The Arizona Department of Insurance and Financial Institutions can provide assistance and customer service related to health coverage in the state. This is the agency that licenses and regulates health insurance companies as well as the agents and brokers who sell policies in the state.

The Medicare Rights Center is a nationwide service, with a website and call center, where Medicare beneficiaries and their caregivers can get information and answers to questions about Medicare benefits, eligibility, and enrollment.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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