How to Read Your Medicare Annual Notice of Change: An Arizona Checklist for 2027
By Andy Childs, Andy Childs Insurance | September 15, 2026
Before you set aside that envelope from your Medicare plan, look for the words Annual Notice of Change, or ANOC. It tells you what is changing in your current plan for the coming year. The question is not just whether the monthly premium changed. It is whether the coverage will still work for the care you actually use.
If you have a Medicare Advantage or Medicare prescription drug plan, your September 2026 notice describes changes taking effect in January 2027. Medicare says to contact your plan if the notice does not arrive. Source: Medicare’s ANOC explanation.
Here is a practical way to review it if you live in Mesa or elsewhere in Arizona. This is a checklist for reviewing your own coverage, not a list of specific 2027 plan recommendations.
The dates to put on your calendar
September 2026: Read your current plan’s ANOC and gather your medication and provider lists. October 2026: Information about next year’s Medicare plans becomes available. October 15 through December 7, 2026: Medicare’s fall Open Enrollment period allows eligible coverage changes. Changes made during that period generally begin January 1, 2027, provided the plan receives your enrollment request by December 7. Sources: CMS Open Enrollment guidance and Medicare Open Enrollment.
These are national Medicare dates; living in Arizona does not create a different fall enrollment calendar. Starting the review now gives you time to ask questions without rushing a decision in December.
1. Confirm the exact plan and year
Start with the plan name on the notice. Compare it with your current insurance card and check that you are reading the material for 2027. An insurance company’s name alone is not enough to identify the coverage you have.
Keep the ANOC alongside the Evidence of Coverage, which gives fuller details about the plan. CMS recommends reviewing both documents. Also keep any separate notice about your plan ending or your coverage changing; do not assume the ordinary renewal process answers a specific notice. Source: CMS.
Write one sentence at the top of your notes: “The plan I am reviewing is ______, for the year ______.” It is a simple way to keep multiple mailings from getting mixed together.
2. Compare more than the premium
Put this year’s and next year’s costs side by side. For Medicare Advantage, check the plan premium, medical deductible, specialist visits, hospital care, outpatient procedures, and the annual out-of-pocket limit. For a stand-alone Part D plan, concentrate on the drug premium, deductible, and prescription costs.
Medicare Advantage plans have an annual limit for covered Medicare medical services, and some plans distinguish in-network from combined in- and out-of-network costs. That is not the same as an all-inclusive household healthcare budget. Prescription coverage and premiums need their own review. You generally remain responsible for the Part B premium even when a Medicare Advantage plan has no additional plan premium. Sources: Medicare coverage comparison and Medicare costs.
My suggested question is: “What might I pay during an ordinary year, and what costs could I face in a year when I need more care?” Do not assume an unchanged premium means unchanged coverage.
3. Check each prescription separately
Make a list of every prescription, including the name, strength, form, and how much you take. Check those details against the plan’s next-year drug list, called a formulary, rather than relying only on a summary in the ANOC.
Confirm whether each drug is covered, its tier, and the applicable copayment or coinsurance. A covered drug can still have a different cost from another covered drug. Plans organize drugs into tiers and may change their formularies. Source: Medicare’s explanation of formularies and tiers.
Also look for prior authorization, step therapy, or quantity limits. These are coverage rules, not instructions to change your medication yourself. Ask your plan and prescriber how any rule applies and whether an exception is appropriate. Source: Medicare drug plan rules.
4. Verify your doctors and pharmacy outside the ANOC
Treat the notice as the starting point, not a personalized confirmation that every doctor or pharmacy you use will be covered. CMS specifically notes that provider and pharmacy networks can change from year to year. Source: CMS.
For an Arizona Medicare Advantage review, write down the exact doctor, practice location, and hospital you use. A Mesa primary-care office and a specialist’s office across the East Valley should be checked separately. Confirm participation for the specific plan and year with the plan and provider’s office; “we take Medicare” is not the same question as whether a provider participates in your Medicare Advantage network. Network rules also differ by plan type. Source: Medicare Advantage plan types.
Check the exact pharmacy location, too. An in-network pharmacy is not necessarily a preferred in-network pharmacy. Where a plan uses preferred pharmacies, that distinction may affect what you pay. Source: Medicare pharmacy guidance.
A useful question to ask is: “For this exact plan in 2027, is this location in network, and what cost-sharing applies?” Record the date and any reference number for the answer.
5. Review extra benefits after your core coverage
If your Medicare Advantage plan includes dental, vision, hearing, transportation, or other extra benefits, check the next-year rules in the plan documents. Look at limits, participating providers, eligibility conditions, and anything you must do before using a benefit. Medicare Advantage plans can offer benefits that Original Medicare does not, but coverage varies. Source: Medicare coverage comparison.
My suggested order is doctors, prescriptions, total costs, then extras. An attractive extra should not distract you from an unanswered question about your regular care.
For help reviewing coverage when you have both programs, see the Medicare and AHCCCS review page.
6. Decide whether keeping the plan still makes sense
A review does not automatically mean a switch. CMS says that when your current plan is still offered and will continue to meet your needs, …
Vision and Hearing Coverage Under Medicare in Arizona
When new Medicare beneficiaries find out that Original Medicare does not cover routine eye exams, glasses, or hearing aids, they are usually surprised. These are basic health needs for older adults. Vision changes accelerate after 60. Hearing loss affects roughly half of people over 75. And yet the original 1965 Medicare program was not built with these benefits in mind, and Congress has only carved out narrow exceptions over the years.
The good news is that there are real ways to get vision and hearing coverage as a Medicare beneficiary in Arizona. Some come through Medicare Advantage plans. Some come through standalone supplemental products. Some come through state programs or community resources. I am a Medicare broker in Mesa, and I help clients navigate these gaps every week. Here is the practical breakdown.
What Original Medicare Actually Covers for Vision
Original Medicare, meaning Part A and Part B together, covers vision care only in specific medical circumstances.
Annual eye exams for routine glasses prescriptions are not covered. If you go to the optometrist for a regular check-up and to update your glasses prescription, you pay out of pocket.
Annual diabetic eye exams are covered. If you have diabetes, Medicare Part B covers a yearly screening for diabetic retinopathy. This is a meaningful benefit for the millions of Medicare beneficiaries with diabetes.
