Frequently Asked Questions

Medicare is the federal health insurance program for:

• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You pay for services as you get them. When you get services, you’ll pay a 

deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Many people choose to add a Medicare Supplement Insurance (Medigap) policy that can help pay some or all of the remaining health care costs, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn't cover, like emergency medical care when travelling outside of the United States.

This link will take you to the Medicare.gov website. Here you can learn more about eligibility and register for Medicare. Medicare Registration 

Even better, you can give me a call at 520-485-5882 so you can have a thorough understanding of all of your Medicare insurance coverage options and then choose the very best options for your healthcare needs. 

Arizona Medicare Answers specializes in helping individuals understand the complexities of Medicare insurance options so that they can easily choose the right plan and services that meet their specific healthcare needs. 

In addition to Medicare, there are almost 160 Medicare Advantage Plans in Arizona. These plans vary by county and the same plan could provide different levels of coverage/deductibles/co-pay's/and services from one county to the next. 

No matter what county you live in, I would look forward to going over with you all the different healthcare options you have to choose from. I can simplify for you an often confusing and complicated process so you can be confident knowing you have the best healthcare coverage available. 

There are several components that make up the range of health care services provided through the Medicare Insurance program.

• Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits.  Most people don't have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while they were working. If you (or your spouse) didn't pay Medicare taxes while you worked and you are age 65 or older, you may be able to buy Part A. If you aren't sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, "Hospital (Part A)" is printed on your card. You can call Social Security at 1-800-772-1213, or visit your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772.

• Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount, however, you could pay more based on your income. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

• Medicare Part C are your Medicare Advantage Plans (like an HMO or PPO) and is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “MA Plans,” are offered by private companies approved by Medicare. Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Many Medicare Advantage Plans offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

• Medicare Part D covers prescription drugs.  Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. 

Here, from United Health Care, is a great guide covering the Medicare program, Medicare and Medicare Advantage Plans. Get it Here!

Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig's disease).  If you are uncertain if you qualify you can visit MEDICARE ELIGIBILTY or give us a call at 520-485-5882. 

Initial Enrollment Period: Three months prior to you turning 65 and three months after the month you turn 65. 

Annual Enrollment Period:  This is October 15th to December 7th every year. If you have Original Medicare, you can switch to a Medicare Advantage plan — or vice versa during this time. You can also switch from one Medicare Advantage plan to another. If you’re happy with your current coverage, you’re not required to make a change. In most cases, your current Medicare plan will automatically renew on January 1. 

Medicare Advantage Open Enrollment Period:  Running from January 1st through March 31st every year, during this time individuals enrolled in a Medicare Advantage plan can make a one-time election to go to either another Medicare Advantage plan with or without prescription drug coverage or Original Medicare. You’ll also be able to enroll in a Medicare prescription drug plan. 

General Enrollment Period:  The General Enrollment Period (GEP) goes from January 1st to March 31st every year. At this time you can enroll in Medicare Part B for the first time if you missed your Initial Enrollment Period (IEP) and do not qualify for the Part B Special Enrollment Period (SEP). Note there could be penalties involved if required coverage lapsed or was never purchased. 

Special Enrollment Periods:  During a Special Enrollment Period (SEP), you can join, switch or drop a Medicare Advantage or prescription drug plan outside the basic enrollment periods. In order to qualify for an SEP, certain events must occur that require you to change your coverage. 

A Special Enrollment Period can or is available during these times:

• You move out of your service plan coverage area
• You move back to the United States after living abroad
• Your employer-provided health insurance plan has ended
• You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital, long-term care facility or jail.
• You have, or have contracted, a chronic disease
• Your Medicare/Medicaid status has changed
• Qualifying for extra help such as becoming Medicaid or Dual-eligible
• Your current plan changed it's contract with Medicare
• Your state has declared a state of emergency

Consider me being there for you just like your Primary Care Physician, Dentist, Car and Home insurance agent or dog groomer. As a professional, certified Medicare advisor and consultant, I am always here to answer your questions, ensure you understand your healthcare plan, and are maximizing the benefits you are entitled to receive. 

