Medicare Advantage in Pima County, AZ

March 2021: Here are enrollment numbers for Medicare Advantage plans in Pima County, AZ.

MEDISUN AND BLUE PATHWAY are Blue Cross Blue Shield of Arizona Medicare Advantage plans.  Blue Pathway is a new plan under a new contract with Medicare.

CHA HMO is the Humana Medicare Advantage plan in Pima County.

PACIFICARE OF COLORADO is the AARP Medicare Advantage plan, which has the largest membership in Pima County.  That’s because this plan – with modifications from year-to-year – has been around for a long time.

UNITEDHEALTHCARE OF WISCONSIN is a plan that has a small premium and slightly different network than the other AARP Medicare Advantage plan.

UNITED HEALTHCARE started offering a PPO plan in 2020 and already has over 5,000 enrollments.

HEALTH NET OF ARIZONA is now owned by Centene Corporation and they moved all their members to the new HEALTH NET OF ARIZONA plan for 2021. They now call their Medicare Advantage plan ALLWELL PREMIER II.  Hard to keep track of all the name changes over the last few years.

AMERIGROUP OF OHIO is owned by Anthem and most people know their plans as CAREMORE.  Anthem moved most of the members from AMERIGROUP OF TEXAS to their AMERIGROUP OF OHIO plans.  The “new” plans have the word “PLUS” after them.

Because Anthem did not auto-move members to the “new” AMERIGROUP OF OHIO plans, they still have 5,723 people in the “old” plans – and those old plans now have very high max out-of-pocket.  This contract change was badly managed – in my opinion.

At the bottom of this list are fairly-new Medicare Advantage plans in the Pima County market. Their low enrollment numbers show how tough it is to pull people away from the long-established plans at the top of the list. For example, BANNER decided to get into the Medicare Advantage business for 2021 – but their enrollment numbers are pretty small.

HOW DO MEDICARE ADVANTAGE PLANS DIFFER?

Each Medicare Advantage plan has a different maximum out-of-pocket (MOOP), which is the most a member would pay for their medical bills in one year. MOOPs range from $2,600 to $6,700.

Certain primary care doctor groups are contracted with only 3 Advantage plans. One primary care group has always been contracted with only one Advantage plan.  If a person mentions certain primary care doctors, I can quickly tell them which Advantage plan(s) they should consider.

EXTRA BENEFITS:  Advantage plans are differentiating themselves by offering “extra benefits” like dental, glasses, hearing aids, and over-the-counter catalogues.  These extra benefits vary quite a bit from one plan to another. 

I have had clients pick one plan because of its generous dental benefits, while other clients appreciate the big over-the-counter allowance of another plan.

DRUG COVERGE

Advantage plans include Part D drug coverage. Which medications they cover, and what they charge in co-pays, can vary A LOT.  Just yesterday, I was looking at Lantus (insulin) and found that one Advantage plan does not even cover it. That really surprised me.

Some Advantage plans call certain generic drugs “brand” drugs, and those drugs will have a higher cost to the member – like $0/generic vs $40/brand for the same medication (!!)

INSULIN SAVINGS PROGRAM

Only three Medicare Advantage companies are offering insulin for a $35 co-pay – and each company can choose which insulin it will cover for $35.

The Insulin Savings Program can offer big cost savings to people who use a lot of insulin, because they pay only $35 to fill a prescription, no matter how much insulin they use. And they have no donut hole/coverage gap.

But…. most Medicare Advantage plans are not participating in the Insulin Savings Program.

If a person tells me they use insulin, I know which plans are participating in the Insulin Savings Program.

It’s complicated!

Doctor networks. Drug coverage. MOOP. Extra benefits. All of these details must be looked at when considering Medicare Advantage plans. As you can imagine, an insurance broker who represents all the plans – and who has many years of experience – can provide the best guidance to people on their Medicare choices. (And Medicare supplements should be discussed as well.)

These numbers come from the CMS website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Monthly-MA-Enrollment-by-State-County-Contract.html

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