Glaucoma screenings are covered for high-risk groups. Annually for people with diabetes, family history of glaucoma, African Americans 50 and older, and Hispanic Americans 65 and older.
Macular degeneration treatment is covered when medically necessary. Injections, laser treatment, and follow-up care for confirmed AMD are covered under Part B.
Cataract surgery is covered. Medicare covers the surgery itself, the standard intraocular lens implant, and one pair of eyeglasses or contact lenses after the procedure. Premium lens upgrades, like multifocal or astigmatism-correcting lenses, are typically not covered and are paid out of pocket.
What is not covered. Routine eye exams for prescription updates. Glasses or contact lenses outside of cataract surgery. Most refractive surgery like LASIK. Vision therapy.
If your vision needs are limited to medical eye care, Original Medicare with a supplement covers things well. If you also need routine eye exams and glasses, you have to fill that gap somewhere else.
What Original Medicare Covers for Hearing
Hearing coverage under Original Medicare is even more limited than vision.
Diagnostic hearing exams are covered when ordered by a doctor for a medical reason. If your physician suspects a medical cause for hearing loss, like an ear infection or a tumor, Medicare Part B covers the diagnostic testing.
Cochlear implants are covered when medical criteria are met. This is a significant benefit for people with severe to profound hearing loss who do not benefit from hearing aids.
What is not covered under Original Medicare. Routine hearing exams. Hearing aids. Hearing aid fittings. Most hearing aid batteries and accessories. Bone-anchored hearing devices for less severe loss.
Hearing aids alone can cost $2,000 to $7,000 per pair. For a typical Medicare beneficiary, that is a major out-of-pocket expense, and it is one of the most-cited reasons people consider Medicare Advantage plans.
How Medicare Advantage Plans Fill the Gap
Most Medicare Advantage plans in Arizona include vision and hearing benefits as part of their package. This is one of the strongest selling points of Medicare Advantage and a real value for many seniors.
Vision benefits on Medicare Advantage plans typically include an annual eye exam, often at no copay. A frame allowance every year or every two years, ranging from $100 to $400 depending on the plan. A lens benefit, often a fixed copay or covered in full. Some plans include contact lens allowances instead of or in addition to frames.
Hearing benefits on Medicare Advantage plans typically include an annual hearing exam, often at no copay. A hearing aid benefit through a contracted vendor like NationsHearing, TruHearing, or UnitedHealthcare Hearing. Hearing aid copays usually start in the $375 to $1,250 per device range for basic technology and go up for premium devices, with a limit of one or two devices every year or two.
The specifics vary considerably by plan. Two Medicare Advantage plans from the same carrier can have very different vision and hearing benefits. Always verify the specific benefits before enrolling.
Standalone Vision and Dental Plans
Some Medicare beneficiaries who stay on Original Medicare with a supplement want to add vision and dental coverage without moving to Medicare Advantage. There are standalone vision plans available, often bundled with dental, that do this.
These plans are private products sold by various carriers. Premiums typically run $25 to $60 per month for combined vision, dental, and sometimes hearing coverage. Benefits include annual exams, frame and lens allowances, and dental cleanings, fillings, and major work.
Standalone plans tend to have annual maximums and waiting periods on major work, especially for dental. Vision benefits are usually straightforward. The math depends on your usage. If you wear glasses and get an exam every year or two, the plan often pays for itself. If you go to the optometrist rarely, you may save money paying out of pocket.
For hearing aids specifically, standalone hearing plans are less common, but discount programs and direct-to-consumer hearing aid options have proliferated. We will get into those next.
Direct-to-Consumer Hearing Aids and OTC Options
In 2022, the FDA approved over-the-counter hearing aids for adults with mild to moderate hearing loss. This created a new category of devices that you can buy directly without a prescription, and prices have dropped dramatically.
Major retailers now sell OTC hearing aids in the $200 to $1,500 price range. Brands like Lexie, Jabra Enhance, Eargo, Sony, and others compete in this space. Quality varies. The best OTC devices in 2026 are remarkably capable for routine use, especially for users with mild loss. The lower end of the market is hit or miss.
For Medicare beneficiaries with mild hearing loss who do not have Medicare Advantage hearing benefits, OTC hearing aids can be a sensible …
Aetna vs Blue Cross Blue Shield of Arizona Medicare Advantage 2026
If you live in Maricopa or Pinal County and are weighing Medicare Advantage options for 2026, two carriers worth a serious look are Aetna and Blue Cross Blue Shield of Arizona, often called BCBSAZ. They are not the largest Advantage carriers in the Valley, but they have specific strengths that can make them the right fit for the right person. Both have $0 premium plans available. Both have decent drug coverage. They differ on network footprint, plan design, and the kinds of extras they emphasize.
I am a Medicare broker in Mesa, and Aetna and BCBSAZ both come up regularly in client conversations. Here is the side-by-side comparison I would walk you through, with an honest read on who each carrier is best for.
Network Footprint in Arizona
Network access is the first place these two carriers diverge meaningfully. The right plan needs to include the doctors and hospitals you actually use.
Aetna in Arizona has built its Medicare Advantage network around a mix of major systems. They contract with HonorHealth, Banner, Dignity Health, Abrazo, and several independent practice associations in the Valley. Aetna’s PPO plans tend to have broader access. Aetna’s HMO plans require you to designate a primary care doctor and stay within the contracted network.
Blue Cross Blue Shield of Arizona is the only Blues plan based in Arizona. Their network is built specifically for Arizona providers and tends to have very strong contracting with Banner, HonorHealth, and Dignity Health. BCBSAZ has been growing its Medicare Advantage business in the Valley and has developed plans that work well within the major Arizona hospital systems.
For Mesa and East Valley patients specifically, both carriers have solid network coverage. The key is to verify the specific doctors you see. Banner-affiliated patients usually have access through both carriers. HonorHealth-affiliated patients usually have access through both. Mayo Clinic, as always, is a more selective question and may or may not be in network depending on the specific plan and year.
Pharmacy and Drug Coverage
Both carriers offer integrated Part D coverage on their Medicare Advantage plans, but the formularies and pharmacy networks differ enough to matter.
Aetna uses CVS Caremark for pharmacy benefits, which means CVS, Target Pharmacy, and many independents are preferred pharmacies. The mail order option through CVS Caremark is reliable. Aetna’s formulary is broad and includes most commonly prescribed medications.
BCBSAZ uses Prime Therapeutics for pharmacy management. Their preferred pharmacy network in Arizona includes Walgreens, Walmart, Costco, Safeway, and a number of independent pharmacies. Mail order is handled through Prime’s network and is generally smooth.
For most generic medications, both carriers come out very close in cost. The difference shows up on brand name medications, specialty drugs, and tier placement. A plan that puts your statin on tier 1 saves you hundreds compared to a plan that puts it on tier 3. The medicare.gov Plan Finder will show the specific cost for your specific medications across both carriers.
The new $2,000 Part D out-of-pocket cap for 2026 applies to both carriers. If your annual drug costs were going to exceed $2,000, the cap caps them at $2,000 regardless of which plan you pick. The plans that come out best are the ones where you stay below the cap with the most predictable monthly costs.
Premiums and Out-of-Pocket Maximums
Both Aetna and BCBSAZ offer $0 premium Medicare Advantage plans in Maricopa County. The Aetna $0 premium plans typically have $0 medical deductibles, modest copays, and out-of-pocket maximums in the mid-$5,000 to $7,500 range for in-network care. The BCBSAZ $0 premium plans are structured similarly, with comparable copay structures and out-of-pocket caps.
Higher-tier plans from each carrier with monthly premiums offer richer benefits. A $30 to $80 per month plan often comes with lower copays for primary care, lower specialist copays, lower hospital cost shares, and richer extras.
The most useful number for most shoppers is the in-network out-of-pocket maximum. Lower maximums mean better protection if you have a bad year. Both carriers have plans with maximums under $5,000 if you look carefully.
Extras: Dental, Vision, Hearing, Fitness, OTC
Both carriers compete heavily on extra benefits. Here is the honest read.
Dental coverage on basic plans from both carriers is reasonable for cleanings and routine care. Aetna’s dental network is generally accessed through a partnership with major dental networks. BCBSAZ has built a strong dental network in Arizona and tends to be competitive on annual maximums and the percentage of major work covered. For someone planning major dental work like crowns or dentures, comparing the specific coverage limits is worth a careful look.
Vision is roughly comparable. An eye exam covered, a frame allowance, lens coverage. Worth more if you wear glasses or are due for an exam.
Hearing aids are an area where both carriers have invested. Aetna and BCBSAZ both offer hearing aid programs through specific vendors with copays starting in the few hundred dollars per device range for basic technology and going up for premium devices. If you need hearing aids, the specifics of each carrier’s program are worth comparing closely.
Fitness benefits at Aetna include programs like SilverSneakers and Renew Active depending on the specific plan. BCBSAZ also typically includes SilverSneakers or a comparable program. Both work for most active seniors.
OTC and grocery allowances vary. Aetna and BCBSAZ both have plans with monthly OTC card allowances. Some BCBSAZ plans include grocery benefits at participating retailers for members with chronic conditions. The amounts and what is covered change every year and are worth checking on the specific plan you are considering.
Transportation, telehealth, in-home support services, and meal delivery after hospital stays show up on richer plans from both carriers. If any of these matter to you, list them as priorities and we can compare.
Customer Service and the Local Factor
This is where BCBSAZ has a unique angle. As the only Blues plan based in Arizona, with corporate offices in Phoenix, BCBSAZ has historically positioned itself as the “local” option. Their customer service team …
Medicare Scams in Arizona: How to Spot Them and Protect Your Parents
Every senior I know in Arizona has gotten a robocall claiming to be from Medicare, the Social Security Administration, or some carrier you have never heard of. The pitch is almost always the same. They have new benefits available. They have noticed a problem with your account. They need to send you a new card. They need to verify your information. Press 1, give them a number, hold for an agent.
Medicare fraud is one of the largest drivers of elder financial abuse in this country. The federal government estimates Medicare fraud at $60 billion or more per year. Arizona’s senior population, including a large snowbird community, is heavily targeted. The bad actors are organized. They know who is on Medicare. They know how to sound official. And they prey on the fact that Medicare is confusing enough that even legitimate calls feel suspicious.
I am a Medicare broker in Mesa, and a big part of my job is helping clients tell the difference between a legitimate communication and a scam. Here is what I tell every new client and every adult child who is helping a parent.
Rule Number One: Medicare Does Not Cold Call
This is the most important thing to internalize. The actual Medicare program, which is run by the Centers for Medicare and Medicaid Services, does not call you. It does not send agents to your house. It does not text you. It does not email you offering benefits.
Medicare communicates with you through paper mail. The Medicare Summary Notice, the explanation of benefits, the card, the Annual Notice of Change letter from your plan, the Medicare and You handbook each fall. All paper. All mailed to the address on file with Social Security.
If a call, text, or door knock claims to be from “Medicare,” it is not. Not directly. There may be a related organization or insurance plan involved, and that is a different conversation. But Medicare itself does not initiate contact this way. When in doubt, hang up.
Rule Number Two: The Government Will Never Threaten You
A common scam pattern uses urgency and fear. Your benefits are about to be cut off. There is a warrant for your arrest related to Medicare fraud. Your card is being suspended. You owe back premiums and need to pay immediately or lose coverage.
None of these scenarios reflect how Medicare actually works. Medicare does not threaten beneficiaries. The Social Security Administration does not call demanding immediate payment. There are no warrants for unpaid Medicare premiums.
If a caller tries to scare you into immediate action, that is a scam. Real Medicare and Social Security business is handled with paper notices, deadlines that are usually weeks or months out, and the option to appeal or call back. Urgency is a manipulation tactic.
The Most Common Scams I See in Arizona
Here are the patterns that show up most often with my clients in Mesa and the East Valley.
The first is the new card scam. Someone calls saying Medicare is sending out new cards and they need to verify your Medicare number, your Social Security number, and sometimes your bank account. There is no legitimate version of this call. Medicare does send new cards occasionally, but you do not need to verify anything to receive one.