As a part of my service to you, I'll be sending you every month a newsletter filled with valuable information related to Medicare and enjoying the most of your senior years. 

MEDICARE: 

Creating the health care coverage you want...

Medicare Part A- If you have worked 10+ years (40 quarters) and had Social Security taxes withheld you most likely will not have a Part A premium. If you don’t get premium-free Part A, you may pay up to $506 monthly in premiums. For a hospital stay in 2023, you also pay a $1,600 deductible per benefit period. 

Medicare Part B- is $164.90 per month in 2023 (or higher depending on income), typically deducted from your Social Security payment.  The Part B deductible is $226 per year. Part B coinsurance—the share you're expected to pay after reaching your deductible—is 20% of the cost for each Medicare-approved service or item. This can make up a significant part of your total out-of-pocket costs. 

Medigap- Also know as Supplemental Insurance,  are policies sold by private carriers to cover some or most of your Medicare Parts A and B costs. Premiums are set by each Each insurance carrier and this monthly amount is determined by what amount you’ll be likely paying in out-of-pocket costs during your coverage period. The 2023 national supplement plan average monthly cost came in at $139 a month. However, Medicap plans can range from $50 to over $400 a month based on the coverage you select. 

Medicare Part D- Your prescription drug coverage will be provided by a separate plan and payment. The current 2023 national average for prescription drug coverage is $32.75

Dental and Vision Supplemental Plan- For vision and dental coverage this will be another plan you will need to purchase. Costs can vary widely and are generally tied to the services you want to have covered, the deductibles and co-pays you choose. The monthly plan cost can range from as low as $12 to over $50 a month. If you want traditional Medicare, one option if your spouse or partner is working, is to enroll in their firms' dental and vision coverage.  

Bottom Line:

After you pay your $226 deductible, you will be responsible for 20% of your Medicare covered health costs unless you have a Medigap policy. There is no limit or cap on the amount you could owe for the medical services provided. 

You can use Medicare for services wherever you are in the country as long as they accept Medicare. You have greater flexibility in choosing the physician of your choice. When needing a specialist there are no prior authorization requirements. 

MEDICARE ADVANTAGE PLANS:

Medicare Advantage Plans are required to provide at a minimum the same coverage as Medicare Parts A and B. You will still pay your monthly Medicare Part B premium of $164.90 a month but many Medicare Advantage Plans are available for no or a small monthly premium. You can see more HERE

Medicare Advantage Plans, a more comprehensive package of health care services...

Medicare Advantage Plans cover Medicare Part's A and B as mentioned above. They can also include Part D coverage, which many people choose. 

Because of the strong incentive for insurance providers to compete against one another benefits are constantly being reviewed and added to their list of benefits and services. Included among these additional services can be; dental and vision coverage, fitness services like health club memberships, food allowances, rent and utility help, mental health services, free transportation for medical visits and Part B reimbursements. 

Bottom Line: 

Medicare Advantage are considered easier to manage as many services are bundled into your one plan. With Medicare Advantage you can choose a plan more tailored or suited to your needs like one covering a chronic disease (a severe or disabling health condition) such as diabetes. For those that travel, national carriers generally allow you to use their network of providers wherever they are located in the country. Many others like the fact that, unlike Medicare, Medicare Advantage Plans have a cap on the amount you will pay out of pocket for your health insurance coverage. 

Medicare does not cover the following services:

• Long-Term Care (also called custodial care)
• Most dental care
• Eye exams (for prescription glasses)
• Dentures
• Cosmetic surgery  
• Massage therapy
• Routine physical exams
• Hearing aids and exams for fitting them
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

For Part D Drug Prescription, Dental, Vision and Skilled Nursing Facility coverage a combination of Supplement and or individual coverage plans must be purchased. 

Medicare Advantage Plans are required by law to meet or exceed Medicare coverage. They do not cover the following services:

• Hospice care (This remains covered by original Medicare Part A)
• Out of Network care (except for emergency and urgent care)
• Experimental drugs excluded by Medicare 
• Clinical trials
• Cosmetic surgery  
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance. 

