The DES Division of Aging and Adult Services houses two programs to aid with Medicare—the State Health Insurance Program (SHIP) and the Senior Medicare Patrol (SMP).
The State Health Insurance Assistance Program (SHIP) is a free health benefits counseling service for Medicare beneficiaries. Our mission is to empower, educate, and assist Medicare-eligible individuals, their families, and caregivers through objective outreach, counseling and training, to help individuals make informed health insurance decisions that optimize access to care and benefits. SHIP is an independent program federally funded by the Administration for Community Living and is not affiliated with the insurance industry.
If you have Medicare and have limited income and resources, you may be able to get help paying for your Medicare monthly payment. You may also qualify for assistance with Medicare prescription drug costs, doctor and hospital visits.
Medicare Advantage Plans are a series of Healthcare Plans that were created in partnership between Medicare and private insurance companies to provide cost efficient healthcare to Medicare-eligible beneficiaries.
When adopting an advantage plan, all healthcare charges are billed through the selected provider and not directly through Medicare.
There are five types of plans available in Arizona:
Health Maintenance Organization (HMO)
HMO is a group of doctors, hospitals and other health care providers who agree to give health care to Medicare beneficiaries for a set amount of money from Medicare each month. In an HMO, you usually must get all your care from the providers that are part of the plan and you need a referral from a primary care physician to go to specialists.
Preferred Provider Organization (PPO)
PPO is a managed care plan in which you use doctors, hospitals, and providers that belong to the network. You can receive services outside of the network for an additional cost. You do not need a referral from a primary care physician to go to a specialist.
Private Fee for Service (PFFS)
PFFS is a private insurance plan that accepts Medicare Beneficiaries. You may go to any doctor or hospital you want. The insurance plan, rather than the Medicare program, decides how much you pay for the services you receive. You may pay more for Medicare covered benefits. You may have extra benefits the original Medicare Plan does not cover.
Medicare Savings Account (MSA)
This type of health plan consists of two parts:
With this type of plan, Medicare pays the premium for the MSA plan and makes a deposit into the MSA established by the beneficiary. The money in the MSA can be used to pay for health services provided before the deductible is met and for services not covered by the MSA plan. After the deductible is met in a given year, Medicare-covered services are covered by the health plan.
Special Needs Plan (SNP)
SNP is an HMO type plan that limits the membership to people eligible for both Medicare and Medicaid (AHCCCS), who reside in certain long-term care facilities or who have chronic or disabling conditions. The Special Needs Plan must be designed to provide Medicare health care and services to people who can benefit the most from things like special expertise of the plan's providers, and focused care management.
Please be advised that not all types of plans are available in every county.
Medicare Plan Finder Online is a tool to search for and compare coverage options available in your area. A general plan search only requires your zip code. To personalize your search, enter your zip code and complete Medicare information.
The Senior Medicare Patrol’s (SMP) mission is to empower and assist Medicare Beneficiaries, their families and caregivers to prevent, detect, and report health care fraud, errors and abuse through outreach, counseling, and education.
SMP is a group of professionally trained staff and volunteers who teach Medicare beneficiaries how to protect their personal information, identify and report errors on their health care statements, recognize scams-such as illegal marketing, providing unnecessary services, and charging for services that were not provided-and report fraud and abuse to the proper authorities. There are SMPs in every state and many U.S. territories.
What do I do if I have been scammed?
If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits, you should contact your provider or plan. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, call your local Arizona SMP Helpline at 1-800-432-4040.
How do SMPs prevent health care fraud?
SMPs conduct outreach in their communities by presenting to groups, hosting exhibits and community events, providing one-on-one counseling, and answering calls to the SMP help lines. SMP volunteers also help Medicare and Medicaid beneficiaries who are unable to address fraud by themselves, and, if necessary, SMPs will refer beneficiaries to outside organizations that can investigate.
How can I protect myself against Medicare fraud?
Protect your personal information. Don’t give sensitive information to someone you don’t know. Your Social Security, Medicare, and bank account numbers can be used to defraud you. You also should avoid sending personal information on the phone or over an unsecure Internet connection. Never purchase items from a website that you’ve found from and e-mail link. If you know the name of an organization you want to do business with, go to the website on your own.
Don’t give any sensitive information out over the phone. Beware of people who say they’re from an organization such as Medicare and they need to know your Medicare number. If they truly were from Medicare, they wouldn’t need to ask. Nor would they call or visit your home. Also, consider getting on the federal DO NOT CALL list.
How can I detect fraud and identify errors?
1 (800) 432-4040
PLEASE NOTE: For questions regarding specific individual Medicare plan benefits or plan selection assistance, or to report suspected Medicare fraud, errors or abuse, individuals should contact the SHIP/SMP office in the county in which they reside.
Area Agency on Aging, Region Six
520-432-2528 extension 222
Area Agency on Aging, Region Eight
Benefits counseling for Tribal communities in Arizona. SHIP Hotline (800) 432-4040 option #2
Area Agency on Aging, Region One
Area Agency on Aging, Region Four
Western Arizona Council of Governments (WACOG)
928-377-4964 or 800-782-1886
Area Agency on Aging, Region Seven
Pima Council on Aging (PCOA), Region Two
Medicare Line: 520-790-7262
Area Agency on Aging, Region Five
Area Agency on Aging, Region Three
Northern Arizona Council of Governments (NACOG)
Show Low 877-521-3500
Flagstaff Office 877-521-3500