Taking advantage of Medicaid Alternatives can be complicated. This page will give you a brief overview of the basics. Click on the GET MEDICAID HELP link at the bottom of the page to find out more.
Senior Health Insurance
Starts With Medicare
Regardless of your income, government provided senior health insurance starts with Medicare. The good news is that Medicare benefits pay for the majority (but not all) of most senior’s medical bills. The not so good news is that Medicare does not pay for everything. Uncovered medical expenses typically fall about about 20% short; and with those expenses frequently running into thousands and even hundreds of thousands of dollars, uncovered medical expenses can be a VERY BIG number.
Fortunately, in addition to Medicare, there are several low-cost and possibly no-cost government funded health insurance options. In Arizona, more than 100,000 very low income seniors qualify for AHCCCS Medicaid. An additional 300,000 low income seniors have just a little too much income to qualify for AHCCCS Medicaid. Fortunately, Medicare Advantage offers those individuals affordable Medicaid Alternatives.
What Medicare Covers
Original Medicare is made up of two parts. Medicare Part A covers hospital insurance. Part B covers medical expenses such as doctor visits, lab work and some personal medical equipment.
Original Medicare typically covers about 80% of Part A and Part B expenses. Patients are responsible for the remainder of their medical expenses, including prescriptions.
Seniors who select Original Medicare have the option of selecting an additional private insurance plan to cover their prescription drug expenses, or a more comprehensive Medicare Insurance Supplement plan (known as a Medigap plan) to fill in the “gaps” in their hospital and medical expenses that Original Medicare leaves uncovered.
Read more about Medicare.
Medicaid In Arizona
In Arizona, AHCCCS Medicaid helps vulnerable seniors pay for some or all of the medical expenses that are not covered by Medicare. And, when AHCCCS Medicaid can be combined with Medicare Advantage benefits, the combination provides a wide range of medical and related services at little and possibly no cost.
Medicaid qualified seniors may be able to combine AHCCCS Medicaid with Medicare Advantage coverage. These coordinated programs are referred to as Dual Special Needs plans. They provide comprehensive low-cost and possibly no-cost coverage for prescription drugs, vision and dental care, over the counter health products and equipment, meals and transportation to health care appointments.
Read more about Medicaid coverage.
Dual Special Needs
In Arizona, AHCCCS Medicaid members may be eligible for a Dual Special Needs (D-SNP) or Chronic Special Needs (C-SNP) plan. These individuals are either:
- People who live in institutions such as a nursing home or who require nursing care at home, or
- People who are eligible for both Medicare and Medicaid, or
- People who have specific chronic or disabling conditions such as diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia
D-SNP and C-SNP plans provide extensive benefits for seniors who are challenged by chronic health conditions and limited income.
Read more about D-SNP Medicare plans . . .
Despite the fact that the majority of Arizona seniors are living on limited incomes, many have just a little bit too much income to qualify for AHCCCS Medicaid. For these individuals, Medicare Advantage plans can be affordable Medicaid alternatives.
In addition to being economical, many Medicare Advantage plans combine medical coverage with additional benefits including routine vision care, hearing aids, routine dental care, prescription drugs and fitness center memberships.
Read more about Medicare Advantage.