If you live in Pima County, Arizona—whether in Tucson, Green Valley, Oro Valley, or other surrounding areas, you have access to some excellent Medicare Advantage plans tailored to your needs. From prescription drug coverage to flexible healthcare options, these plans are designed to meet the unique demands of our community.
Let’s explore everything you need to know about Medicare Advantage in Pima County for 2025, including local zip codes and resources to help you navigate your options.
Overview of Medicare Advantage in Pima County
Medicare Advantage plans in Pima County combine hospital, medical, and often prescription drug coverage into one convenient plan. Here’s a quick breakdown:
- Total Companies Offering Plans: 5
- Total Plans Available: 30
- Plan Type Breakdown:
- Plans with prescription drug coverage (MA-PD): 65%
- Special Needs Plans (SNP): 20%
- Flexible HMO-POS plans: 15%
Whether you’re in zip code 85705 (central Tucson), 85739 (Oro Valley), or 85614 (Green Valley), there are plans designed with your specific needs in mind.
Types of Medicare Advantage Plans
In Pima County, you can choose from several plan types, depending on your healthcare needs and budget.
Health Maintenance Organization (HMO)
- Requires you to stay within a network of local doctors and hospitals.
- Referrals are necessary for specialists.
- Offers lower premiums and out-of-pocket costs.
With Tucson’s extensive healthcare network, including facilities in zip codes like 85712 (near Banner – University Medical Center Tucson), HMOs can be an affordable and convenient option.
Preferred Provider Organization (PPO)
- Allows visits to out-of-network providers for a higher cost.
- No referrals needed for specialists.
If you split your time between Pima County and other parts of Arizona or travel frequently, PPOs offer the flexibility you need.
Special Needs Plans (SNP)
- Designed for individuals with chronic conditions, Medicaid eligibility, or those residing in nursing homes.
- Provides coordinated and specialized care.
These plans are especially helpful for residents in areas like South Tucson (zip code 85713) who need extra healthcare support.
HMO-POS (Point-of-Service)
- Combines the cost-effectiveness of an HMO with the flexibility of a PPO.
- Ideal for those who want out-of-network options while keeping costs manageable.
Costs and Maximum Out-of-Pocket Limits
One key benefit of Medicare Advantage plans is the annual maximum out-of-pocket (MOOP) limit, which protects you from excessive medical expenses. Here’s how plans in Pima County are structured:
- $0–$3,000: 10% of plans
- $3,001–$4,500: 35% of plans
- $4,501–$6,000: 40% of plans
- $6,001–$9,350: 15% of plans
Residents in areas like Green Valley (85622) often prefer plans with lower MOOP values, while those with occasional healthcare needs may opt for higher limits to save on premiums.
Top Insurance Providers in Pima County
Several trusted insurance companies offer Medicare Advantage plans in Arizona.
- Budget-friendly plans for those who prefer in-network providers.
- Flexible options for frequent travelers or snowbirds.
- Plans specifically designed for individuals managing chronic conditions or dual eligibility.
Local Tips for Enrolling in Medicare Advantage Plans
If you’re ready to enroll in a Medicare Advantage plan, here are some practical steps:
Work with a Local Insurance Agent
Since 1996, Medicare Health Benefits has been serving the Tucson community. Our licensed agents have deep knowledge of local plans and providers, making us a long time, trusted resource for Pima County residents. Call (520) 760-6223 or visit their office at 123 W. Camino Real, Tucson, AZ 85704, for personalized guidance.
Visit Your Local Social Security Office
For assistance with Medicare enrollment or questions about eligibility, you can visit a Social Security office near you:
- Tucson Social Security Office
Address: 3500 N Campbell Ave, Tucson, AZ 85719
Phone: 1-800-772-1213
Residents in Oro Valley or Marana may also find this location convenient.
Enroll Online
Explore Medicare Advantage plans in your area by visiting Medicare.gov. Enter your zip code to compare plans and find the one that suits your needs.
Ask Around
In retirement-friendly communities like Green Valley (85614), many residents have experience with Medicare Advantage plans. Ask your neighbors or local groups for recommendations—they’re often a wealth of knowledge.
Common Questions About Medicare Advantage in Pima County
What Are the Copayments for Doctor Visits?
Copayments depend on the plan. Many HMOs in central Tucson (85716) feature low or no copays for primary care visits.
Do Plans Include Dental or Vision Coverage?
Yes! Many plans in Pima County include additional benefits like dental, vision, and hearing coverage, which are popular among retirees in areas like Oro Valley (85737).
Can I Switch Plans Later?
You can make changes during the Annual Enrollment Period (AEP) or if you qualify for a Special Enrollment Period (SEP). For example, moving to a new county may allow you to update your plan if it’s not already available in the county you’re moving to.
Why Choose Medicare Advantage in Pima County?
Medicare Advantage plans in Pima County provide an excellent mix of affordability, flexibility, and comprehensive coverage. Whether you’re relaxing in the scenic foothills of Oro Valley, enjoying the vibrant culture of downtown Tucson, or retiring in Green Valley, there’s a plan to meet your needs.
For personalized guidance, contact Medicare Health Benefits, a trusted local resource since 1996. Their team is dedicated to helping you find the right plan for your lifestyle and budget. Call (520) 760-6223 or visit their office to get started.
