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Frequently Asked Questions

Questions about Medicare in Arizona? We have Answers.

Medicare doesn't cover everything. If you need certain services that aren't covered under Medicare Part A or Part B, you'll have to pay for them yourself. Medicare does not cover items such as dental care, eye exams, hearing exams, and outpatient prescription drugs.

  1. You can choose Original Medicare. If you want prescription drug coverage, you must join a Medicare Prescription Drug Plan (Part D).
  2. You can choose to join a Medicare Advantage plan (like an HMO or PPO). Most Medicare Advantage plans include prescription drug coverage.

If you have limited income and resources, you may qualify for help to pay for some healthcare and prescription drug costs. If you qualify for Extra Help and join a Medicare drug plan, you'll:
  • Get help paying your Medicare drug plan's monthly premium, yearly deductible, coinsurance, and copayments
  • Have no coverage gap
  • Have no late enrollment penalty
To see if you qualify for Extra Help, call:
  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week; or
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
  • Your State Medicaid Office.

All of these plans help cover healthcare expenses not covered by Medicare. MA plans include your Original Medicare benefits and other benefits in one plan. If you join an MA plan, you will use one member ID card for your healthcare and prescription drug needs. You do not need an additional Medicare Supplement. MA plans allow you to enhance your Original Medicare coverage by selecting only those additional benefits that are important to you.

To choose, you'll need to compare the level of coverage for each and see which best fits your needs. Help is available — contact us at 1-888-288-4398, TTY:711 or call your insurance agent.

To be eligible for either a Medicare Advantage or a Medicare Supplement plan, you must have Medicare Part A and Part B and continue to pay your Part B premiums (and Part A, if applicable) unless otherwise paid for by a third party. To be eligible for a Medicare Part D plan, you must be eligible for Part A or enrolled in Part B — you do not need to have both.

An Explanation of Benefits (EOB) is a notice that we will send to you each month that you fill a prescription. It gives you a summary of your prescription claims and costs.
An EOB is not a bill. If everything included in your EOB looks accurate, you do not need to take any action. If you see something unusual or inaccurate, like claims for prescriptions you never received, you should contact us as soon as possible.

This is coverage that can help you pay for prescription drug costs that aren't covered by Original Medicare. Medicare Part D plans are offered by private companies that provide benefits for generic and brand-name prescription drugs. Medicare Part D plans can be paired with Original Medicare, a Medicare Supplement plan, and/or a Cost plan.

After you enroll, you will get a member ID card that you should use whenever you have a prescription filled. You will usually pay a monthly premium and a share of the cost of your prescriptions. Your share of the cost could be in the form of copayments or a coinsurance.

You may also have a deductible that you must meet before coverage begins. Drug plans can vary by what types of drugs are covered, how much you pay, and which pharmacies you can use. All drug plans must provide a standard level of coverage that is set by Medicare.

You can enroll in a Blue MedicareRx plan, regardless of your income or health, if you meet the following basic eligibility requirements:
  • Must have Medicare Part A and/or Part B (you do not need to have both)
  • Live in the plan's service area
  • Must be a U.S. citizen or lawfully present in the U.S.
You never have to do a health or income screening before you enroll in a Medicare Part D plan. If you are asked for either of these things before you enroll in a plan, you should report this to Medicare.

Your first chance to enroll will be during your initial enrollment period (IEP). You can also make changes to your Medicare coverage each year during the annual enrollment period (AEP), which runs from October 15 through December 7.

Knowing when you can enroll, disenroll, and make changes to your coverage is important so that you can avoid enrollment penalties and lapses in coverage.

You should still think about joining a Medicare prescription drug plan. Most people need prescription drugs to stay healthy as they age. Enrolling in a Medicare Part D plan can protect you from unexpected prescription costs if you need to start taking them. Plus, joining as soon as possible means you pay your lowest monthly premium. Delaying your Part D enrollment can result in a Part D late enrollment penalty (LEP).

This is an amount that is added to your monthly Part D premium. Starting at the end of your initial enrollment period, the Part D late enrollment penalty (LEP) is applied if you go 63 or more days in a row without creditable Part D coverage. The amount of the penalty is based on the amount of time you go without creditable coverage and must be paid for as long as you have Part D coverage.

The best way to avoid the Part D LEP is to enroll in a Part D plan when you are first eligible. If you have coverage through your employer, make sure it is considered creditable.

This is coverage that pays as much as or more than Medicare's standard prescription drug coverage. If you have prescription drug coverage through your employer, it may be creditable (contact your benefits administrator or human resources contact to find out). That means, if you decide to switch to a stand-alone prescription drug plan later, you would not have to pay the Part D late enrollment penalty (LEP). If your coverage is not creditable, you may have to pay the Part D LEP.

Generally, no. If you have coverage through your employer and enroll in a Medicare Part D or Medicare Advantage Prescription Drug (MAPD) plan, you could be disenrolled from your employer plan. You also may not be able to rejoin your employer's plan if you change your mind later.

Before you make changes to your employer plan, you should talk to your benefits administrator or human resources contact to learn the rules of your coverage.

If you know you want to drop your employer's coverage, consider how much coverage you will need and how much you want to spend. Check to see if your drugs are covered on the drug lists, or formularies, for any stand-alone Part D or MAPD plans you're considering.

