The Good News

The good news about Medicare is that it pays for the majority (but not all) of most senior’s medical bills. Unfortunately, the not so good news is that Medicare typically does not pay for about 20%. As a result, many income-challenged seniors find accessing quality healthcare unaffordable.

Fortunately, low-income seniors do have low-cost and possibly no-cost healthcare benefit options.

Option 1: Original Medicare

Original Medicare is made up of two parts: Part A covers hospital insurance, and Part B covers medical expenses such as doctor visits, lab work and some medical equipment.

Original Medicare typically covers about 80% of Part A and Part B expenses. You are responsible for the remainder of your medical expenses including prescription.

If you select Original Medicare, you will probably want to select an additional private insurance plan to provide Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Medigap plans fill the “gaps” in hospital and medical costs that Original Medicare does not cover. Medigap offers 10 different levels of supplementary insurance in groups called Medigap A, B, C, D, F, G, K, L, M or N. Each sequential level provides higher coverage in exchange for a higher cost.

Option 2: Medicare Advantage

Medicare Advantage plans can be a low-cost, or in some cases no-cost alternative to Original Medicare. The most common are HMO and PPO Plans.

  • An HMO, or Health Maintenance Organization is a group of doctors, hospitals, and other health care providers who agree to give health care to Medicare beneficiaries for a fee that Medicare pays to them. In an HMO, you usually must get all your care from the providers that are part of the plan and you need a referral from a primary care physician to go to specialists.
  • A PPO, or Preferred Provider Organization is a managed care plan that provides you with services from doctors, hospitals and other providers that belong to a network. You have the option of receiving services from  providers outside the network at additional cost. You do not need a referral from a primary care physician to go to a specialist.

Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug Plan (MAPD).

Option 3: Medicaid

Medicaid provides low-cost and possibly no-cost healthcare insurance and is potentially available to the approximately 200,000 Arizona seniors (age 65+) who have incomes that are at or below 135% of the federal poverty level.

Read more about how Medicaid works.