Arizona Medicare Stats

• More than 1.4 million Arizona residents are enrolled in Medicare as of 2025
• About 47% of AZ Medicare beneficiaries are enrolled in Medicare Advantage plans
• About 185,000 Arizona residents have Medigap (Medicare Supplement) plans
• The most popular Medigap plan in Arizona is Plan G

Medicare is a government-run health insurance program that mainly serves people who are 65 or older. Though it also covers younger people with qualifying disabilities or specific medical conditions. 

If you’re caring for a family member who’s approaching their 65th birthday, it’s important to know that they must sign up for Medicare during a specific window known as the Initial Enrollment Period (IEP). This seven-month period starts three months before the month they turn 65 and ends three months after that month. Missing this window means waiting until the next General Enrollment Period (GEP), which runs from January 1 to March 31 each year. It can also lead to costly penalties. We’ll explain those details a bit later in this article.

Medicare also requires that the applicant is a U.S. citizen, or a lawful permanent resident who has lived in the U.S. continuously for at least five years prior to applying.

How to Apply for Medicare in Arizona

Depending on the enrollee’s situation, the Medicare enrollment process is either automatic or manual.

Automatic Medicare Enrollment: What to Expect

If you care for someone who has been receiving Social Security retirement benefits for at least four months before turning 65, they’ll be automatically signed up for both Medicare Part A (hospital insurance) and Part B (medical insurance) when they reach their 65th birthday. In this case, there’s no need to take any action. Medicare will mail a welcome package and their new Medicare card about three months before coverage begins. Or they may receive their card during the 25th month of their Social Security Disability Insurance (SSDI) benefits.

For those who haven’t started Social Security benefits at least four months before turning 65, enrolling in Medicare isn’t automatic. They’ll need to actively apply during their Initial Enrollment Period, (IEP).

If your loved one is still working at 65 and has health coverage through their employer or their spouse’s employer, they may be able to delay Medicare enrollment without penalty. When they eventually retire or lose employer coverage, they can sign up for Medicare during a Special Enrollment Period, avoiding late fees.

Manual Medicare Enrollment: What to Expect

Enrolling in Medicare manually is a straightforward process. Here’s a clear breakdown to guide you through each step:

1. Gather the necessary documents
   
   • proof of your name
   • Proof of date of birth
   • Social Security number
   • Evidence of U.S. citizenship or lawful residency

2. Decide how you want to apply. 
   
   • Apply online at the Social Security Administration’s website
   • Call 1-800-772-1213 (TTY: 1-800-325-0778)
   • Visit your local Social Security office in person

3. Choose the Medicare coverage that fits your needs (details will follow).
   
   • Original Medicare (Part A and Part B)
   • A Medicare Advantage plan (Part C)
   • Optional prescription drug coverage (Part D) 
   • Optional Medicare Supplement (Medigap) policy 

4. Submit your application along with any required documentation.

5. After applying, review the enrollment confirmation that Social Security sends you. 

Once approved, a Medicare card should arrive by mail within 2–4 weeks, though the full approval process can take up to 6–8 weeks in some cases.

Important Note for all Medicare Enrollees

If the person you care for has employer-sponsored health coverage that includes a Health Savings Account (HSA), once they enroll in any part of Medicare, they can no longer contribute to their HSA. Many people with HSAs choose to delay both Part A and Part B to keep making HSA contributions while they’re still working and covered by their employer’s plan.

Late Enrollment Penalties

Let’s say the person you care for doesn't sign up for Medicare during the IEP, and they don't qualify for a Special Enrollment Period (SEP). What happens? They may have to pay late enrollment penalties when they eventually enroll. And the fines get higher the longer they wait. Some fines  will be charged monthly for as long as they’re covered. So whatever you do, don’t let them miss the IEP. 

The Many Parts of Medicare, Explained

For a lot of people choosing from the many Medicare coverage options can be one of the most overwhelming challenges of enrolling in Medicare. Generally, there are two options: Original Medicare (Parts A and B) and Medicare Advantage (Part C). In Arizona, a little over half of Medicare enrollees choose Original Medicare over Medicare Advantage. Nationwide, it’s pretty evenly split. 

Let’s break down both options.

Original Medicare

If the person you care for chooses Original Medicare, they’ll pay for services as they receive them. That’s why sometimes you hear people call it Fee For Service Medicare. Your loved one would pay a deductible and usually a 20% coinsurance for Medicare-approved services. About 99% of all healthcare providers accept Medicare. And your loved one can choose to see any of them without needing a referral. 

