If you’re a Medicare beneficiary living in Alabama, you can get private insurance through Medicare Advantage (Medicare Part C) 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 these private plans. Your Alabama Medicare Advantage coverage depends on the plan you select and on where you live (not all plans are available state-wide).
Medicare Advantage (Part C) is required by law to offer at least the same benefits as Original Medicare. So, while Alabama Medicare Advantage plans cover the same hospitalization and medical benefits offered by Original Medicare, they may offer additional benefits, like vision, hearing, and dental services, 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 can enroll in a Medicare Advantage plan during the following periods:
Alabama Medicare beneficiaries who decide to enroll in a Medicare Advantage plan have a number of plan options available to them.
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 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 at a higher cost.
Private Fee-for-Service (PFFS) plans are unusual in that 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.
Any Part C 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 premiums to keep your health coverage.
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: