How Medicare Advantage works
Medicare Advantage, also called Part C, is a way to get your Medicare benefits through a private insurance company that contracts with Medicare. The plan covers everything Part A and Part B cover, such as hospital stays, doctor visits, outpatient care and tests, and most plans also include Part D prescription drug coverage.
When you join a Medicare Advantage plan you are still in Medicare. You keep paying your Part B premium (the standard amount is $202.90 a month in 2026), and the plan may charge its own premium as well. Instead of Original Medicare paying your doctors, the plan pays them, and the plan's rules decide which doctors you can see, whether you need referrals or approval before some services, and what you pay for each service.
To join, you need Part A and Part B and you must live in the plan's service area. In Arizona, service areas are set county by county, so the plans open to someone in Phoenix are not the same as the plans open to someone in Show Low or Safford.
HMO vs. PPO plans
Most Medicare Advantage plans in Arizona are HMOs or PPOs. The difference is mainly how strictly they keep you inside their network.
| Plan type | Network | Referrals | Out-of-network care |
|---|---|---|---|
| HMO | You use the plan's doctors, hospitals and other providers. | Usually needed to see a specialist. | Generally not covered, except emergencies, urgent care and out-of-area dialysis. |
| PPO | The plan has a network, and you pay less when you use it. | Usually not needed. | Covered, usually at a higher cost, if the provider agrees to treat you. |
| Other types | Private Fee-for-Service plans and Medical Savings Account plans work differently and are less common. | Depends on the plan. | Depends on the plan. |
A PPO has two out-of-pocket limits: one for in-network care and a higher combined limit for in-network and out-of-network care together (up to $13,900 in 2026).
Networks in metro and rural Arizona
Because Medicare Advantage plans depend on local networks, the number of plans tracks where Arizona's doctors and hospitals are. The Phoenix area (Maricopa and Pinal counties) and the Tucson area (Pima County) have the most choices. Rural counties in the north and east have far fewer, and in those areas the closest in-network hospital or specialist may be a long drive away.
| County | Plans open to everyone | Special needs plans | Companies |
|---|---|---|---|
| Maricopa | 52 | 40 | 16 |
| Pima | 52 | 36 | 15 |
| Pinal | 47 | 24 | 14 |
| Yavapai | 20 | 11 | 6 |
| Yuma | 17 | 11 | 6 |
| Mohave | 12 | 5 | 5 |
| Coconino | 13 | 11 | 7 |
| Navajo | 8 | 8 | 6 |
| Greenlee | 8 | 7 | 5 |
| Apache | 7 | 5 | 5 |
Source: CMS 2027 Medicare Advantage Landscape file. Every county is listed on our Arizona counties page, with how plans changed from 2026.
Tip: Before you join, check that your own doctors, the hospital you would use and your pharmacy are in the plan's network for the coming year. Networks can change, and a plan sold in your county may still have few providers near your town. If you get care at an Indian Health Service, tribal or urban Indian facility, see how IHS works with Medicare.
Special needs plans
Special needs plans (SNPs) are Medicare Advantage plans limited to people with particular needs. They include Part D drug coverage, and their doctors, benefits and drug lists are built around the group they serve. For 2027, CMS lists 57 special needs plans in Arizona. There are three kinds:
D-SNP (dual eligible)
For people who have both Medicare and AHCCCS (Arizona's Medicaid program). See AHCCCS and Medicare.
C-SNP (chronic condition)
For people with certain serious or disabling chronic conditions, such as diabetes, chronic heart failure or end-stage renal disease. A doctor usually has to confirm the condition.
I-SNP (institutional)
For people who live, or are expected to live, 90 days or longer in a nursing home or similar facility, or who need that level of care at home.
Costs and the out-of-pocket limit
What you pay in a Medicare Advantage plan depends on the plan: its premium (if any), deductibles, and the copayments or coinsurance it charges for each service. Each plan's Summary of Benefits shows these costs.
Unlike Original Medicare, every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. For 2026, Medicare allowed an in-network limit of up to $9,250; plans may set a lower limit. Plan premiums and Part D drug costs don't count toward it. Drug costs have their own yearly cap of $2,100 in 2026 (see Part D in Arizona).
Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Snowbirds, travel and moving
Arizona has many seasonal residents, and Medicare Advantage is the part of Medicare where travel matters most, because plans are built around a local network.
