Medicare offers healthcare coverage to Arizona residents age 65 or older, or to those Arizona residents that suffer from certain medical disabilities. In 2016, 1,261,000 people are enrolled in Medicare in Arizona, accounting for 18.5% of the population in Arizona. In 2009 about $9,395 was spent per Medicare enrollee in Arizona, approximately 9.36% lower than the national average of $10,365. From 2015 to 2030 the senior population in Arizona is projected to more than double (estimated 100.73% increase) according to calculations based off of the 2000 Census. Thus the number of Medicare beneficiaries in Arizona is also expected to substantially increase.
Medicare beneficiaries and their caretakers can receive free, one-on-one, and unbiased health benefits counseling from Arizona’s State Health Insurance Assistance Program (SHIP). Furthermore, Arizona participates in a national Senior Medicare Patrol (SMP) program which aims to educate individuals on how to detect, avoid, and report cases of Medicare waste, fraud, and/or abuse.
When you are eligible for Medicare you may sign up for Original Medicare (Part A & Part B), which cover hospital services and medical services, respectively, or you may enroll in a Medicare Advantage Plan (Medicare Part C). If you enroll in Original Medicare you also have the option to purchase a separate or stand alone prescription drug plan (Part D). Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. For most Medicare beneficiaries, Part A is already paid through paycheck deductions during their working years (or their spouse's) but most Medicare beneficiaries pay premiums for Part B unless they qualify for financial assistance. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a stand alone prescription drug plan to go with their Original Medicare coverage. Most Medicare Advantage plans also include additional health benefits such as vision, dental, or hearing coverage and you have the option to purchase a Medicare Advantage plan with prescription drug coverage (MAPD) in almost all states.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in Arizona is $60.28, 3.52% less than the national average of $62.48. 47.19% of 2017 Medicare Part C insurance plans in Arizona have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Arizona the average annual drug deductible for Medicare Part C insurance plans with drug components is $174.63. 27.94% of 2017 Medicare Part C insurance plans with a drug component in Arizona have a $0 annual drug deductible.
- 95.24% of 2017 Medicare Part C insurance plans without a drug component in Arizona have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Arizona is $5,946.34. 10.11% of 2017 Medicare Advantage plans in Arizona had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in Arizona was 3.4 stars in 2017.
- Among Arizona's 2017 Medicare Advantage plans with CMS star ratings:
- 26.97% earned a score of 4 or 4.5 stars
- 70.79% earned a score of 3 or 3.5 stars
- 2.25% of plans are too new to be measured
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation