Medicare Advantage

What is Medicare Advantage?

Also known as “Part C”, Medicare Advantage plans (MAPD). These plans can offer additional benefits over Original Medicare. When you enroll in Medicare Advantage it takes the place of Original Medicare.  You cannot have a Medicare Advantage plan when you are enrolled in a Medicare Advantage. Most Medicare Advantage plans have prescription drugs rolled into them.

You must be enrolled in Medicare Part A & B to be eligible to enroll in a Medicare Advantage Plan.

With Medicare Advantage plan, most plans require you to see your Primary doctor to be referred to a Specialist and prior authorization for certain test and treatment. Maricopa county in Arizona has approximately 38 different Medicare Advantage Plans available – most have a $0 monthly premium.  We are authorized to represent and certified to sell over 35 different MAPD plans, ensuring you find the right one.

We offer many Medicare Advantage plans in Arizona:

Medicare Advantage Plan Definitions
HMO = Health Maintenance Organization – Typically associated with “networks”.  HMO’s usually require a referral by your Primary Care Physician in order to see a specialist.  Only emergency coverage out of network.

PPO = Preferred Provider Organization – A PPO is a plan that has a network (like an HMO), but allows you to step out of that network and obtain services at virtually any doctor, specialist or hospital as long as they will accept payment from the plan. The insurance company will still participate in the share-of-costs, but your share will be higher than if you stayed within the PPO network.  No referrals are required with a PPO plan.

SNP = Special Needs Plan – A special needs plan is designed for those receiving extra financial help from the state or government.  To qualify for a SNP plan, either a low-income subsidy (LIS) is required, or you must be receiving some level of Arizona Long Term Care (ALTC) benefits from the state.  SNP plans have $0 costs for all services. Some include comprehensive dental, unlimited transportation and extra benefits such as Coordinated Services.

PFFS = A Medicare PFFS Plan – is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. 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.

CHRONIC PLANS =  Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. People who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia).

MSA = Medical Saving Account – Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Account Plans available outside of Medicare. You can choose your health care services and providers.

Medicare MSA Plans have 2 parts – Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.

• High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
• Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account. You can use money from this savings account to pay your health care costs before you meet the deductible.

Having served the Medicare community since 2018, I’m Independent, Local, Licensed, Certified,  Authorized to sell and contract with most of the insurance companies in Arizona. I work for my clients and NOT for the insurance companies.

You have questions – I have the answers or know where to find them! Please contact me with your questions at (928) 433-7702 Ext 1 TTY: 711 or Ginny@tstib.com

Our services are NO cost to you as the insurance companies pay us a commission. You receive the value benefits of an independent broker working for you and not an agent working for an insurance company so there is no difference in cost to you. We are here for you year a round