Medicare Advantage Plans
In Maricopa County there are 88 Medicare Advantage plans to choose from, and in Navajo County there are 16. Advantage plans cover all the benefits included in Medicare parts A and B (hospital/doctor) and the vast majority include Part D coverage (prescriptions.) Many Advantage plans include extra benefits like vision and dental.
When attempting to choose between enrolling in an Advantage plan or a Medicare supplement plan consider the following: Ask yourself how Advantage plans can seemingly charge less per month and offer more coverage than a supplement plan? What happens if you enroll in Advantage plan and experience a serious illness, will this preclude you from obtaining a supplement plan down the road if you choose?
The average Advantage plan will have a total maximum out of pocket annual financial exposure of about $7000 in deductibles, co-pays, and co-insurance. A BCBSAZ Senior Security Plan G Medicare supplement policy has an annual maximum out of pocket of $233 (The 2022 Part B deductible.) Advantage plans typically require that you receive medical services from a list of pre-selected providers in your area. Plan G Medicare supplement plans allow you to see any Medicare contracted provider in the country. Approximately 94% of all doctors and hospitals in the country are contracted with Medicare (more below.) You can move out of state and keep Plan G coverage, not so with Advantage plans.
Arizona Medicare supplement plans are medically underwritten (unless you are in the initial open-enrollment period.) If you choose an Advantage plan instead of a supplement plan and experience a serious medical condition, you may not qualify for a supplement plan in the future. Or, if you do qualify you may not receive the lowest premium rate. Why would you want to switch to a supplement plan instead of keeping your Advantage plan? Much less financial exposure and a lot more doctors and hospitals at your disposal are the two main reasons. Try finding a specialist in your area that accepts your Advantage plan coverage. On the slight chance that they are in-network, how long will you wait to get an appointment?
The vast majority of doctors and hospitals have a contract with Medicare. The majority are Participating, some are non-Participating, and 6% do not have any agreement with Medicare. Participating providers accept Medicare reimbursements as payment in full. Non-Participating providers do not accept Medicare reimbursement rates as payment in full and can charge up to 15% more (Plan G Medicare supplement plans pay the 15%) The 6% of providers that have no agreement whatsoever with Medicare must have Medicare patients sign a form stating that the patient understands that they are on the hook for everything, that Medicare is not going to pay a dime on their behalf.
By the way, if you subtract Pediatric physicians from the 6%, you’re left with 1% of all doctors not accepting Medicare. Having access to essentially 99% of all doctors in the country with a Plan G is an important distinction between Advantage plans and supplement plans.
Lastly, Arizona Medicare supplement plans do not include prescription coverage (aka Part D.) Purchasing Part D drug coverage is inexpensive, prices ranging from $8-$50 a month on average. The national average price is $33. For those taking generics and no brand name medications a $10 plan if fine. Medicare.gov has a great tool online that will do all the comparison shopping for you based on specific medications prescribed. If you don’t buy prescription coverage the government will penalize you 1% for each month you qualified for coverage but went uninsured.