Pima County Medicare Advantage Plans

In this article...
  • For Pima County seniors, Medicare Advantage plans offer an alternative to Original Medicare. Learn about the costs and coverage available through Part C plans.

For Pima County’s 118,783 Medicare beneficiaries, Medicare Advantage plans offer an alternative to Original Medicare. Currently, 39 MA plans are available in Pima, and coverage is provided through Medicare-approved private companies, following rules set by Medicare. MA plans, which are also referred to as Medicare Part C, may offer additional benefits that aren't available through Original Medicare.

Some Medicare Part C plans include coverage for prescription medications. Known as Medicare Advantage Prescription Drug plans, or MAPDs, these plans offer comprehensive coverage for seniors who want to minimize their out-of-pocket costs. 

Learn more about Medicare Advantage plans in Pima County, Arizona, including average costs, out-of-pocket expenses and what’s involved in obtaining prescription drug coverage.

Average Cost of Medicare Advantage Plans in Pima County

On average, Pima County Medicare Advantage enrollees paid a monthly premium of $12.21 per month in 2021. The in-network out-of-pocket spending maximum averaged $4,415.33, which is the amount beneficiaries are required to pay annually for in-network services before their plan covers 100% of care. The spending maximum includes out-of-pocket expenses such as the $121.56 average annual drug deductible, which applies to Medicare Advantage Prescription Drug plans in Pima. For beneficiaries concerned about the quality of the county's MA plans, Medicare rated 34% of plans four stars or higher.

Learn More About Medicare Advantage Prescription Drug Plans

Pima County Medicare beneficiaries who are interested in a Part C policy may choose among the following types of plans, depending on their needs and circumstances:

  • HMO: HMO enrollees typically receive services through in-network providers and must obtain referrals for visits to specialists. However, most plans permit out-of-network care in emergencies or for out-of-area dialysis. HMO plans often include prescription drug coverage.
  • PPO: Members of PPO plans can typically go in or out of network for care, including hospitalization, although visits to non-network providers may cost considerably more. Referrals are usually not needed for visits to specialists, and many PPO plans include prescription drug coverage.
  • PFFS: Private fee-for-service plans determine how much a doctor or facility will be paid for services, and members may seek care from any in- or out-of-network provider that agrees to the plan’s terms. Some PFFS plans include prescription drug coverage. Otherwise, members may seek coverage for medications through standalone Medicare drug plans, which are also known as Part D plans.
  • SNP: Special Needs Plans are designed for individuals with specific conditions or medical characteristics. Benefits such as providers and drug formularies are tailored to members’ unique needs, and most care is provided by in-network physicians and facilities. SNPs are required to provide prescription drug coverage.

In addition to these primary types of plans, some members may be eligible for standalone prescription drug plans. Otherwise known as a PDP or Part D plan, a standalone prescription drug plan adds coverage for prescription medications to Original Medicare and some PFFS plans. It’s important to note that some MA plans, such as HMOs, may disenroll members who sign up for a separate drug plan.