The second is the brace, knee, or back pain scam. A caller asks if you have any pain and offers a “free” knee brace, back brace, or other durable medical equipment. They take your Medicare number, bill Medicare for thousands of dollars worth of equipment that you may or may not receive, and disappear. Medicare will get billed for everything in your name, often for products you never wanted or needed. The cap on this scheme has been hundreds of millions of dollars in fraudulent claims.
The third is the genetic testing or DNA test scam. A caller offers a free cancer screening or DNA test and sends you a kit to mail back. They bill Medicare for an expensive panel and pocket the difference. The “test results” are usually generic and useless.
The fourth is the COVID-19 or new health benefit scam. Caller claims new pandemic-era benefits, free at-home test kits, or emergency benefits that require your Medicare number to claim. Sometimes there are real benefits being offered by the government, but they are never delivered through cold calls.
The fifth is the agent impersonation scam. Someone calls claiming to be from a specific carrier or to be working with a local broker. They say they need to verify information, update your plan, or send you new materials. They ask for personal details that they then use to enroll you in a different plan you did not authorize, often during AEP. This one is particularly damaging because the victim might not realize what happened until weeks later when they get a letter confirming a plan change they never made.
The sixth is the door-to-door pitch. An agent or unlicensed person shows up at the front door claiming to be from Medicare or a specific plan. Federal rules actually prohibit licensed agents from making unsolicited door-to-door sales to Medicare beneficiaries. If someone is at your door uninvited and trying to talk plan benefits, they are either an unlicensed scammer or a licensed agent breaking the rules. Neither is acceptable. Do not let them in. Do not give them your information.
What Scammers Want From You
Scammers want a few specific things, and knowing what they are after helps you spot the trap.
They want your Medicare number. This number is used to bill Medicare. With it, a fraudulent provider can submit claims in your name for services you never received.
They want your Social Security number. This is the master key to your identity and can be used for tax fraud, account takeovers, and a lot worse than just Medicare fraud.
They want your bank account or routing numbers, supposedly to set up “automatic premium payment” or refund a …
HSAs and Medicare: The 6-Month Rule That Trips Up Most People at 65
If you have a Health Savings Account and you are approaching 65, there is one Medicare rule you absolutely have to understand. It is not advertised. Your HR department probably will not catch it. The IRS will not warn you in advance. But it can result in real tax penalties and lost contributions that you cannot get back.
I am a licensed Medicare broker in Mesa, and I have watched this rule blow up more than one client’s retirement plan. The fix is straightforward if you know about it ahead of time. The fix is much harder if you find out after you have already enrolled. So this article is the heads-up I wish more people got before they crossed into Medicare territory.
The Rule in One Paragraph
If you enroll in any part of Medicare, including premium-free Part A, you become ineligible to contribute to a Health Savings Account. Period. Even if you are still working. Even if you are still on a high-deductible health plan through your employer. Even if Part A is free and you signed up automatically. The IRS does not allow HSA contributions for anyone enrolled in Medicare.
That is the simple version. The wrinkle is that Medicare Part A enrollment is automatically backdated up to 6 months when you do enroll, but never earlier than your 65th birthday. So if you wait until age 67 to enroll in Medicare, your Part A start date is set retroactively to 6 months before your enrollment month. Any HSA contributions you made during those backdated 6 months are technically excess contributions, subject to a 6 percent excise tax every year they remain in the account.
This is the trap. Most people do not realize Medicare backdates Part A. They keep contributing to an HSA right up until they sign up for Medicare. Then they get hit with a tax bill they were not expecting.
How Backdating Actually Works
Let me give you a concrete example. Say you turn 65 on April 15, 2025, but you decide to keep working and contributing to your HSA through June 2026. In June 2026 you enroll in Medicare, with a start date of July 1, 2026.
Medicare looks at your enrollment date and backdates Part A coverage to January 1, 2026. That is 6 months before your July effective date. Any HSA contributions you made between January 1, 2026, and June 30, 2026, are now excess contributions because you were technically Medicare-eligible during that period.
The IRS treats those contributions as taxable income for the year you made them, plus a 6 percent excise tax for every year they remain in the account. To fix it, you have to withdraw the excess plus any earnings before the tax filing deadline. If you miss that deadline, the penalties stack up.
This is why anyone planning to keep contributing to an HSA past 65 has to plan their Medicare enrollment carefully. The cleanest path is to stop HSA contributions at least 6 months before you enroll in Medicare. That way the backdating window covers a period when you were not contributing, and there are no excess contributions to clean up.
The Most Common Way People Get Caught
The single most common scenario is people who turn 65 and assume that because they are still working, they do not need to think about Medicare. Then later they decide to enroll, often when they are about to retire, and they get blindsided by the backdating rule.
A close second is people who file for Social Security at 65 or before age 65 while still working. Filing for Social Security automatically enrolls you in Medicare Part A. If you were contributing to an HSA, your HSA eligibility ended the month your Part A started. Most people do not realize this and keep contributing for months or years before someone tells them.
A third scenario is the spouse who was covered under their working spouse’s HSA-eligible high-deductible plan. They turn 65, get auto-enrolled in Part A because they were already drawing Social Security, and the working spouse’s HSA contributions become problematic on the family contribution side.
If you are at all involved with an HSA, it is worth a 30-minute conversation with someone who knows the rules before you do anything Medicare-related. The cost of getting it right is zero. The cost of getting it wrong starts at a few hundred dollars and can climb into the thousands.
How to Plan for This Properly
There are basically three paths.
Path one is to stop HSA contributions at least 6 months before you enroll in Medicare. If you plan to enroll in Medicare on January 1 of the year you retire, your last HSA contribution should be no later than June of the previous year. This gives the backdating window a clean overlap with a period when you were not contributing.
Path two is to delay Medicare enrollment past your initial enrollment period. This requires having creditable coverage from a large employer plan, which lets you delay Part B without a penalty. The important detail is that you also have to actively decline Part A or refuse to file for Social Security, because filing triggers automatic Part A enrollment. Your HR department or a Medicare broker can confirm whether your situation supports this.
Path three is to enroll in Medicare on time and stop HSA contributions in advance, accepting that you are giving up some HSA contribution years. For people in their late 60s with already-significant HSA balances, this is often the right call.