- Emergencies and urgent care are covered anywhere in the United States, in any Medicare Advantage plan.
- Routine care away from home is usually not covered by an HMO. A PPO may cover out-of-network care at a higher cost if the provider agrees to bill the plan.
- The 6-month rule: if you leave your plan's service area for more than 6 months in a row, the plan must disenroll you, unless it has a visitor or traveler program that lets you stay enrolled for up to 12 months. Ask the plan whether it has one; not every plan does.
- Moving for good, into Arizona or away from it, gives you a special enrollment period to pick a plan where you now live.
- Mexico and other countries: Medicare generally doesn't cover care outside the U.S. See Does Medicare work in Mexico?
If you split the year between Arizona and another state, Original Medicare with a Medigap policy may fit better, because it works with any provider in the country who accepts Medicare. Read more on our snowbirds and seasonal residents page and Can snowbirds keep their Medicare plan?
When you can join or switch
- Initial Enrollment Period: the 7 months around your 65th birthday month.
- Annual Enrollment Period: October 15 to December 7 each year, with changes starting January 1. Right now that window is open for 2027 coverage.
- Medicare Advantage Open Enrollment Period: January 1 to March 31. If you are in a Medicare Advantage plan, you can make one change: switch to another Medicare Advantage plan, or drop it and go back to Original Medicare (and join a Part D plan).
- Special enrollment periods for moving, losing other coverage, getting AHCCCS or Extra Help, and other life events.
Details and dates are on our enrollment periods page.
Plans ending in 2027
Check your Annual Notice of Change. For 2027, some companies stop offering Medicare Advantage plans in some Arizona counties. If your plan is ending, you have until the end of February 2027 to choose new coverage, and you may have a guaranteed right to buy a Medigap policy. See Arizona plans ending in 2027 for what to do.
Getting help choosing
To see the Medicare Advantage plans sold where you live, see plans in your ZIP code. To talk it through, call (602) SENIORS (602-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you. Agents can explain plans from the companies they work with and check your doctors and drugs.
For information on every option in your area, Medicare's own help line is 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), and its plan finder is at Medicare.gov.
Sources
- Medicare.gov — Your health plan options
- Medicare.gov — Health Maintenance Organization (HMO)
- Medicare.gov — Preferred Provider Organization (PPO)
- Medicare.gov — Special Needs Plans (SNP)
- Medicare.gov — Special Enrollment Periods
- eCFR — 42 CFR 422.74, disenrollment by the MA organization (6-month absence rule)
- CMS — Medicare Advantage and Part D Landscape files, contract year 2027
- Medicare.gov — Medicare & You handbook
Frequently asked questions
How many Medicare Advantage plans are there in Arizona for 2027?
CMS's 2027 plan data lists 89 Medicare Advantage plans open to everyone in Arizona, offered by 16 companies, plus 57 special needs plans. You can only join plans sold in your county: Maricopa and Pima counties have the most choices, while Apache, Greenlee and Navajo counties have the fewest.
Can I keep my Arizona Medicare Advantage plan if I spend the summer in another state?
You can stay enrolled, but an HMO generally covers only emergency and urgent care, plus out-of-area dialysis, while you are away; routine care usually has to wait until you're back in your plan's service area. If you are away from the service area for more than 6 months in a row, Medicare rules require the plan to disenroll you unless it offers a visitor or traveler program that allows a longer stay.
Is there a limit on what I pay in a Medicare Advantage plan?
Yes. Every Medicare Advantage plan has a yearly out-of-pocket limit for Part A and Part B services. For 2026, Medicare allowed in-network limits of up to $9,250, and plans can set lower limits. Your plan's Evidence of Coverage shows its own limit; premiums and drug costs don't count toward it.
My Medicare Advantage plan won't be offered in my county in 2027. What happens?
Your plan must send you a notice. You can choose a new Medicare Advantage plan or drug plan during the Annual Enrollment Period through December 7, and a special enrollment period lets you choose until the end of February 2027. If you do nothing, you return to Original Medicare on January 1 without drug coverage, so you'd need to join a Part D plan. You may also have a guaranteed right to buy certain Medigap policies.
Can I leave Medicare Advantage and go back to Original Medicare?
Yes. You can switch during the Annual Enrollment Period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you want a Medigap policy after you switch, be aware that outside your Medigap open enrollment period or a guaranteed-issue situation, companies in Arizona can review your health and may turn you down.
