How to Choose the Right Medicare Plan in Arizona

Medicare is a tremendous resource in helping you meet your healthcare needs as you age. If you have spent any amount of time watching television, you have most likely heard the word Medicare being tossed around on news stories and commercials. Particularly in a political climate, Medicare is a hot topic of debate between candidates.

Even if you are familiar with the word, the Medicare system is far from straightforward. It is quite overwhelming when you are faced with making decisions in regards to your healthcare needs. To avoid making uninformed decisions, it is wise to spend time exploring the Medicare program. You’ll gain a better understanding of how the Medicare system works, and even more important, how to maximize the program’s benefits and available resources.

After reading this article, you will have a better understanding of the Medicare program. We’re going to cover what Medicare is, how it can help you, which plan may be best for you, and what you need to get started and enrolled.

What is the Medicare Program?

  • In a nutshell, after the realization that many people in the aging population were unable to obtain and afford health insurance, the Medicare program was established in 1965 by the United States government. The program was designed to provide affordable and adequate health insurance for Americans aged 65 and older.

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Who can Get Medicare?

  • Private insurers do not want to insure a population of people who don’t provide a good return. Those who require a great deal of healthcare resources, such as the aging population, those with disabilities or a particular illness, make them even more difficult to insure.

    Medicare is somewhat of a social safety net designed to address this social problem. The health insurance program is available to every person who is a citizen of the United States and is 65 years of age or older. Medicare is also available to citizens who have an end-stage renal disease (ERSD) or those who receive Social Security Disability Insurance (SSDI) regardless of their age.

How Does the Program Work?

When signing up for Medicare, you choose parts of the program that work for you. The program is divided into parts A, B, C, and D. The parts essentially cover different medical costs. Before we go into more detail on each part, you should know that when you initially sign up for Medicare, you will choose one of two categories, which then determines the way you receive your Medicare benefits.

The first category choice is Original Medicare. This program is offered directly through the federal government and is the traditional fee-for service program. The second category choice is Medicare Advantage. Choosing this category provides you with a plan that is managed by a health insurance company that contracts with the federal government. We will discuss the advantages and disadvantages of these two categories later on in this article.

Parts A – D Basics
Healthcare costs are divided into parts A – D as previously mentioned. While there are supplemental plans, we will focus on A – D in this article. Here is a basic breakdown of what each part includes in regards to your options and coverage.

Medicare Part A Coverage

  • Hospital bills and related inpatient care expenses
  • Skilled nursing care cost
  • Nursing home cost
  • Hospice Care
  • Homebound physical and occupational care

Medicare Part B Coverage

  • Preventive services
  • Medically necessary outpatient services
  • Ambulance services
  • Medical equipment
  • Limited amount of prescription drug coverage
  • Outpatient mental health services

Medicare Part C Coverage
(Advantage Plans only)

  • Parts A & B coverage
  • More restrictive in regard to where you receive care and what is covered
  • Managed by private insurance
  • Options for dental and vision coverage
  • Options for Part D coverage

Medicare Part D Coverage

  • Prescription drug coverage

Part D is only available through private insurance providers and is automatically included with Medicare Advantage. You can choose a standalone Part D plan or Prescription Drug Plan (PDP) on the Original Medicare plan.

Original Medicare vs. Medicare Advantage

  • The difference between these two plans will be the difference in where you can go and receive medical care and what you will pay out of pocket.

    Original Medicare gives you the freedom to go just about anywhere in the country. Medicare Advantage has network restrictions based on your private provider’s insurance plan. One advantage to choosing Medicare Advantage is lower premiums and reduced out-of-pocket costs.

When and How to Enroll

You automatically qualify for Medicare enrollment at age 65 as long as you or your spouse contributed payroll taxes for at least ten years. If you fail to sign up for Medicare when you turn age 65, you forfeit all your Social Security benefits. For this reason, most people enroll when they turn 65. This rule only applies to Medicare Part A and you can opt out of enrolling in Part B, which has a premium.

If you are already receiving Social Security benefits on your 65th birthday, you are automatically enrolled in Part A and Part B. You will receive a card in the mail approximately three months before you turn 65. At that time, you may choose to decline Part B coverage. Worth noting is that if you decline and decide to enroll at a later time, you will then pay a lifetime penalty each month.

For those not receiving Social Security Benefits, you will sign up during an initial enrollment period, which is a seven-month period, surrounding your 65th birthday.

Although there are many regulations and rules that apply for enrollment, there are many insurance experts in Arizona who are willing to help you navigate the Medicare program.