Original Medicare is divided into two main parts, Part A and Part B. Each part covers different types of health care expenses. 

Your loved one can also purchase prescription drug coverage (Part D). And they can buy supplemental coverage (a Medigap policy, Parts F-N) that covers many of the costs that Medicare Parts A and B don’t. 

Medicare Part A (Hospital Insurance) 

What Part A covers:

• inpatient hospital costs 
• care provided in skilled nursing facilities 
• hospice care 
• home health care required after discharge from a hospital or skilled nursing facility

Note: There is no out-of-pocket maximum for Part A. So the amount your loved one could spend on these types of healthcare costs is unlimited.

Medicare Part B (Medical Insurance)

What Part B covers:

• certain doctors' services 
• outpatient care 
• durable medical equipment 
• preventive services 
• home health services for enrollees who meet eligibility criteria* 

Note: Part B also has no out-of-pocket maximum.

*To learn if the person you care for qualifies for home health services covered by Medicare, and if you qualify to get trained, certified, and hired as a paid member of their home health team, take the RubyWell quiz.

Medicare Part D (Prescription Drug Coverage)

What Part D covers: 

• a portion of the cost of prescription drugs 
• many recommended vaccines

Medicare Plans F, G, and K-N (Medicare Supplement Insurance or Medigap)

What Medigap Plans cover:

• your loved one’s share of out-of-pocket costs in Original Medicare, including
  
  • deductibles 
  • coinsurance

The different Medigap plan letters refer to different levels or amounts of coverage. Medigap plans can “underwrite.” That means if your loved one has pre-existing health conditions, the plan can charge them more. The only time Medigap plans can’t underwrite is when the enrollee first becomes eligible to apply for Medicare (during the IEP). 

Medicare Advantage (Medicare Part C)

These Medicare-approved plans are offered by private companies. They must include all of the Part A and Part B benefits. Many usually include Part D coverage as well as many “supplemental benefits” that aren’t covered by Original Medicare. These can include:

• vision
• hearing
• dental
• gym memberships
• prepaid Over-the-counter debit cards
• and more

Medicare Advantage (MA) plans can’t “underwrite.” So pre-existing health conditions aren’t considered when determining cost. 

Most MA plans operate like an HMO or PPO. When your loved one chooses from a network of approved health care providers, they receive the maximum benefit amount. And if they need to see a specialist, they’ll need a referral from their primary care physician in order for the visit to be covered. 

With an MA PPO, they can see a provider outside the network, but they’ll pay a higher copay. And in many cases, they won’t need a referral or prior authorization to see a specialist. 

If the person you care for chooses an MA plan, they cannot add a Medigap plan to their coverage. 

Which Arizonans are Eligible for Medicare?

Since Medicare is a federal program, eligibility rules are the same in Arizona as for every state:

• The person you care for must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 consecutive years. 
• They must meet age, disability, or medical condition requirements.

Age Requirement

Arizonans who are at least 65 years old are eligible for Medicare.

Disability Requirement

Some Arizonans may qualify for Medicare before they turn 65. They must have received Social Security Disability Insurance (SSDI) payments or Railroad Retirement Board disability benefits for at least 24 months.

Medical Condition Requirement 

Arizonans can qualify for Medicare before age 65 if they have been diagnosed with either of these diseases:

• End-Stage Renal Disease (ESRD)
• Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, 

What Does Medicare Cost in AZ?

Medicate reviews and updates their premium and deductible costs for Medicare every year. You can find the most current information on the Medicare costs page at Medicare.gov.

Part A Medicare Costs

Monthly Premium

Good news: The Part A monthly premium is $0 if your loved one or their spouse paid Medicare taxes while working for a certain period. And free is good! 

If they aren’t eligible for this premium-free Part A, they can purchase Part A for a monthly premium that can range from $278 to $505 (in 2025). The cost depends on how long they or their spouse worked and paid Medicare taxes.

Deductible

The Part A deductible is $1,676 per benefit period in 2025.

What is a benefit period? It begins the day your loved one is admitted to a hospital or skilled nursing facility. And it continues throughout their stay, and includes any subsequent stays as long as they don’t go more than 60 consecutive days without inpatient care.

Coinsurance

Your loved one will also have to pay any coinsurance related to their hospital or skilled nursing care.

Part B Medicare Costs

Monthly Premium

Everyone pays a monthly premium for Part B. In 2025, that premium is $185.

Deductible

The annual deductible in 2025 is $257. 

Coinsurance

After they meet their deductible, the person you care for will be responsible for 20% coinsurance payments for any Part B services they receive. 

