October 6, 2016
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).
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 can enroll in a Medicare Advantage plan during the following periods:
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.
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:
*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.