The wrong move is to keep contributing to the HSA past 65 without thinking about Medicare. Whatever path you take needs to be deliberate.
What to Do With the HSA Money You Already Have
Even if you stop contributing, your existing HSA balance is still yours. After 65, you can use HSA funds for any expense without the 20 percent penalty that would have applied earlier. You will pay regular income tax on …
Medicare and Diabetes in Arizona: Coverage, Costs, and the 2026 Insulin Cap
Roughly one in four Americans on Medicare lives with diabetes. In Arizona that number is even higher in some communities. If you or a parent is on Medicare and managing diabetes, the choices you make about your plan have real financial consequences. The right plan can mean predictable, reasonable costs. The wrong plan can leave you spending thousands a year on supplies, medications, and equipment.
I am a Medicare broker in Mesa, and diabetes is one of the most common chronic conditions among my clients. The good news is that Medicare actually covers diabetes care fairly well, and the Inflation Reduction Act has made some big improvements in recent years, including a hard cap on insulin costs. The trick is understanding which parts of Medicare cover what, and choosing a plan that handles your specific situation well.
The $35 Insulin Cap and What It Actually Covers
The biggest recent change in Medicare diabetes coverage is the $35 monthly cap on insulin. Starting in 2023, Medicare Part D plans have been required to cap a 30-day supply of any covered insulin at $35. There is no deductible to meet first. If you fill an insulin prescription on January 2, you pay no more than $35 for that 30-day supply. Same on April 2. Same on October 2.
In 2026, the cap is still in place. It applies to all Medicare Part D plans, both standalone Part D plans paired with Original Medicare and the integrated drug coverage in Medicare Advantage plans.
The cap also applies to insulin used in pumps, which is covered under Part B in some cases instead of Part D. Pump insulin under Part B is also capped at $35 per month.
A few things to watch. The cap is on a 30-day supply. If your prescription is for a 90-day supply, you pay up to $105 instead of having three separate $35 fills. If your insulin is non-formulary on your specific plan, you can still get the $35 price by switching to a covered insulin or by appealing through your doctor. Almost every plan covers at least the major insulin formulations like Lantus, Basaglar, Humalog, NovoLog, Tresiba, and similar.
If you are on insulin and paying more than $35 a month, something is wrong. Either you are on a plan that does not cover your specific insulin, or there has been an administrative error. A broker or your pharmacist can help you sort it out.
Continuous Glucose Monitors Under Medicare
Continuous glucose monitors, or CGMs, have transformed diabetes management. Medicare covers them under Part B durable medical equipment when you meet certain criteria.
To qualify for CGM coverage, Medicare generally requires that you are on insulin or have a documented history of problematic hypoglycemia. The most common covered devices in Arizona are the Dexcom G7 and the FreeStyle Libre 3, both of which are widely available through Medicare-approved DME suppliers in the Valley.
Under Original Medicare, after you meet the Part B deductible, you pay 20 percent of the Medicare-approved amount for the device and supplies. A Medigap supplement like Plan G covers that 20 percent, leaving you with predictable, often near-zero out-of-pocket costs for ongoing CGM use.
Under Medicare Advantage, CGM coverage is required at the same level as Original Medicare, but copays and prior authorization requirements vary by plan. Some plans handle CGM smoothly. Others put you through paperwork and delays. If CGM is essential to your management, the plan’s track record on durable medical equipment matters.
Other Diabetes Supplies Medicare Covers
Beyond insulin and CGMs, Medicare covers a range of diabetes-related supplies and services. The coverage is split between Part B and Part D, which trips people up.
Under Part B, Medicare covers blood sugar test strips, lancets, blood sugar monitors, control solutions, and external insulin pumps and the insulin used in them. Diabetic foot exams once a year if you have diabetic neuropathy. Diabetes self-management training when prescribed by a doctor. Medical nutrition therapy with a registered dietitian. Therapeutic shoes for people with severe diabetic foot disease.
Under Part D, you get oral diabetes medications like metformin, GLP-1 agonists like Ozempic and Mounjaro when used for type 2 diabetes, and insulin used by injection rather than pump. Drug coverage and tier placement vary by plan.
The Part B versus Part D split matters because supplements like Plan G cover the Part B side completely. Drug costs come out of Part D, which is separate. Knowing where each item falls helps you predict your costs.
How to Pick the Right Plan if You Have Diabetes
Here is how I think about plan selection for clients with diabetes.
If you take a lot of medications, including insulin, oral diabetes drugs, and other related medications for blood pressure, cholesterol, and so on, drug coverage is the single most important factor. We run your full medication list through every available plan and find the one that covers them at the lowest combined cost. The $35 insulin cap helps, but the rest of your medications can swing the math by hundreds or thousands of dollars a year.
If you use a CGM, the plan needs to handle DME smoothly. Some Advantage plans require prior authorization for every reorder, which is a hassle. Original Medicare plus a supplement is generally the simplest path for CGM users because the rules are uniform and there is no per-plan variation.
If you are on a pump, similar logic applies. Pump supplies, infusion sets, reservoirs, and pump insulin all need to be covered without obstacles. Original Medicare with a supplement keeps the rules simple and predictable.
If your diabetes is well managed, you take metformin and one other medication, and you do not use a CGM or pump, almost any reasonable plan will work. In that case, the decision comes down to your other priorities like network, premium, and extras.
Specialists, Endocrinologists, and Network Considerations
If you are managing diabetes seriously, you probably see an endocrinologist at least once or twice a …
7 Signs Your Parent Picked the Wrong Medicare Plan (And How to Fix It)
If you are an adult child, there is a good chance you have wondered whether your parent is on the right Medicare plan. Maybe Mom mentions a doctor visit cost more than she expected. Maybe Dad got a surprise bill from a specialist. Maybe their drug costs are creeping up every year. Maybe they just shrug when you ask about their plan and say, “It is what it is.”
I am a Medicare broker in Mesa, and a lot of the families I work with come to me because something stopped feeling right. The good news is that picking the wrong plan is fixable. Most years, your parent has at least one window during which they can switch. The bad news is that nobody flags the problem for them. The plan keeps charging the premium and processing claims, and it is up to your parent or someone watching out for them to notice the warning signs.
