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Medicare Advantage plans are offered by private insurance companies that contract with Medicare. You still pay your Part B premium, but the plan replaces Original Medicare as the way your claims are paid. Most plans in the Tucson area include Part D drug coverage.
Every Advantage plan has a yearly maximum out-of-pocket limit for covered medical services. Once you reach it, the plan pays 100% of covered care for the rest of the year. Many plans also include routine dental cleanings, eyewear allowances, hearing aids, gym memberships and over-the-counter allowances.
The trade-off is networks. HMO plans usually require you to use in-network doctors and get referrals, while PPO plans let you go out of network for a higher cost. Before we recommend a plan, we check that your doctors, your hospital (Banner, TMC or Northwest) and your prescriptions are covered.
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What is included
The coverage you can expect. Exact benefits depend on the plan and the insurance company you choose.
Everything in Parts A and B
Hospital, doctor, lab, imaging and preventive care, with copays instead of 20% coinsurance on many services.
Prescription drugs
Most plans include Part D coverage with a formulary and preferred pharmacies.
Routine dental
Cleanings and exams, with some plans adding fillings, crowns or dentures up to an annual limit.
Vision and hearing
Eye exams, an eyewear allowance and hearing aid benefits through plan vendors.
Everyday extras
Quarterly over-the-counter allowances, fitness memberships and rides to medical appointments on select plans.
Yearly spending limit
A maximum out-of-pocket amount for covered medical care, so a bad year has a ceiling.
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How we help you choose
Map your care
We list your doctors, specialists, hospital preferences and every prescription with the dose.
Search local plans
We compare the plans we represent in your ZIP on network, drug costs, copays and extras.
Enroll and follow up
We submit your application, confirm your ID card arrives, and check in before your first appointment.
Why people choose it
Low or $0 monthly plan premiums in many Pima County ZIP codes
A yearly out-of-pocket maximum for medical care
Dental, vision and hearing extras in one plan
One card and one customer service number
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Costs, and what moves them
Sample figures to help you plan. Your advisor confirms the exact amounts for your age, ZIP code and plan.
Sample costs for Medicare Advantage. Illustrative only, not a quote.
Cost
Sample amount
Good to know
Plan premium
$0 - $89 / month
Sample range for Tucson-area plans
Primary care copay
$0 - $10
Varies by plan and network
Specialist copay
$15 - $45
Referral may be needed on HMO plans
Max out-of-pocket (in network)
$3,400 - $8,300
Sample range, medical services
Factors that change your price
Whether your doctors and hospital are in the plan network
The tier and pharmacy pricing of your prescriptions
HMO versus PPO flexibility
How often you travel outside Arizona
Figures are illustrative samples and not a quote. Medicare amounts change every January.
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Medicare Advantage questions we hear
Yes. You keep paying the Part B premium to Medicare, and some plans add their own monthly premium on top. A few plans include a Part B giveback that reduces what you pay.
Plans must notify you, and you can usually choose a new in-network doctor. In some cases you qualify for a Special Enrollment Period. Call us and we will review your options.
Yes, during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Buying a Medigap plan later may require health questions, so we plan ahead with you.
They are included in the plan design, but most have limits, such as a set dental maximum or an eyewear allowance. We show you the exact amounts in the Evidence of Coverage before you enroll.
Emergency and urgent care are covered nationwide. Routine care outside the service area is limited on HMO plans, so frequent travelers often prefer a PPO or Original Medicare with Medigap.