Part D Medicare Costs

Monthly Premium

Every Medicare Prescription Drug plan (Part D) charges a monthly premium. The premiums vary. In 2024, they averaged approximately $55.50.

Deductible

Also varying by plan, Part D plan deductibles were no more than $545/year in 2024.

Recent Protection

As of January 1, 2025, Medicare beneficiaries don’t pay more than $2,000 for prescription drugs during a given plan year. We all can thank the 2022 Inflation Reduction Act for that.

Medigap (Parts F-N) Costs

Monthly Premium

Private insurance companies sell Medigap policies with costs that vary widely based on coverage and insurance provider. In 2023, the average monthly premium for Medigap policies was $186.49. It’s wise to speak with several insurance providers in your area to understand pricing options available. 

Medicare Advantage (Part C) Costs

Monthly Premium

If the person you care for chooses a MA plan, they’ll still pay the Medicare Part B premium ($185/month). And if they don’t qualify for premium-free Part A, they’ll have to pay for Part A, too ($278 to $505).

Additionally, they may have to pay a Part C monthly premium, depending on the MA plan. Premium amounts can vary widely since MA plans are offered by private insurance companies and may provide different supplemental benefits. The average monthly plan premium for all MA plans was $18.50 in 2024.  Some Medicare Advantage plans started offering reductions in the Medicare Part B premium in 2025.

Does Medicare Pay Family Caregivers in AZ?

Medicare does not pay family caregivers in any state. However, RubyWell is helping family caregivers in Arizona get trained and certified as home health aides. So they can be hired by one of our home health agency partners to provide medically necessary home health services for their loved one on Medicare.

RubyWell works like this in Arizona:

1. RubyWell can review your loved one’s health information to predict if they meet criteria for covered home health services. 
2. RubyWell guides you through the process of requesting a home health referral order from your loved one’s doctor. 
3. RubyWell helps you get trained and certified as a home health aide. Training includes 59 hours of online coursework and 16 hours of hands-on training to meet Medicare certification requirements. 
4. Meanwhile, RubyWell refers you and the person you care for to one of our Home Health Agency partners near you. The agency develops the care plan for your loved one and interviews you for a home health aide position. 
5. Once you earn your certification, the agency can hire you to provide the covered home health services for your loved one, under the supervision of a skilled nurse. 

Take this short quiz to see if you and the person you care for are eligible for the RubyWell program.

Advice from a Medicare Expert

Still feeling overwhelmed by all of the Medicare choices? You’re not alone. Luckily there are professionals who can help people sort through all the options. One of them is Gustavius Smith. He’s CEO of Rxcare.ai, a technology company that’s simplifying Medicare for beneficiaries and brokers.

He says, “Choose the plan that’s right for you.” His best advice for selecting Medicare coverage? “Start by asking a friend for the name of a trusted Medicare broker. However, this should be the last time you rely on friends, relatives, or acquaintances for Medicare advice.”

Alternatively, Smith suggests attending a Medicare educational seminar hosted by a licensed broker in your area. There you should receive unbiased information. And you can ask questions in a no-pressure setting. You can confirm what you learn in the seminar with the Medicare & You handbook provided by CMS.

“Then, create a Medicare.gov account and schedule a one-on-one session—either in person or online—with the broker you met at the seminar,” adds Smith. “This broker will guide you in selecting the best Medicare coverage for your needs. And they won’t charge you for this service.”

Arizona Resources for Make Medicare Enrollment 

Arizonans have access to the State Health Insurance Assistance Program (SHIP) This is a free service that offers one-on-one counseling to help those who are eligible for Medicare, their families, and caregivers understand the Medicare enrollment process. SHIP counselors provide unbiased advice, help compare plans, and assist with applications and paperwork. You can reach Arizona SHIP at 800-432-4040 for personalized assistance.

The Northern Arizona Council of Governments (NACOG) and regional Area Agencies on Aging also offer free Medicare benefits counseling and support. These resources are designed to help you make informed decisions and navigate the complexities of Medicare enrollment.

Frequently Asked Questions About Medicare in AZ

How does Medicare work?

Like other health insurance, Medicare covers a percentage of certain healthcare expenses. What’s covered, and how much coverage is provided, varies based on which Medicare coverage you choose. 

What is Medigap?

Medigap is another name for Medicare Supplement Insurance. This is insurance you can buy from a private health insurance provider to help cover out-of-pocket costs that Original Medicare Part A and Part B don’t cover, such as: 

• copayments 
• coinsurance 
• and deductibles 

All Medigap policies in each lettered plan (Plans F, G, and K-N) offer the same basic benefits. For example: all Medigap Plan G policies offer the same basic benefits no matter what state they’re offered in, but their cost may vary by insurance provider.

