What Are Medicare Advantage Plans in Alabama?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans bundle Part A (hospital insurance) and Part B (medical insurance), and most include Part D (prescription drug coverage). Many plans also offer additional benefits like dental, vision, hearing, telehealth, and fitness memberships.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare (Parts A and B). Most people qualify for Medicare enrollment at age 65, though some may become eligible earlier due to disability or medical conditions such as ALS or ESRD.

You can enroll during the following periods:

• Initial Enrollment
• General Enrollment
• Special Enrollment

Missing your enrollment window or not qualifying for premium-free Part A may result in late penalties.

What Types of Medicare Advantage Plans Are Available in Alabama?

Alabama offers several types of Medicare Advantage plans:

• Health Maintenance Organizations (HMOs): Require you to use a network of doctors and hospitals; referrals are needed for specialists.
• Preferred Provider Organizations (PPOs): More flexible than HMOs, allowing out-of-network care at higher cost and usually no referrals.
• Private Fee-for-Service (PFFS): Lets you see any Medicare-approved provider who accepts the plan terms; some PFFS plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions such as diabetes or heart disease.
  • I-SNPs: For individuals who live in institutions or need nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For those who qualify for both Medicare and Medicaid; these plans often include extra benefits with minimal or no costs.
• Medical Savings Accounts (MSAs): Pair a high-deductible health plan with a medical savings account funded by your plan provider.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, MSAs and some PFFS plans do not. If your plan doesn’t offer drug coverage, you may:

• Enroll in a standalone Part D plan (if allowed).
• Face a late enrollment penalty if you wait to get prescription drug coverage and do not have other creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, take time to understand Medicare Advantage costs. Here’s what to consider:

• Premiums: Some plans have $0 premiums, though other costs may be higher. Others have monthly fees depending on benefits.
• Deductibles, Coinsurance & Copays: Understand how much you’ll pay for services before and after your deductible.
• Out-of-Pocket Maximums: Plans limit how much you’ll spend each year on covered services.
• Extra Benefits: Some plans offer services beyond Original Medicare, including dental, vision, hearing, telehealth, and gym memberships.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, drop, or switch an MA plan.
• General Enrollment (Jan 1–Mar 31): For new Part B enrollees.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or go back to Original Medicare.
• Special Enrollment Periods: May apply if you:
  • Move out of your plan’s area
  • Lose existing coverage
  • Experience plan termination
  • Develop a condition qualifying you for a SNP

What If You Want to Change Your Medicare Advantage Plan?

You can switch Medicare Advantage plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Once you enroll in a new plan, your previous coverage will end automatically when the new plan becomes active.

What Are Medicare Resources in Alabama?

Alabama provides several helpful resources for Medicare beneficiaries:

• Alabama SHIP Program: Offers free counseling on Medicare coverage and options.
• Alabama SMP Program: Educates beneficiaries on identifying and avoiding Medicare fraud.
• Alabama Department of Insurance: Oversees insurance providers and helps with Medicare complaints.
• Alabama Medicaid Program: Offers financial assistance to low-income residents. Visit medicaid.alabama.gov or call 1-800-362-1504. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, are standardized plans sold by private insurers that cover out-of-pocket expenses not covered by Original Medicare, such as deductibles, coinsurance, and copayments.

• You must have Medicare Parts A and B to enroll.
• The best time to enroll is during your six-month Medigap Open Enrollment Period, which starts when you enroll in Part B.
• After this window, you may be subject to medical underwriting.
• Medigap plans do not include drug coverage—you’ll need a separate Part D plan.
• There are 10 standardized Medigap plans. Medicare Supplement Plan G had the highest enrollment in 2023, and both Plans G and N are growing rapidly.
• Plan F is no longer available to individuals who became eligible for Medicare after January 1, 2020.
• Medigap offers consistent benefits, no network restrictions, and nationwide access to Medicare providers.

Learn more about Medicare Supplement plans in Alabama.

Next Steps

If a Medicare Advantage plan in Alabama aligns with your healthcare needs and budget, compare options in your area. Evaluate provider networks, premiums, out-of-pocket costs, and available extra benefits—then enroll during the appropriate enrollment period.