Medicare updates these ratings each fall for the following year. These ratings can change each year. These ratings help drive Medicare Advantage Plan providers to continually review, revise and improve on the services they provide in order to attract and retain their members. 

Their are also several types of Medicare Advantage Plans to choose from. Each have their own advantages and disadvantages depending on your needs. Our focus in working with you is to let you compare and select the best plan for your healthcare. 

Here is a chart you can view and print that provides a side-by-side comparison. CLICK HERE 

HEALTH MAINTENANCE ORGANIZATIONS (HMO's)

 An HMO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except for Emergency Care and Out of the area Urgent Care, including dialysis care.

1. They may or may not charge a monthly premium. With an HMO you do continue to pay your monthly Part B premium. 
2.  Prescription drugs are covered in most HMOs.  If you want prescription drug coverage, you have to join an HMO that offers it. If you join an HMO plan that doesn't offer drug coverage, you can't join a separate Medicare drug plan. 
3. Unlike Medicare, you can just go to anyone that accepts Medicare.  You generally must get your care and services from doctors, other health care providers, and hospitals in the plan’s network (except for emergency, urgent care, or out-of-area dialysis).
4. In an HMOPOS plan, you may be able to get some services out of network for a higher copayment or coinsurance. 
5. HMO's have what is called a MOOP, or an annual maximum out-of-pocket cost that you will pay for medical care. Without a Medicare Supplement plan, with Medicare you will continue to pay 20% of your Medicare bills throughout the year. 
6. While many HMO's still require referrals there is a growing trend for them not to be needed to receive care from a specialist. 
7. Most HMO's will require you to have selected a Primary Care Physician, and one that is within their network. 

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

Here is a chart you can view and print that provides a side-by-side comparison. CLICK HERE 

PREFERRED PROVIDER ORGANIZATIONS (PPO's)

 A PPO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals. You pay less if you go to providers and facilities that belong to the plan's network. You can also generally go to out‑of‑network providers for covered services, but you’ll usually pay more.

1. They may or may not charge a monthly premium. With a PPO you do continue to pay your monthly Part B premium. 
2.  Prescription drugs are covered in most PPOs.  If you want prescription drug coverage, you have to join an PPO that offers it. If you join a PPO plan that doesn't offer drug coverage, you can't join a separate Medicare drug plan.
3. With a PPO  you can also use out-of-network providers for covered services, if they’re participating in Medicare or accept assignment, but you'll usually pay more. Before you get services from an out-of-network provider, contact your PPO Plan to ensure the services are medically necessary and covered by your plan. You’re always covered for emergency and urgent care. 
4. You DO NOT need to select a Primary Care Physician
5. You DO NOT need a referral to see a Specialist
6. Because certain providers are "preferred," you can save money by using a PPO.
7. Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

Here is a chart you can view and print that provides a side-by-side comparison. CLICK HERE 

SPECIAL NEEDS PLANS (SNP's)

 A Special Needs Plan (SNP) provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.

SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. 

NOTE: You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan. If you or a loved one are not in a SNP and you think could benefit from being in a SNP you can enroll in a SNP at any time. Let's say someone has just been diagnosed with Diabetes or Chronic Kidney Disease, that diagnosis makes the person eligible to change to a SNP.  

There are three different types of SNP's:

1. Dual Eligible SNP (D-SNP) – You’re eligible for both Medicare and Medicaid. Some D-SNPs may provide Medicaid services in addition to Medicare services. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, depending on the state and your eligibility.
2. Chronic Condition SNP (C-SNP) – You have one or more of these severe or disabling chronic conditions:
   • Chronic alcohol and other dependence
   • Certain autoimmune disorders
   • Cancer (excluding pre-cancer conditions)
   • Certain cardiovascular disorders
   • Chronic heart failure
   • Dementia
   • Diabetes mellitus
   • End-stage liver disease
   • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
   • Certain severe hematologic disorders
   • HIV/AIDS
   • Certain chronic lung disorders
   • Certain chronic and disabling mental health conditions
   • Certain neurologic disorders
   • Stroke

        3. Institutional SNP (I-SNP) – You live in the community but need the level of care a facility                            offers, or you live (or are expected to live) for at least 90 days straight in a facility like a:

• Nursing home
• Intermediate care facility
• Skilled nursing facility
• Rehabilitation hospital
• Long-term care hospital
• Swing-bed hospital
• Psychiatric hospital
• Other facility that offers similar long-term, health care services and whose residents have similar needs and health care status as residents of the facilities listed above.

