Medicare Advantage vs. Medigap in Arizona

How each option works

Everyone with Medicare starts with a choice between two paths. Both cover everything Original Medicare covers; they differ in how you get care and how you pay for it.

Either way you keep paying your Part B premium ($202.90 standard in 2026), unless an AHCCCS Medicare Savings Program pays it for you.

Side-by-side comparison

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.

Prior authorization in Arizona

Medicare Advantage plans can require you or your doctor to get approval before some services, such as certain scans, procedures or a skilled nursing stay. Original Medicare traditionally hasn't, but since January 1, 2026, Arizona is one of six states in CMS's WISeR model, which runs through 2031 and adds prior authorization or pre-payment review in Original Medicare for a short list of services, such as skin substitutes, electrical nerve stimulator implants and knee arthroscopy for osteoarthritis. CMS says it doesn't change what Medicare covers and excludes emergency and inpatient-only services. Ask your doctor whether it affects a procedure you're planning.

Arizona factors to weigh

Urban and rural networks

Medicare Advantage choices depend heavily on your county. For 2027, CMS lists 52 Medicare Advantage plans open to everyone in Maricopa County and 52 in Pima County, but 7 in Apache County, 8 in Greenlee County and 8 in Navajo County. In rural counties, fewer plans can mean networks with fewer local doctors and long drives to in-network specialists. Original Medicare works the same in every county. Look up yours on the county pages.

Snowbirds and travel

If you split the year between Arizona and another state, the differences matter most. Original Medicare and Medigap have no service area and no time limit away. A Medicare Advantage plan covers emergency and urgently needed care anywhere in the U.S., but routine care away from home depends on the plan, and under 42 CFR 422.74 the plan must disenroll you after more than 6 months in a row away, or up to 12 with a visitor/traveler program. See snowbirds and seasonal residents.

Care across state lines

Some Arizona communities get much of their care in a neighboring state. People in Mohave County may go to Nevada, people in Greenlee County to New Mexico, and people in Yuma and La Paz counties to California. Original Medicare covers providers in any state who accept Medicare. A Medicare Advantage plan's network may or may not include providers across the state line, so if you rely on them, check the plan's provider directory, or call the provider's office, before you enroll. Along the Navajo Nation, the same question applies to care in New Mexico and Utah; see tribal nations and IHS.

AHCCCS members and D-SNPs

If you have both Medicare and AHCCCS, the usual comparison changes. Insurers generally can't sell you a Medigap policy while you have Medicaid, and AHCCCS or a Medicare Savings Program such as QMB already helps with Medicare's cost sharing. People with full AHCCCS benefits may be able to join a dual-eligible special needs plan (D-SNP), a Medicare Advantage plan designed for people with both programs, and can change plans more often than once a year. If you have ALTCS for the elderly and physically disabled, the D-SNP you pick can change which ALTCS plan you're in. Read AHCCCS and Medicare and Can I have AHCCCS and Medicare Advantage?

Arizona's one-time Medigap window

This is the factor people most often miss. Your Medigap open enrollment period lasts 6 months from the month you're 65 or older and enrolled in Part B. During it, any company must sell you any Medigap policy it offers in Arizona without health questions. After it, Arizona gives you no birthday rule or yearly switching right (A.R.S. § 20-1133), so an insurer can review your health history and may decline you or charge more.

That makes switching back harder. If you choose Medicare Advantage at 65 and want Original Medicare with Medigap at 72, you can drop the plan during the Annual Enrollment Period or the January 1 to March 31 Medicare Advantage Open Enrollment Period, but the Medigap application may be underwritten. Federal law protects you in some cases:

• Trial rights. If you joined a Medicare Advantage plan when you first became eligible at 65 and leave within the first 12 months, you can buy any Medigap policy sold in Arizona. If you dropped a Medigap policy to try Medicare Advantage for the first time and leave within 12 months, you can get your old policy back if it's still sold, or another one.
• Your plan leaves. If your plan stops serving your area, or you move out of it, you can buy Medigap Plan A, B, D, G, K or L (or C or F if you were eligible before 2020).

More on whether Medigap is guaranteed issue in Arizona and when you can buy Medigap.

