Medicare Advantage Plans in Alabama
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: February 10, 2021
Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare Parts A and B that provides hospital and general medical care. Alabama seniors who choose a Medicare Advantage plan have the same coverage as Original Medicare and may have additional options, including prescription drugs, dental, vision, and hearing services. Like most employee healthcare options, Medicare Advantage plans are offered by private insurance companies, not the federal government, as with Original Medicare. However, the insurers are approved and regulated by the government. Depending on a senior's needs, a Medicare Advantage plan may provide better overall value.
- 1 In 2019, there were 49 Medicare Advantage plans available in Alabama.
- 2 37% of the total Medicare population in Alabama is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $10,731 per beneficiary in Alabama, which is 6% higher than the national average.
- 4 Available Medicare Advantage plans range from seven to 37 across Alabama’s 67 counties.
Medicare Advantage Plans in Alabama
Types of Medicare Advantage Plans
In Alabama, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available varies by county. Before choosing a plan, it’s important to understand the eligibility and enrollment requirements, especially for SNPs. Seniors should also learn about the coverage options provided and the costs before committing to a plan. To help with this decision-making process, seniors may wish to consult state and local resources that offer guidance about Alabama’s Medicare Advantage program.
Health Maintenance Organizations (HMO)
HMO plan enrollees must choose providers who are part of a network of doctors, hospitals, and other medical professionals. The plans generally only cover services from network providers. If plan members opt for medical care outside of the network, they’re responsible for the cost, except in specific emergency situations. Seniors with HMO plans must also choose a primary physician within the network who makes the majority of their treatment decisions and refers them to specialists, as necessary. Although HMO plans have these restrictions, they’re a popular choice because they usually offer more affordable premiums and lower deductibles than other types of Medicare Advantage plans.
Preferred Provider Organizations (PPO)
For Alabama seniors who want a Medicare Advantage plan with more flexibility, PPO plans may be a better choice. Although these plans typically have higher premiums and always have deductibles, they tend to have larger networks of healthcare providers and will usually pay at least part of the cost for visits to an out-of-network provider. Plan members who use in-network providers typically pay lower co-pay and coinsurance rates. PPO plans also don’t require seniors to choose a primary care provider, and plan members usually don’t need referrals to see specialists.
Private Fee-For-Service Plans (PFFS)
Out of all the Medicare Advantage plan types, PFFS plans offer the most flexibility to plan members when it comes to which healthcare providers they can see. PFFS plans may have a partial or full network of providers, or they may have no network at all. This allows seniors to receive full coverage when they visit any Medicare-approved provider who accepts the plan’s terms and conditions of payment. However, members tend to pay higher premiums under a PFFS plan because they pay providers on a fee-for-service basis. PFFS plans are less common than other types of Medicare Part C plans, and there may not be a PFFS plan available in some Alabama counties.
Special Needs Plans (SNP)
SNPs are special Medicare Advantage plans that only accept members who have certain health conditions or meet specific conditions. These plans are typically limited to a geographic service area that may be as small as one city or county, and they tend to have very high premiums because of the type of coverage they provide. An SNP is only available to those who live in nursing homes or require home care, are eligible for both Medicare and Medicaid, or have specific chronic or disabling illnesses or diseases. Seniors who are members of an SNP plan must receive all of their care from a targeted provider network. These plans are less common and may not be available in all areas.
Enrollment & Eligibility for Medicare Advantage Plans in Alabama
Alabama seniors become eligible for Medicare Parts A and B when they reach 65 years of age. They may also enroll earlier if they have a qualifying disability. These seniors may choose a Part C, or Medicare Advantage, plan instead if they meet the following qualifications:
- Live in an area where Medicare Advantage plans are sold
- Are not enrolled in Medigap insurance
- Are a U.S. citizen or permanent resident
- Do not have an end-stage renal disease (an SNP may offer coverage)
Individuals who receive Social Security or Railroad Retirement Board benefits are automatically enrolled in Medicare Parts A and B when they turn 65.