Additionally:

1. Some plans may charge a premium, in addition to the monthly Part B (Medical Insurance) premium. However, if you have Medicare and Medicaid, most of the costs will be covered for you. Contact your Medicaid office for more information. 
2. All SNPs must provide Medicare drug coverage (Part D).
3. Some SNPs require that you get your care and services from providers and facilities in the plan’s network (except for emergency care, out-of-area urgent care, or out-of-area dialysis).
4. Some SNPs offer out-of-network coverage, so you can get services from any qualified provider or facility, but you’ll usually pay more.
5. The SNP may or may not require you to have a Primary Care Physician. If you have primary care doctor or provider you like, ask the plan if you can keep them.
6. Referrals may be required for certain services but not others. 
7. Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care. 
8. C-SNPs can limit membership to a single chronic condition or a group of related chronic conditions.
9. D-SNPs can help coordinate your benefits between Medicare and Medicaid.  
10. All SNPs use a care coordinator to help you stay healthy and develop a care plan with you.

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

Here is a chart you can view and print that provides a side-by-side comparison. CLICK HERE 

PRIVATE FEE FOR SERCIVE PLANS (PFFS)

 A PFFS is a type of Medicare Advantage Plan. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.   

1. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium. 
2.  Prescription drugs may be covered. If your PFFS plan doesn’t offer drug coverage, you’ll need to join a separate Medicare drug plan (Part D) to get drug coverage. 
3. You can go to any Medicare-approved provider or facility that accepts the plan’s payment terms, agrees to treat you, and hasn’t  opted out of Medicare (for Part A- and Part B-covered items and services).
4. If you join a PFFS plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network provider or facility who accepts the plan’s terms, but you may pay more. In an emergency, doctors, hospitals, and other providers must treat you.
5. You DO NOT need to choose a Primary Care Physician
6. You DO NOT need to get a referral to see a Specialist
7. The plan decides how much you pay for services. The plan will tell you about your costs in the “Annual Notice of Change” and “Evidence of Coverage” that it sends each year.
8. You’ll need to show your plan membership ID card each time you go to a health care provider. Your provider can choose at every visit whether to accept your plan’s terms and conditions of payment. 
9. You can’t use your red, white, and blue Medicare card to get heath care because Original Medicare won’t pay for your health care while you’re in a PFFS plan. Keep your Medicare card in a safe place in case you return to Original Medicare in the future.
10. Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
11. If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

Here is a chart you can view and print that provides a side-by-side comparison. CLICK HERE 

MEDICAL SAVINGS ACCOUNTS (MSA's)

An MSA is a type of consumer-directed Medicare Advantage Plan (Part C). These plans are similar to Health Savings Account (HSA) Plans like you’d get from an employer or the Marketplace. With MSA Plans, you can choose your health care services and providers (these plans usually don’t have a network of doctors, other health care providers, or hospitals). 

MSAs combine a high-deductible insurance plan with a medical savings account to pay for your health care costs. You're responsible for handling the money in your account, including deciding whether to pay for health care services using your account funds or other funds you have.

There are two parts to the Medicare MSA Plans:

1. High-deductible health plan: This is a special type of Medicare Advantage Plan. This type of plan only starts to cover your costs once you meet a high yearly 

deductible, which varies by plan. 

2. Medical savings account (MSA): This is a special type of savings account. Medicare gives the plan an amount of money each year for your health care expenses. This amount is based on your plan. The plan deposits money into your MSA account once at the beginning of each calendar year. Or, if you become entitled to Medicare in the middle of the year and join a Medicare MSA Plan at that time, the plan will deposit the money into your account the first month your coverage starts.