How do I purchase a Medicare Supplement (Medigap)?

1. Choose a plan: ‍
   
   • Compare the benefits of each lettered plan and choose one that meets your needs (current and future).

2. Research insurance providers:
   
   • Find insurance companies in AZ that sell the plan you’re interested in.
   • Check with the Arizona Department of Insurance and Financial Institutions (DIFI) Consumer Affairs Division for any complaints against the companies:
     
     • Phone: (602) 364-2499 or (800) 325-2548 (outside Phoenix)
     • Email: consumers@azinsurance.gov
   • Get free, unbiased help: ‍
     
     • State Health Insurance Assistance Program (SHIP)
     • The Northern Arizona Council of Governments (NACOG) 
     • Regional Area Agencies on Aging for free, unbiased help.

3. Compare prices: 
   
   • Since the benefits are the same across each lettered plan, the main difference between companies offering the same lettered plan is price. So ask for quotes from several companies. Price differences can vary based on:
     
     • discounts for non-smokers, married individuals, or automatic payment 
     • medical underwriting
     • perks like gym membership discounts
     • agent commissions
     • insurance company pricing strategy
     • and more

4. Take your health into account: If you have a chronic condition, consider a plan that offers more coverage.

5. Understand coverage details: 
   
   • Ask exactly what the policy covers and find out if there are any limitations.

Can I save money on Medicare costs?

Medicare Advantage

Choosing a Medicare Advantage plan and staying in-network could save money compared to Original Medicare. While you still pay the Part B premium, many MA plans offer $0 additional premiums. And they may include vision, dental, and hearing coverage. Compared to Original Medicare, MA plans tend to have lower expected out-of-pocket costs.

Medicare Savings Programs

Arizona offers Medicare Savings Programs that can help people with lower-incomes afford Medicare premiums, deductibles, and copayments.

• The Qualified Medicare Beneficiary (QMB) Program helps pay for Part A and B premiums, deductibles, coinsurance, and copayments. In 2024, the monthly income limit was $1,275 for individuals and $1,724 for married couples.
• The Specified Low-Income Medicare Beneficiary (SLMB) Program helps pay for Part B premiums. The 2024 monthly income limit is $1,526 for individuals and $2,064 for married couples.
• The Qualifying Individual (QI) Program helps pay Part B premiums. The income limits are slightly higher than SLMB.

You may qualify if your income is above the limits because some states have different limits or don't count certain types of income.

There are several ways to apply for these programs.

• Submit your application electronically via the Health-e-Arizona Plus website.
• Download and complete the application form, then mail it to:

AHCCCS Medical Assistance Specialty Programs (MA-SP)
801 E Jefferson St
Phoenix, AZ 85034

• Fax your completed application to (602) 258-4619.
• Call if you need help or have questions:
  
  • (602) 417-5010 (for area codes 480, 602, or 623)
  • 1-800-528-0142 (for area codes 520, 760, or 928)
    

How do I contact Medicare in AZ?

Call Medicare Directly at 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week, except for some federal holidays. TTY: 1-877-486-2048 for assistance.

Visit medicare.gov for information or to chat online with a representative.

How do I protect the person I care for from Medicare fraud?

Regularly review their Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs) statements to confirm they actually received each service. Make sure all the details are accurate, including the doctors’ names, care facilities, and dates of service. Look for suspicious charges or services that don’t look familiar. 

Treat their Medicare card like a credit card. Only give their Medicare number to trusted healthcare providers. Be wary of unsolicited calls or visits offering free medical services or equipment.

Learn what Medicare plans can and cannot do before joining a plan.

Stay updated on Medicare-related scams. Report suspicious activity. 

• If you suspect fraud, call 1-800-MEDICARE (1-800-633-4227). 
• For issues related to Medicare Advantage or drug plans, contact the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379). 
• The Center for Medicare and Medicaid services (CMS) suggests working with Senior Medicare Patrol (SMP) to help report suspected fraud. 

Are there any other government benefits that my loved one may be eligible for?

Currently, there are many federal and state programs that offer benefits to aging adults and their family caregivers in Arizona. Each has its own eligibility requirements. Read this article to learn about the 6 Most Overlooked Government Benefits for Seniors. And stop by the Arizona Governor’s Office on Aging website and the Arizona Department of Economic Security, Division of Aging and Adult Services to find local resources. 

We hope the information here helps you navigate your financial journey through caregiving. If you know other family caregivers in AZ, share the link to this article with them.

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