Prescription drug costs can add up quickly and many people need financial assistance covering some of the costs. If you meet certain income requirements, you could be eligible for Medicare's assistance program, Extra Help.

To see if you qualify for Extra Help, contact Medicare, the Social Security Administration, or your state Medicaid office.
  • Medicare: 1-800-633-4227 (TTY: 1-877-486-2048) 24 hours a day, seven days a week
  • The Social Security Administration 1-800-772-1213 (TTY: 1-800-325-0778) 7 a.m. to 7 p.m., Monday through Friday
  • The state Medicaid office

Pharmacies in our network that offer preferred cost sharing will usually offer the lowest prices for your prescriptions. These are sometimes called preferred pharmacies. We worked with these pharmacies to get lower prices on some of the prescriptions on our drug list, or formulary.

Some pharmacies in our network offer only standard cost sharing. This means, you may pay more for some prescriptions at these pharmacies. Pharmacies that are not included in our network are out-of-network, and you would have to pay all costs for prescriptions filled at these pharmacies. Use our pharmacy locator tool to find a pharmacy near you.

When you look at our plan's drug list, sometimes called the formulary, or use our online tools, you will notice that each covered drug is on a tier. Drug tiers are levels that we use to categorize prescription drugs and lower costs. Each tier costs a different amount. Typically, drugs on tier 1 will be the least expensive and drugs on tier 5 will be the most expensive.

Each drug on our drug list is put into 1 of 5 tiers. Each tier has a different cost-sharing amount in the form of a copay or coinsurance.
  • Tier 1: Preferred generic - This tier is the lowest tier and generally contains the lowest cost generics
  • Tier 2: Generic - Contains generics
  • Tier 3: Preferred brand - Contains preferred brand drugs and non-preferred generic drugs
  • Tier 4: Non-preferred drugs - Contains non-preferred brand drugs and non-preferred generic drugs
  • Tier 5: Specialty - Contains very high-cost brand and some generic drugs, which may require special handling and/or close monitoring

You can submit a claim. For faster processing, you should fill out a claim form and send us your receipts for the purchase you want us to repay you for. You can submit a claim without using the claim form, but it may take us longer to process your claim.
You can get the claim form and more information online. You can also read Chapter 5 in your Evidence of Coverage to learn more about situations when you should ask us to pay our share of your prescription costs.

An Explanation of Benefits (EOB) is a notice that we will send to you each month that you fill a prescription. It gives you a summary of your prescription claims and costs.
An EOB is not a bill. If everything included in your EOB looks accurate, you do not need to take any action. If you see something unusual or inaccurate, like claims for prescriptions you never received, you should contact us as soon as possible.
Blue Cross® Blue Shield® of Arizona (BCBSAZ) is contracted with Medicare to offer HMO and PPO Medicare Advantage plans and PDP plans. Enrollment in BCBSAZ plans depends on contract renewal.

BCBSAZ offers BluePathway HMO and BlueJourney PPO Medicare Advantage plans. BCBSAZ Advantage, a separate but wholly owned subsidiary of BCBSAZ, offers Blue Medicare Advantage Standard, Classic, and Plus HMO plans.

You are eligible to enroll in a BCBSAZ Medicare Supplement plan if you are age 65 or older, entitled to Medicare Part A, and enrolled in Medicare Part B, and you live in the plan service area. You must continue to pay your Medicare Part B premiums (and Part A, if applicable), if not otherwise paid for by Medicaid or another third party. During the first six months when you are age 65 and also enrolled in Medicare Parts A & B you cannot be denied a Medicare Supplement plan when you apply for one, regardless of health status.

Health Choice Pathway HMO D-SNP is a Health Plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Health Choice Pathway HMO D-SNP depends on contract renewal. Health Choice Pathway Member Services can be reached at 1-800-656-8991, TTY: 711, 8 a.m. to 8 p.m., 7 days a week.

Blue Cross Blue Shield of Arizona (BCBSAZ) and Health Choice Arizona (HCA) comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We provide free aids and services to people with disabilities to communicate effectively with us, such as qualified interpreters and written information in other formats such as large print and accessible electronic formats. We also provide free language services to people whose primary language is not English, such as qualified interpreters and written information in other languages. If you need these services call 1-800-446-8331 (TTY: 711) for BCBSAZ Medicare Advantage or 1-833-229-3593 (TTY: 711) for BCBSAZ Blue MedicareRx (PDP) or 1-800-656-8991 (TTY: 711) for HCA.

Member Services can be reached at 480-937-0409 (in Arizona) or at our toll-free phone number at 1-800-446-8331 (TTY users should call 711). Hours are 8 a.m. to 8 p.m., Monday through Friday from April 1 to September 30; and 7 days a week from October 1 to March 31. Member Services also has free language interpreter services available for non-English speakers.

Birdi, Inc. Part D Services is an independent company providing prescription mail order services.

Spanish (BCBSAZ): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-446-8331 (TTY: 711).

Navajo (BCBSAZ): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-446-8331 (TTY: 711).

Spanish (HCA): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-656-8991 (TTY: 711).

Navajo (HCA): Díí baa akó nínízin: Díí saad bee yάnílti’ go Diné Bizaad, saad bee άkά’ άnída’ άwo’ dę͗ę͗, t’άά jiik’eh, éí nά hóló̖, kojí̖ hódíílnih 1-800-656-8991 (TTY: 711).

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Last Updated 11/1/2022