You can use this money to pay your Medicare-covered costs before you meet the plan’s deductible. You can access the money using a checking account or special debit or credit card your bank gives you. Check with your plan for details. The yearly deposit and yearly deductible are pro-rated based on when your enrollment begins.

Considerations and Questions to ask yourself before choosing and MSA:

1. How much will be deposited into my account each year?
2. What’s the plan’s deductible?
3. How are services counted against the deductible?
4.  Is there a limit on the charges that will count toward the deductible?
5. What am I responsible for paying after I meet the plan’s deductible?
6. Is other insurance offered to work with my plan, like dental, vision, or long-term care?
7. Is there any coverage of preventive services before meeting the deductible?

You are NOT eligible for an MSA if any of the following apply:

1. You have health coverage that would cover the Medicare MSA Plan deductible. This includes benefits under employer or union retiree plans.
2. You joined another Medicare Advantage Plan.
3. You get benefits from the U.S. Department of Defense (TRICARE) or the U.S. Department of Veterans Affairs.
4. You're a retired Federal government employee and part of the Federal Health Benefits Program (FEHBP).
5. You're eligible for Medicaid.
6. You're currently getting hospice care.
7. You live outside the U.S. more than 183 (total) days a year.

With an MSA:

1. You continue to pay your Part B premium 
2. You DO NOT need to select a Primary Care Physician
3. You DO NOT need a referral to see a Specialist
4. If you join a Medicare MSA Plan and want Medicare drug coverage, you'll have to join a separate Medicare drug plan.
5. MSA Plans generally don't have a network of health care providers. You can get covered services from any Medicare provider in the U.S. or U.S. territories.
6. If you use all of the money in your account and you have additional health care costs, you'll have to pay for your Medicare-covered services out of pocket until you reach your plan's deductible.
7. Money left in your account at the end of the year stays there, and may be used for health care costs in future years.

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

 Medicare Part D is a voluntary outpatient prescription drug benefit. Medicare Prescription Drug plans are offered by private health insurance companies and cover your prescription drug costs for covered medications. You can choose to receive this coverage in addition to: Original Medicare (Part A and Part B).

If you do not enroll in Part D when you are first eligible, and you do not have creditable drug coverage, you will likely have to pay a premium penalty if you later enroll in a Part D plan. While SEPs let you enroll in Part D outside of a standard enrollment period, you will still owe a premium penalty for late Part D enrollment in many cases. 

There are two exceptions: You will not have a penalty if you qualify for Extra Help—a federal program that helps pay for most of the costs of the Medicare drug benefit—or if you show that you got inadequate information about the creditability of your other drug coverage. 

What is creditable drug coverage? Your plan must meet or exceed Medicare standards of coverage. If you are turning 65 and still employed you will need to make certain that your drug coverage plan is comparable to the Medicare Part D Prescription drug plan. You do not need to have both if your employer's coverage is creditable. The same is true if you are covered under a company, union, military, federal or state government plan. 

If you do not have creditable coverage at age 65 you will need to purchase a standalone Part D Prescription Drug Plan (PDP) or enroll in a Medicare Advantage Plan (MAPD) that include Part D prescription drug coverage. 

The current average national premium in 2023 for a standalone plan (PDP) is $32.74. If your income is above a certain limit ($97,000 if you file individually or $194,000 if you're married and file jointly), you'll pay an extra amount in addition to your plan premium (sometimes called “Part D-IRMAA”). Prescription Drug coverage included with an MAPD has no additional monthly premium. 

Whether a PDP or MAPD, you will have a co-pay is based on the drug tier your medication falls under. Many Tier 1 and Tier 2 formulary drugs are now being provided with no co-pay. A drug not covered under the Medicare Part D formulary may not be covered by a standalone PDP or MAPD. It is important to check the formulary to be certain your prescriptions are covered and what the co-pay will be.  

SUGGESTION:  If your medication is in a higher cost tier or not covered on your PDP or MAPD plan's formulary (approved drug list), you may want to see if you can ask for an exception to get the plan to cover it completely or at a lower cost. "Best" Price: Another strategy is to ask your pharmacist for the “best” price for the prescription. 