Here are the seven I see most often.
Sign 1: Their Doctor Is Not in Network
This is the most common and most fixable problem. Your parent enrolled in a Medicare Advantage plan and did not realize, or did not remember, that the plan has a network. Now they are seeing their primary care doctor or a specialist and getting hit with out-of-network bills, or worse, the doctor stopped seeing them entirely because the plan does not cover them.
The signs are subtle. A higher-than-expected bill after a routine visit. A note from the doctor’s billing office about a charge insurance did not cover. Your mom mentioning she has to see a different doctor now because hers “stopped taking the insurance.”
The fix is to switch plans during the next eligible window. We make a list of the doctors she actually wants to keep, and I find a plan that includes all of them in network. Sometimes that means a different Medicare Advantage plan from a different carrier. Sometimes it means moving to Original Medicare with a supplement, which has no network at all.
Sign 2: They Are Paying a Premium for a Plan They Could Get for Less
Your parent is on a Medicare Advantage plan that charges, say, $80 a month. They believe that is just what Medicare costs. In reality, there are $0 premium plans in Maricopa County that offer comparable benefits. They are paying $960 a year for nothing.
This usually happens when someone enrolled years ago and never reviewed the plan since. The market shifts every year, plans change, and a plan that was the best deal in 2018 may not be a competitive deal in 2026.
The fix is an annual review. Plans change every year, and a comparison run during AEP will show whether their current plan is still the right choice or whether they should move to something else.
Sign 3: Their Drug Costs Have Climbed Year Over Year
This is one of the easiest signs for an adult child to spot. Your dad takes the same medications he has been taking for five years, but the cost at the pharmacy keeps going up. Maybe the medication moved to a higher tier. Maybe the carrier changed the formulary. Maybe the deductible is now higher.
Your parent might assume the cost is just rising naturally. Sometimes that is true. But if a drug used to be in tier 2 and is now in tier 4, that is a plan-level change that you can fix by switching to a different plan whose formulary places it more favorably.
The fix is to enter their current medications into the medicare.gov Plan Finder, or have a broker do it, and see what each available plan would cost for those drugs over a year. The right plan often saves hundreds.
Sign 4: They Are Avoiding Care Because of Costs
This one is heartbreaking and more common than people realize. Your mom needs a hearing aid but the plan covers nothing. Your dad needs physical therapy after his hip surgery but the copays are too high. Your parent skips a follow-up appointment because they cannot afford the specialist visit.
If you notice your parent declining care or rationing visits, the plan is probably misaligned with their needs. Some plans cover hearing aids well. Some have low specialist copays. Some have rich physical therapy coverage. The right plan, picked specifically for what they actually need, can change this picture.
The fix is to look at what care they need and find a plan that covers it well. For some families this means moving from a $0 premium MA plan to a richer MA plan with a small premium and better coverage. For others, it means moving to Original Medicare with a Plan G supplement, where almost everything is covered.
Sign 5: They Got a Surprise Bill After a Hospital Stay or Procedure
Your parent went into the hospital for something serious, recovered, and a few weeks later started getting bills. The bills add up to thousands. Your parent assumed the plan would cover everything.
Medicare Advantage plans have out-of-pocket maximums, but those maximums in Maricopa County range from around $4,000 to over $7,500 for in-network care. Out-of-network care has a separate, higher maximum on PPO plans, and HMO plans generally do not cover out-of-network care at all. A serious hospital stay can hit the out-of-pocket maximum, especially if any of the services were out of network or required a referral that was not obtained.
The fix in some cases is helping your parent appeal denied claims. The fix going forward is to choose a plan with a lower out-of-pocket maximum or move to Original Medicare with a supplement, where there is essentially no out-of-pocket exposure for Medicare-covered services.
Sign 6: They Travel and the Plan Does Not Travel With Them
Your parents winter in Arizona and summer in Wisconsin. Or they live in Mesa year-round but visit grandkids in Texas for months at a time. Or they have a cabin in Colorado.
Most …
UnitedHealthcare vs Humana Medicare Advantage in Maricopa County 2026
If you live in Maricopa County and are shopping Medicare Advantage plans for 2026, two carriers are going to come up in almost every conversation. UnitedHealthcare and Humana are the two largest Medicare Advantage carriers in the country and both have a serious presence in the Valley. They run heavy advertising. Their plans are easy to find. Both are reasonable choices. But they are not the same, and the right one for you depends on your doctors, your medications, and how you actually use healthcare.
I am a licensed Medicare broker in Mesa, and I help seniors compare these two carriers all the time. This is the side-by-side I would walk you through in person, broken down by what actually matters when you are picking a plan.
Network Footprint in the Valley
The biggest practical difference between Medicare Advantage carriers is which doctors and hospitals are in network. A plan with the best benefits in the world is the wrong plan if your primary care physician will not accept it.
UnitedHealthcare in Maricopa County contracts heavily with Banner Health, which has the largest hospital and clinic footprint in the Valley by far. If you see Banner doctors, get care at Banner Estrella, Banner Desert, or Banner Gateway, and use Banner Urgent Care, UnitedHealthcare typically covers them in network. UHC also has solid contracting with HonorHealth, Dignity Health, and many independent practices. Their PPO plans tend to have the broadest networks in the Valley.
Humana in Maricopa County has built strong relationships with HonorHealth, Dignity Health, Abrazo, and several independent provider groups. They contract with Banner on some plans but historically have had a more limited Banner footprint than UHC. Humana’s HMO plans require you to pick a primary care doctor and stick with the network. Their PPO plans give you more flexibility but tend to have higher premiums.
The practical takeaway. If your primary care doctor or specialists are part of the Banner system, UnitedHealthcare is usually the easier fit. If your providers are HonorHealth, Abrazo, or independent, both carriers may work but Humana has often had stronger contracting in those networks. The right answer is to actually verify each of your specific doctors against the plan’s network before you enroll, not after. I do this for every client.
Drug Coverage and Pharmacy Networks
The next thing that matters is how each carrier covers your specific medications. Both UHC and Humana offer integrated Part D coverage on most of their Medicare Advantage plans, but their formularies and pharmacy networks differ.
