Frequently Asked Questions (FAQs)

Where are Banner Medicare Advantage plans available? 

Banner Medicare Advantage plans are available to Medicare-eligible individuals who reside in Maricopa, Pima, Pinal, Santa Cruz and/or Yuma Counties in Arizona (known as the plan “service area”). You must live in one of these areas to join the plan and reside in the service area while you are a plan member. Once becoming a Banner Medicare Advantage member, if you plan to move out of the service area, please call our Customer Care Center.  

Who is eligible to join Banner Medicare Advantage? 

You can join Banner Medicare Advantage if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area.

I recently moved to Maricopa, Pima or Pinal County, and the Medicare plan I chose is not offered here. May I enroll in Banner Medicare Advantage now or do I have to wait for annual open enrollment? 

If you have moved to Maricopa, Pima, Pinal, Santa Cruz or Yuma County and the county in which you now live is not in your current plan’s service area, you need to contact our Customer Care Center for your current plan. Your current plan will confirm whether or not you are in the plan service area; if you are not, they will initiate a “Special Enrollment Period” for you, during which you can enroll in a Banner Medicare Advantage plan, if eligible. 

Can I choose my doctors/providers? 

Banner Medicare Advantage includes a network of more than 3,000 providers across medical specialties and sub-specialties. You will have the opportunity to choose each of your providers among this network, as well as change providers at any time. To see if your providers are in the Banner Medicare Advantage network, click here

Does the Banner Medicare Advantage network of providers include physicians that speak languages in addition to English, like Spanish?   

Yes. At Banner, we appreciate and honor the diversity of our members. That’s why we have providers within our network that speak additional languages, including Spanish. In addition, we offer language interpretive services for members at no cost, as well as plan materials in additional languages. To learn more about how we support your culture and lifestyle as well as in-language services, please read about our commitment to cultural competency. 

Can I go to a provider who is not in the Banner Medicare Advantage network?

Banner Prime members generally must use our network of providers. If you use out-of-network providers without getting authorization first, you will have to pay the cost for these services, just like Traditional Medicare. There are a few exceptions to this rule. These exceptions include emergencies, urgently needed services when the network is not available (such as, when you are out of the area), out-of-area dialysis services, and cases in which Banner Prime authorizes you to use out-of-network providers.  

Banner Plus members have the option of using in-network or out-of-network providers. Out-of-network providers may have higher copayments or coinsurance than our in-network providers. Emergency care and urgent care are the same copayment whether you get that care from in-network or out-of-network providers.  

How do I compare the Banner Medicare Advantage plan options with the Original Medicare Plan? 

For each Banner Medicare Advantage plan, a Summary of Benefits, which enables you to easily compare what the Banner Medicare Advantage plan covers for each benefit. In summary, Banner Medicare Advantage members receive all the benefits offered through the Original Medicare Plan plus additional benefits.

If I choose a Banner Medicare Advantage plan during annual enrollment, can I switch to a different Banner Medicare Advantage plan during the year? 

You are limited in when and how often you can join, change or leave a Medicare Advantage Plan (also known as a Medicare private health plan) or prescription drug plan (Part D). 

  • You can enroll in a Medicare Advantage or Part D plan during the initial period when you first qualify for Medicare.
  • You can switch from your Medicare Advantage Plan to another MA Plan, or to Original Medicare with or without a Part D plan, during the Medicare Advantage Open Enrollment Period (MA OEP). The MA OEP occurs each year from January 1 through March 31. You can only use this period if you have a Medicare Advantage Plan.
  • You can change your health coverage and add, drop, or change your drug coverage during Fall Open Enrollment. Fall Open Enrollment occurs each year from October 15 through December 7. 

Outside of the above three periods, you can only change your health and/or drug coverage if you qualify for a Special Enrollment Period (SEP). 

Do Banner Medicare Advantage plans cover Medicare Part B prescription drugs as well as  Part D prescription drugs? 

Yes. Banner Medicare Advantage covers both Medicare Part B and Part D prescription drugs.   

Where can I get my prescriptions filled?  

Banner Medicare Advantage offers a mail -order option as well as an expansive network of pharmacies at which you can have your prescription filled and refilled. Banner Family Pharmacy offers mail -order prescription services with co-pays less than or equal to what you would pay at a retail pharmacy; additionally, you can receive 90-day supplies shipped right to your home with no shipping costs. If you choose to have your prescription filled at a retail pharmacy, you must use an in-network pharmacy; if you get a prescription filled at an out-of-network pharmacy, the costs may not be covered by your Banner Medicare Advantage plan. For a list of Banner Medicare Advantage network pharmacies, click here.  

What is a Formulary?

A Formulary - commonly called a “list of covered drugs”- is a list of all prescription medications covered by your plan. Banner Medicare Advantage’s Formulary is expansive and designed to meet the wide variety of medical needs of our members. As our members’ needs are constantly evolving and new medications become available regularly, the list of covered drugs is updated. Anytime a change to the list impacts you, Banner will notify you before the change is made and work with you to get you a temporary supply of the medication to provide you and your provider the opportunity to review your treatment plan and change the prescribed medication, as appropriate. For most medical conditions, more than one brand or type of medication is available for treatment, so you can feel confident an appropriate alternative will be available. Your provider will review the available options with you, so you can choose the option that’s right for you. With your physician’s assistance, our Customer Care Center can also be contacted to request an exception, in the event the needed medication is not on the current Formulary List. To see if your medications are included in the current Banner Medicare Advantage Formulary Directory, click here.  

Learn more about the referral and prior authorization process. View the tip sheet below.