Identifying your best senior health insurance options can be complicated. This page will give you a brief overview of the basics. Click on the GET 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 expenses typically fall about 20% short. With uncovered expenses frequently running into thousands and even hundreds of thousands of dollars, medical expenses not covered by Medicare can be a VERY BIG number.
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, they can select 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.
AHCCCS Medicaid Options
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.
These combined AHCCCS Medicaid and Medicare Advantage 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 Plans
AHCCCS Medicaid qualified seniors may be eligible to combine AHCCCS Medicaid with Medicare Advantage coverage. These coordinated programs are referred to as Special Needs Plans. These plans limit membership to people with specific diseases/characteristics.
Chronic Special Needs Plans are a category of D-SNP plans that serve people who have chronic conditions such as cancer, cardiovascular disorders, chronic heart failure, diabetes and a number of other chronic conditions.
Institutional Special Needs Plans are available to individuals who live in an institution such as a nursing home, or require care in their own home.
Dual Eligible Special Needs Plans are available to individuals who have both Medicare and Medicaid.
Special Needs Plans provide a wide range of medical and related services at little and possibly no cost. Many include 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 Dual Special Needs Plans . . .
Arizona Long Term Care
Arizona Long Term Care (ALTCS) is the AHCCCS Medicaid senior health insurance program that provides low and no cost long term care for financially and medically eligible residents who are aged, blind, disabled or have a developmental disability.
ALTCS offers a complete array of acute medical, skilled nursing, assisted living, home health, behavioral health services, home and community based services, and case management services to all eligible persons.
The application process includes requirements for residency, age, disability, citizenship status and medical eligibility requirements.
Read more about ALTCS Medicaid 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 can be an affordable alternative.
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 alternatives . . .