UnitedHealthcare’s formulary tends to be broad, with most common medications covered at predictable tiers. Their plans pair with OptumRx for pharmacy benefits, which has a large preferred pharmacy network including Walgreens, CVS, Walmart, and Albertsons in the Valley. Mail order through OptumRx is generally smooth.
Humana has its own pharmacy benefit, including a strong relationship with Walmart for low-cost preferred pharmacy access. Their formulary is competitive and many specialty medications are covered well. Humana’s mail order pharmacy is run in-house and works reliably.
For most generics, both carriers come out very close in cost. The real differences show up on brand name medications and specialty drugs. A diabetic on a specific brand of insulin might pay $35 a month on one carrier and $0 a month on the other depending on tier placement and the manufacturer rebate arrangements. A heart patient on a specific brand of blood thinner might find the same drug on tier 3 at one carrier and tier 4 at another. These differences add up to real money over a year.
This is where the medicare.gov Plan Finder is your friend. Enter the exact medications you take, including dosages, and the tool will show you what each plan would cost you for those drugs over the year. A broker can run this comparison faster, but the data source is the same.
Premiums, Deductibles, and Out-of-Pocket Maximums
Both carriers offer $0 premium plans in Maricopa County, and both also offer plans with monthly premiums for richer benefits.
UnitedHealthcare’s most popular $0 premium plan in Maricopa County is the AARP Medicare Advantage plan. The plan typically has a $0 medical deductible, modest copays for primary care and specialists, and an out-of-pocket maximum somewhere in the mid-$5,000 range for in-network care. Higher-tier UHC plans with monthly premiums offer broader networks, lower copays, or richer extras.
Humana’s most popular $0 premium plan is the Humana Honor or similar branded plan. Specifications vary year to year, but the structure is comparable. $0 deductible, similar copays, similar out-of-pocket maximums.
The plans can look almost identical on paper. The differences show up in the specific copays for things you might use a lot. One plan might have a $0 copay for primary care visits while the other has $10. One might charge $300 a day for the first 5 days of a hospital stay while the other charges $325 for the first 7 days. These are not earth-shaking differences, but they matter to budget-conscious shoppers.
The most important number on any Advantage plan is the out-of-pocket maximum. This is the most you can spend on covered medical services in a calendar year. Once you hit it, the plan pays 100 percent for the rest of the year. In Maricopa County for 2026, both UHC and Humana have plans in the $4,000 to $7,500 range. Lower out-of-pocket maximums mean better protection if you have a bad year. Higher numbers mean you accept more risk in exchange for richer extras or lower premiums elsewhere.
Extra Benefits That Get Marketed
Both carriers spend a lot of advertising money promoting extras like dental, vision, hearing, fitness, OTC allowances, transportation, and grocery benefits. Here is the honest comparison.
Dental coverage on the basic plans from both carriers is decent for cleanings and routine care, modest for major work like crowns or dentures. UHC’s AARP plans typically include a network through DentaQuest. Humana has its own dental network. Coverage levels are roughly comparable, with annual maximums often in the …
Medicare Extra Help and Savings Programs: Do You Qualify in Arizona?
A lot of Arizona seniors are paying more for Medicare than they need to. Not because they picked the wrong plan, but because they qualify for help they did not know existed. The federal government runs two main programs that can dramatically lower Medicare costs for people on limited incomes, and Arizona’s Medicaid program adds a layer of help on top of that. Together, they can save a qualifying person several thousand dollars a year. Yet roughly half of the seniors who qualify never apply.
I am a licensed Medicare broker in Mesa, and one of the first things I check with new clients is whether they qualify for Extra Help or one of the Medicare Savings Programs. The income and asset limits are higher than most people think, and the application process is straightforward. Here is how it works.
What Extra Help Actually Is
Extra Help, also called the Low Income Subsidy or LIS, is a federal program that helps pay for Medicare prescription drug coverage. If you qualify, the program pays your Part D premium up to a benchmark amount, eliminates or reduces your deductible, and caps your prescription copays at very low amounts. In 2026, qualifying for Extra Help can mean paying as little as $1.55 for generic drugs and $4.90 for brand name drugs, with no donut hole. For someone taking several medications, that can be the difference between filling prescriptions and skipping doses.
In 2024, Extra Help expanded so that there are now no partial benefits. Anyone who qualifies gets the full subsidy. This made the program much simpler and more valuable for people just over the old partial-benefit thresholds.
To qualify for Extra Help in 2026, your income generally needs to be at or below 150 percent of the federal poverty level, and your resources need to be below the program limits. The income limit for 2026 is approximately $1,907 per month for a single person and $2,574 per month for a married couple. The resource limit is around $17,220 for a single person and $34,360 for a married couple. Resources include checking and savings accounts, stocks, and bonds. They do not include your home, your car, household belongings, or burial plots.
If you are receiving full Medicaid benefits, get help from your state with Medicare premiums, or get Supplemental Security Income, you automatically qualify for Extra Help and do not need to apply separately.
Medicare Savings Programs in Arizona
Medicare Savings Programs, or MSPs, are state-administered programs that help pay Medicare premiums and sometimes deductibles and coinsurance. In Arizona, MSPs are run by AHCCCS, the state Medicaid agency. There are three main levels.
The Qualified Medicare Beneficiary program, or QMB, is the most generous. If you qualify, the state pays your Part B premium, your Part A premium if you have one, and your Medicare deductibles and coinsurance. Effectively, your out-of-pocket Medicare costs go to zero. The 2026 income limit for QMB in Arizona is approximately $1,304 per month for a single person and $1,762 per month for a married couple.
The Specified Low-Income Medicare Beneficiary program, or SLMB, pays your Part B premium only. The 2026 income limit is approximately $1,564 per month for a single person and $2,114 per month for a married couple.
The Qualifying Individual program, or QI, also pays your Part B premium. The 2026 income limit is approximately $1,754 per month for a single person and $2,371 per month for a married couple. QI funding is limited each year, and applications are processed in the order they are received.
All three MSPs have a resource limit of approximately $9,660 for a single person and $14,470 for a married couple. As with Extra Help, your home, your car, and personal belongings do not count.
People who qualify for any MSP automatically qualify for Extra Help. So if you sign up for QMB, SLMB, or QI, your prescription costs drop dramatically as a bonus.