Alabama seniors who wish to enroll in a Medicare Advantage plan must do so during specific enrollment periods. These periods differ for first-time applicants and those already enrolled in a Medicare plan who wish to change plans. The following criteria can help you determine which is the right enrollment period for your situation.
- Initial coverage election periods are for first-time joiners and run for a seven-month period, covering the three months prior to an enrollee’s 65th birthday month, the birthday month itself, and the three months following.
- Current Medicare recipients who want to switch to Medicare Advantage for the first time or Medicare Advantage members who wish to change plans can do so during annual election periods, which run from October 15th to December 7th each year.
- Medicare Advantage plan members who want to change plans or switch back to Original Medicare may do so during open enrollment periods, which run each year from January 1st to March 31th.
- Individuals who already had Medicare Part A but enrolled in Part B for the first time during the open enrollment period may qualify for a special enrollment period that runs from April 1st to June 30th if they wish to switch to a Medicare Advantage plan.
Prescription Drug Coverage
Most seniors will need prescription drug coverage. Seniors who are covered by Medicare Part A or Part B can get a stand-alone Medicare prescription drug plan, also called Medicare Part D. However, many plans under Medicare Part C, or Medicare Advantage, have prescription drug coverage. Sometimes Medicare Advantage plans that come with prescription drug coverage are called MA-PDs.
Because seniors covered under Original Medicare need a separate prescription drug plan, this has caused some confusion for Medicare Advantage plan members. If a senior opts for a Medicare Advantage plan and needs drug coverage, it’s best to choose a plan that includes a Part D component. Members of some Medicare Advantage plans are prohibited from enrolling in a separate Medicare Part D plan. If they do, they’ll be automatically disenrolled from their Medicare Advantage plan and returned to Original Medicare.
Medicare Advantage Resources in Alabama
Healthcare coverage is one of the most pressing issues for Alabama seniors. Having the right plan can make a huge difference in a senior’s quality of life. However, it can sometimes be difficult for seniors to navigate all the available options to find a plan that best serves their needs. Fortunately, several organizations in Alabama provide assistance to seniors who are trying to choose a Medicare Advantage plan.
Alabama State Health Insurance Assistance Program (SHIP)
The State Health Insurance Assistance Program (SHIP) is a free counseling program provided by the Alabama Department of Senior Services. The Alabama SHIP is part of a federal network of SHIP programs located in every state. The purpose of SHIP is to provide free health insurance information and guidance for people eligible for Medicare.
Since private insurers provide Medicare Advantage plans, SHIP counselors are volunteers who are not affiliated with any insurance company and don’t try to sell seniors a specific plan. SHIP keeps all of its counseling records confidential. SHIP counselors typically work through the state’s Area Agency on Aging Offices.
Contact Information: Website | 800-243-5463
Senior Medicare Patrol
The Alabama Administration on Aging (AOA) started the Senior Medicare Patrol (SMP) in 1996 to help seniors who are at risk of being victims of healthcare fraud. Seniors who are overwhelmed by their healthcare choices may not know which plans and resources are trustworthy and need assistance. The SMP trains retired professionals and other seniors about how to recognize and document healthcare fraud and provides better awareness and understanding of available healthcare programs in Alabama. The goal is to give seniors the knowledge to protect themselves from financial and medical consequences of Medicare and Medicaid fraud, error, and abuse.
Contact Information: Website | 800-243-5463
Legal Counsel for the Elderly
Legal Services Alabama has a special program called Legal Counsel for the Elderly that provides free legal, educational, and outreach services to qualifying Alabama residents aged 60 and older. Legal Services Alabama is a statewide, nonprofit law firm. Any senior who needs representation or advice about a legal issue, including an insurance question, may apply for its services. However, not everyone who applies receives assistance because of program limitations, and only the individual who needs legal assistance may apply.
Contact Information: Website | 866-456-4995
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