Frequently Asked Questions

The Initial Enrollment Period (IEP) is your first chance to sign up for Medicare. It starts three months before your 65th birthday, includes the month you turn 65, and ends three months after you turn 65. If you sign up in one of the three months before your birthday month, your Medicare coverage begins on the 1st day of your birthday month.

The VA encourages you to sign up for Medicare Part B as soon as you can when turning 65. This is because:  Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from. Funding for VA health care could change in the future.

If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a 10% penalty for each 12 month period you delay for your lifetime.

If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D as long as you enroll when you’re first eligible or within 63 days of when you no longer have VA health care or other creditable prescription drug cover

You’ll need to choose which benefits to use each time you receive care.

You’ll need to get care at a VA medical center or other VA location to use VA benefits. You are covered for your care if the VA pre-authorizes you (meaning the VA permits you ahead of time) to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.

If you go to a non-VA (or VA authorized) care facility, Medicare may pay for other services you may need during your stay. Or, if the VA only authorized some services in a non-VA location, then Medicare may pay for other services you may need during your stay. Check your Medicare plan, so you know which care locations and services you’re covered for.

Original Medicare: is a fee-for-service health insurance program with two parts:  Part A and Part B. You typically pay a portion of the costs for covered services, as you use them. The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital is $1,600 for 2023. Under Part B, the deductible is $226 for 2023, and after meeting the deductible,you typically pay 20% for outpatient services unless you select a Medigap plan. With Original Medicare, you can see any doctor or hospital that takes Medicare, anywhere in the U.S

Medicare Advantage Plan (Part C): a type of Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits instead of Original Medicare. It usually also includes drug coverage (Part D). You join a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. In most cases, you’ll save significant money but will need to use doctors within your plan’s network.  

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. 

• You need both Part A and Part B to buy a Medigap policy.
• Some Medigap policies offer coverage when you travel outside the U.S. 
• Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision, dental, hearing aids, private-duty nursing, or prescription drugs (Part D). 
• If you’re over 65 and have a health condition, you may not be able to qualify for a Medigap policy, or you may have to pay more.

Medigap policies are standardized and, in most states, named using letters. Lettered plans provide different benefits and costs vary based on the level or amount of benefits.  

The best time to enroll in Medigap is three months before you turn 65, through your 65th birthday month, and ends three months later. Enrolling when you are first eligible guarantees you will begin with the best rate. Those who delay can see their price go up when they decide to enroll. 

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP. 

You are eligible for a MA plan in Arizona if your “domicile,” and true home is in Arizona and where you intend to return to after any absences. Though domiciled elsewhere, you are nevertheless considered a “statutory resident” under state law, meaning you spend more than half the year in the state. an answer to this item.

If you move to a new city that is outside of your plan's network, you will lose your Medicare Advantage (MA) or Part D plan.It is best to inform your existing MA or Part D plan that you are moving. Assuming you have a Medicare Advantage plan, you have a Special Enrollment Period (SEP) and two months after you arrive in your new residence to enroll in a new plan or opt to return to Original Medicare. You should also visit the local social security office to make a change to resident address. 

Private Duty Home Care

Many private pay home care providers are in and around Phoenix as well as other Arizona cities. Private duty providers offer hourly or per-visit nursing, home health aide, and other non-skilled home care services. Family members or the patient need to call a licensed home care provider to inquire about or set up services. Preferably check reviews and testimonials and perform several provider comparisons. Most home care providers use an intake coordinator and will provide a free in-home assessment to develop a care plan. Payment is usually privately paid unless there is insurance or the patient qualifies for Aide and Attendance benefits through the Veteran Administration. 

Intermittent Home Health Care

Home Health Care is different than Private Duty Home Care. It covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language, pathology services, continued occupational therapy services, and more when both "Qualifying Criteria" and "Coverage" criteria are met. 

Individuals must be homebound and meet the following conditions:

• Was discharged from the hospital or a Transitional Care Unit (TCU), and the attending physician orders home health care 
• has an illness/injury requiring the aid of a support device; the use of special transportation; or the assistance of another person to leave their home
• has a medical condition that makes leaving home medically challenging, requiring considerable and taxing effort 
• makes infrequent absences from home for medically necessary reasons and may attend religious services or receive therapeutic, psychosocial, or medical treatment in an adult care facility licensed or certified by the state
• must be under the care of a physician
• services must be reasonable and necessary based on diagnosis and clinical consideration.