Why So Many Eligible Seniors Never Apply
There are a few reasons people who could qualify never get the benefit.
The first is a misconception about income limits. People hear “low income” and assume the limits are very low. They are not. A senior in Arizona living on $1,800 a month from Social Security and a small pension is right at the SLMB or QI threshold. Plenty of my clients are surprised to find out they qualify.
The second is the asset question. People assume their savings disqualify them. The resource limits are reasonable, especially when you remember that the home and car do not count. A widow with $30,000 in savings, no car payment, and a paid-off house can absolutely qualify.
The third is paperwork avoidance. The application is not that bad, but it is not zero work. People put it off, and putting it off costs them real money every month.
The fourth is pride. Some seniors do not want to feel like they are taking welfare. I get it. I gently push back on this when it comes up. These programs exist because Medicare premiums and drug costs have outpaced what most retirees actually have to spend. There is no shame in using a program designed for exactly your situation.
How to Apply in Arizona
You can apply for Extra Help directly through the Social Security Administration. The application is free, takes about 30 minutes, and can be done online at ssa.gov, by phone at 800-772-1213, or in person at any Social Security office. You will need basic information about your income, your bank accounts, and your retirement assets.
For Medicare Savings Programs in Arizona, you apply through AHCCCS. You can apply online at healthearizonaplus.gov, by phone, or by mail. AHCCCS will ask for proof of income, proof of resources, and Medicare eligibility documentation. The decision usually comes within 45 days.
If you qualify for an MSP, that automatically triggers the Extra Help application, so you only need to apply once. The state and Social Security coordinate behind the scenes.
If …
Power of Attorney for Medicare: What Adult Children Need to Know in Arizona
If you are an adult child helping a parent with Medicare, sooner or later you will run into a wall. You call the insurance company about your mom’s claim and they refuse to talk to you. You try to enroll your dad in a new plan and they will only speak with him. You want to compare options on his behalf and the broker, even me, has to verify he has authorized you to be involved. This is not anyone being difficult. It is privacy law working exactly the way it is supposed to.
The fix is to put the right paperwork in place before you actually need it. I have been a Medicare broker in Mesa for 7 years, and I have watched too many families scramble to get power of attorney signed during a hospital stay or after a stroke. Doing it ahead of time, while a parent is healthy and mentally clear, takes about an hour and saves an enormous amount of stress later.
This guide is about the practical pieces of helping with a parent’s Medicare in Arizona, including what documents you actually need, what each one lets you do, and how to handle the conversations with insurance companies when you need to act on a parent’s behalf.
Why HIPAA Stops You at the Door
The Health Insurance Portability and Accountability Act, or HIPAA, protects the privacy of your parent’s health information. It applies to insurance companies, doctors, hospitals, pharmacies, and Medicare itself. By default, none of those entities can share your parent’s medical or insurance information with anyone, including their adult children.
This is the case even if you are listed as an emergency contact. It is the case even if you are paying their bills. It is the case even if you have been their primary caregiver for years. Without specific authorization, you have no legal standing to access their information or make decisions on their behalf.
There are a handful of ways to gain that authorization. The right ones to set up depend on what you actually need to do.
The Three Documents Most Families Should Consider
There are three legal instruments that come up most often in Medicare situations. Not every family needs all three, but understanding them helps you decide what is right for your situation.
The first is a Medicare Authorized Representative form, often called a Form 1696 or a similar plan-specific form. This document gives a named person the right to act on the Medicare beneficiary’s behalf for Medicare-related matters. With this on file, an insurance company will speak to you about your parent’s plan, claims, appeals, and enrollment. It is the lightest-weight option and is sufficient for most ongoing plan management. It is also revocable at any time and can be limited in scope.
The second is a HIPAA Authorization form. Each carrier has its own version. Once your parent signs and submits one, the carrier can share information with the people listed. This is helpful for getting claim explanations and benefits information but does not let you make decisions or sign on your parent’s behalf.
The third is a durable power of attorney, sometimes split into a financial power of attorney and a healthcare power of attorney. A financial POA gives you legal authority to handle financial matters, including paying premiums, signing enrollment forms, and dealing with insurance and Social Security. A healthcare POA, also called a healthcare proxy or healthcare surrogate in some states, lets you make medical decisions if your parent cannot make them themselves. In Arizona, these are governed by state law and need to be drafted and signed properly to be valid.
For most adult children helping with day-to-day Medicare, a Medicare Authorized Representative form plus a HIPAA authorization is enough. For situations where a parent’s cognitive abilities are declining, where they are unable to make their own decisions, or where you may need to act broadly on their behalf, a durable power of attorney is essential.
How to Get the Documents Set Up
Setting up the basic Medicare authorizations is free and takes about 30 minutes. Each insurance company has a form on its website. You and your parent fill it out together, your parent signs, you submit it. The carrier processes it within a few business days, and from that point forward, you can call and speak with them about your parent’s plan.
Setting up a durable power of attorney is a bigger deal. In Arizona, the documents need to be signed in front of a notary, and the healthcare POA also requires a witness who is not a family member or healthcare provider. You can use a fill-in-the-blank form available from the Arizona Attorney General’s office, hire an estate planning attorney to draft custom documents, or use an online service. For most families, the Attorney General forms are sufficient and free. For families with complex assets or specific concerns, an attorney is worth the cost.
The biggest mistake I see is families waiting until a crisis. Once a parent has had a stroke, a serious cognitive decline, or a hospitalization that affects their decision-making capacity, they may no longer be legally able to sign these documents. At that point, the family has to go through guardianship or conservatorship in court, which is expensive, slow, and stressful. Doing the paperwork while everyone is healthy is one of the kindest gifts you can give your future self.
What You Can Actually Do With Each Authorization
Knowing what authorization gives you what powers helps you avoid frustration on the phone with insurance companies. Here is the practical breakdown.
With a Medicare Authorized Representative form filed with a specific carrier, you can call that carrier, discuss the plan, ask about claims, file appeals, request enrollment forms, and generally handle plan administration. You cannot enroll your parent in a different plan, change their address, or modify their banking information for premium payments. Those actions require their direct involvement.
With a HIPAA authorization, you can …