How long you stay in the initial coverage period depends on your drug costs and your plan's benefit structure. For most plans in 2023, the initial coverage period ends after you have accumulated $4,660 in total drug costs.  Once your out-of-pocket spending reaches $7,400, you'll automatically get “catastrophic coverage.” Generally, this means you'll only pay a small coinsurance percentage (no more than 5%) or copayment for your covered Part D drugs for the rest of the calendar year. 

NOTE: This is a general overview only. For specific information on this and other plans you can contact me at 520-485-5882 or set up an appointment to see me. 

 TRICARE For Life (TFL) is Medicare-wraparound coverage if you are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. Coverage is only for those with Medicare and who are TRICARE-eligible. Coverage doesn’t extend to family members. 

• TFL Enrollment not required
  • TFL Coverage is automatic if you have Medicare Part A and B
  • Coverage starts the first day Medicare Part A and B are in effect
  • You must pay Medicare Part B premiums

There are a number of different ways to become eligible for TRICARE and a coverage options available to TRICARE members.  If you have questions concerning TRICARE for the most accurate and up to date information visit the official TRICARE site HERE.

There may be times when you are considering additional coverage from a private health insurance provider. If you have any questions about this, please call me or send me an email at cs@arizonamedicareanswers.com

Arizona Medicare Answers helps individuals understand and enroll in the best health insurance options for their health care concerns and lifestyle. We are certified to offer and assist you in enrolling in straight Medicare, Medicare Supplement (Medigap) Plans, Part D Prescription Drug Coverage (PDP's), Vision and Dental plans and a variety of Medicare Advantage (MA or MAPD)  Plans from most, but not all, of the Medicare/Medicare Advantage Insurance providers in Arizona. A list of the current carriers is located at the bottom of the  home page. 

To enroll in an Arizona Medicare or Medicare Advantage health insurance plan with a fully certified Arizona Medicare Answers professional, you call or text me at 520-485-5882, email us at CS@ArizonaMedicareAnswers.com .  The Center for Medicare Services (CMS) requires us to complete with you a Scope of Appointment 48 hours prior to meeting with you. For in-office appointments that requirement is waived.  In addition to straight Medicare, our list at the bottom of the page shows the Medicare Advantage Providers we are currently certified and have chosen to represent. 

This is a concern for many. If you have straight Medicare, you are covered wherever they accept Medicare. If you choose a Medicare Advantage Plan you will want to choose a carrier that has network coverage in both states. 

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance. 

Medicare updates these ratings each fall for the following year. These ratings can change each year. These ratings help drive Medicare Advantage Plan providers to continually review, revise and improve on the services they provide in order to attract and retain their members. 

Yes, this is known as the Low Income Subsidy (LIS) program.  Depending on your income and assets, you may qualify for either full or partial Extra Help. The first number to consider is your income, set at or below $22,116 annually for a single person and at or below $29,820 for couples. 

If you are currently enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.

Extra Help also provides assistance with the Part D Prescription Drug. It pays for all or a portion of your Part D premium up to a state specified amount, it lowers the cost of your Part D prescription drug co-pay, it eliminates any payment penalty you may have incurred if you enrolled later than the required time frame and the LIS program provides a special nine month time period beginning the first of each year to enroll in a Part D Prescription Drug plan.   

To apply for Extra Help call Social Security at 800-772-1213 or go to their website HERE

Yes, absolutely! No matter where you live I have access to all the Medicare and Medicare Advantage Plans and options that are available in every county in Arizona. After reviewing your specific needs with you, together we can look at and have you select the very best healthcare coverage plan for you. We can do all this over the phone or online through a Zoom link. 

The complexity and variety of the Medicare and Medicare Advantage options don't allow us to answer every question here. And the correct answer is always the one that is specific to your needs and circumstances. We welcome the opportunity to help you get the answers and healthcare services you need., go over plan offerings and help you enroll in the plan best suited to your needs. Please email us at cs@arizonamedicareanswers.com so we can provide the best, most complete answer to your question(s).