If you’re a Medicare beneficiary living in Alabama, you may be able to get Medicare insurance through the Medicare Advantage (Medicare Part C) program as an alternative to government-run Original Medicare, Part A and Part B. Alabama residents enrolled in Medicare Advantage, like those in other states, get their Part A and Part B benefits through private, Medicare-approved insurance companies. Your Alabama Medicare Advantage coverage depends on the plan you select and on where you live (not all plans are available state-wide).
How Medicare Advantage works in Alabama
Medicare Advantage plans are required by law to offer at least the same benefits as Original Medicare (except for hospice care, which Medicare Part A covers). So, while Alabama Medicare Advantage plans cover the same hospitalization and medical benefits offered by Original Medicare, they may offer additional benefits depending on the plan you choose.
In Alabama, as in other states, you need to meet these requirements to qualify for Medicare Part C:
- You must be enrolled in Original Medicare, both Part A and Part B.
- You must live in the service area of the Medicare Advantage
- You can’t have end-stage renal disease (ESRD), in most cases. There are a few exceptions. If you have ESRD and you’d like to enroll in Medicare Advantage, contact Medicare and see if you qualify (contact information is at the end of this article).
You can enroll in a Medicare Advantage plan during the following periods:
- Initial Coverage Election Period (ICEP):This is the period when a person is first eligible to sign up for Medicare Advantage.
- For those who enroll in Original Medicare (Part A and Part B) the first time they’re eligible, Medicare Advantage coverage is available as well. The ICEP is a seven-month period that starts three months before the month where you turn 65. The ICEP then runs through your birth month, and for three months after that.
- For those who delay enrollment in Medicare Part B, the ICEP is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your ICEP would be April 1 to June 30.
- You may already be enrolled in an Alabama Medicare Advantage plan but need to switch plans to get better or different coverage. You can change plans during the Annual Election Period, from October 15 to December 7 each year. Your new coverage generally begins on January 1 of the following year after you switch Medicare Advantage plans.
- As an Alabama Medicare beneficiary, you’re allowed to switch Medicare plans during Special Enrollment Periods if you experience certain special circumstances. These events include (but are not limited to) losing your current coverage, qualifying for other coverage, changes in your current plan that affect your health benefits, and moving to a new address where your old plan may not be available at all.
- If for some reason you decide to drop your Medicare Advantage plan and instead switch back to Original Medicare, Part A and Part B, you can do so during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year in Alabama and the rest of the United States. Since Original Medicare doesn’t include prescription drug coverage, you can add a stand-aloneMedicare prescription drug plan (Part D) during this time.
Types of Medicare Advantage plans in Alabama
Alabama Medicare beneficiaries who decide to enroll in a Medicare Advantage plan may have a number of plan options available to them – but remember, plan availability may vary.
Health Maintenance Organization (HMO) plans usually require beneficiaries to visit doctors, health care providers, and hospitals already included in the health plan’s network. In addition, HMO plans may require you to get a referral from your primary care doctor to receive coverage for a number of health services.
Health Maintenance Organization Point-of-Service (HMO-POS) plans, on the other hand, offer a bit more flexibility, allowing beneficiaries to sometimes go out of network for some health services (usually at a higher cost).
Preferred Provider Organization (PPO) plans* in Alabama (as in other states) may offer even more flexibility than HMO-POS plans, allowing beneficiaries to choose doctors, health-care providers, and hospitals outside the plan’s network, but again usually at a higher cost.
Private Fee-for-Service (PFFS) plans the plan itself decides how much it will pay for your health-care providers and hospital visits. The plan also determines your share of each expense.
Medical Savings Account (MSA) plans generally combine a high deductible with a savings account that beneficiaries can use to pay for their health-care expenses.
Medicare Special Needs (SNPs) plan limit enrollment to beneficiaries with special health needs, those living in institutions like nursing homes, or people who qualify for both Medicaid and Medicare. These plans offer coverage tailored to suit their health needs. There are SNPs for HIV/AIDS patients, for example, and for patients with congestive heart failure.
A Medicare Advantage plan that includes prescription drug coverage is called a Medicare Advantage Prescription Drug plan. Most of the plan types listed above include this coverage; they combine health and prescription drug coverage into a single insurance policy. It’s very important for you to understand that if you choose to enroll in any type of Medicare Advantage plan, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium to keep your health coverage.
Comparing Medicare Advantage plans in Alabama
Alabama Medicare Advantage plans may charge different costs and may have different rules regarding health services, depending on the plan you choose. These rules may change on an annual basis, so it’s important to compare available Medicare Advantage plans based on your own health needs and area of residence. Here are some other useful tips to consider before shopping for a plan:
- It’s important to remember that premiums for a Medicare Advantage plan with the same coverage and benefits can vary among counties in Alabama.
- Do keep in mind that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, in order to maintain your health coverage.
- Medicare Advantage plans may offer additional benefits, such as routine dental care, along with the basic hospital and medical insurance available under Original Medicare. Think about which benefits are important to you.
- You may also want to decide whether or not you want prescription drug coverage with your Medicare Advantage policy, and which prescriptions you need the plan to cover.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.