If your plan is ending in 2027

Several companies end Medicare Advantage plans in Arizona for 2027: three stop selling regular plans in some counties, and others end some plans while keeping others. If you received a non-renewal notice, you can choose another Medicare Advantage plan or go back to Original Medicare. Your special enrollment period runs until February 28, 2027; choose by December 31, 2026 to avoid a gap. If you go back to Original Medicare, you have a guaranteed right to buy a Medigap policy until 63 days after your plan ends, which is March 4, 2027, and you'll want a Part D plan too. See Arizona plans ending in 2027.

How to decide: questions to ask yourself

There's no single right answer. Your answers to these questions point you toward the option that fits:

1. Doctors: Are the doctors and hospitals you want in a plan's network, or do you want to see any provider in the U.S. that accepts Medicare?
2. Location: Do you live in a county with many plans or few? Do you get care across a state line?
3. Time away: How many months a year do you spend outside Arizona, and how much routine care do you need while you're away?
4. Costs: Would you rather pay more each month and less when you get care, or less each month and copays when you get care, up to a yearly limit?
5. Drugs: Which drug coverage includes your prescriptions and your pharmacies?
6. Approvals: How do you feel about prior authorization and referrals for some services?
7. Health and the future: If you might want Medigap later, are you prepared for health questions, given Arizona's one-time window?
8. Other coverage: Do you have AHCCCS, ASRS or other retiree coverage, TRICARE For Life, VA or IHS care that changes the picture?

Turning 65? Start with Turning 65 in Arizona. To see what's sold where you live, compare plans in your ZIP code, or call (602) SENIORS (602-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you, about plans from the companies they work with.

Sources

• Medicare.gov — Compare Original Medicare and Medicare Advantage
• Medicare.gov — When can I buy Medigap?
• CMS — Choosing a Medigap Policy (trial rights and guaranteed issue rights)
• Arizona Legislature — A.R.S. § 20-1133, Medicare supplement insurance
• NAIC — State Medigap rules: "Birthday Rule" and coverage for under 65, as of May 11, 2026
• eCFR — 42 CFR 422.101, Requirements relating to basic benefits (maximum out-of-pocket limits)
• eCFR — 42 CFR 422.74, Disenrollment by the MA organization
• CMS — Wasteful and Inappropriate Service Reduction (WISeR) Model
• AHCCCS — Members with Medicare and AHCCCS (dual eligible)
• AHCCCS — ALTCS-EPD and D-SNP alignment FAQ
• CMS — Medicare Advantage and Part D Landscape files, CY2027

Frequently asked questions

Can I switch from Medicare Advantage to Medigap later in Arizona?

You can return to Original Medicare during the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period, but getting a Medigap policy is a separate step. Arizona has no birthday rule, so unless you have a federal guaranteed-issue right, such as your plan leaving your area or a trial right in your first year, an insurer can ask health questions and may turn you down or charge more.

Which is better for Arizona snowbirds, Medigap or Medicare Advantage?

Neither is right for everyone. Original Medicare with Medigap works with any provider in the U.S. that accepts Medicare, with no time limit away from home. A Medicare Advantage plan covers emergencies and urgently needed care anywhere in the U.S., but routine care away from its service area depends on the plan, and the plan must disenroll you after more than 6 months away unless it has a visitor/traveler program.

Is there an out-of-pocket limit with Medicare Advantage?

Yes. Every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. In 2026 the in-network limit can be no higher than $9,250; a plan can set a lower limit, so check each plan's Evidence of Coverage. Original Medicare has no yearly limit by itself; a Medigap policy fills that gap to the extent of its plan letter.

Can I have Medigap if I have AHCCCS?

Generally not. Insurers generally can't sell you a Medigap policy if you have Medicaid, and AHCCCS or a Medicare Savings Program like QMB already helps with Medicare's cost sharing. People with full AHCCCS benefits and Medicare may be able to join a dual-eligible special needs plan (D-SNP) instead.

My Medicare Advantage plan is ending in 2027. Can I get Medigap?

Usually yes. When a Medicare Advantage plan stops serving your area, you have a federal guaranteed right to buy Medigap Plan A, B, D, G, K or L (or C or F if you were eligible before 2020) without health questions. For plans ending December 31, 2026, you can apply until 63 days after the plan ends, which is March 4, 2027.

Medicare in your Arizona county

Plans, local agents and help, county by county: Apache · Cochise · Coconino · Gila · Graham · Greenlee · La Paz · Maricopa · Mohave · Navajo · Pima · Pinal · Santa Cruz · Yavapai · Yuma