What Are Medicare Advantage Plans in Alabama?
If you’re looking for Medicare Part A and B coverage in Alabama, Medicare Advantage plans are a useful option. These are offered by private insurance companies that must follow Medicare guidelines. Medicare Advantage (MA) plans, or Medicare Part C, typically include prescription drug coverage, also known as Medicare Part D.
What You Need to Know
Medicare Advantage plans come in several types, including HMO and PPO.
They include coverage for Medicare Part A and B, or Original Medicare.
Some Medicare Advantage plans have no premiums, while others carry a monthly cost.
What Types of Medicare Advantage Plans Are Available?
There are several types of Medicare Advantage plans from which to choose:
1) HMO:1 Health maintenance organization, which limits members to a contracted medical network of providers.
2) PPO:2 Preferred provider organization, which offers a greater choice of providers than an HMO but typically at an increased cost.
3) SNP:3 Special needs plans, which are for patients needing specialized care. There are three types:
- Chronic condition: A condition lasting one or more years, requiring ongoing medical attention
- Dual eligible: For those who get both Medicare and Medicaid
- Institutional: For those who need or expect to need services in long-term care or another inpatient facility
4) PFFS: Private fee-for-service. These are typically networks where a group of contracted providers offer medical care, and the plan decides how much it pays for services. You don’t have to pick a primary care doctor.
5) MSA: Medicare savings account, a two-part plan mixing high-deductible coverage with a medical savings account.
What Are Prescription Drug Options with Medicare Advantage?
Prescription drug coverage under Medicare Advantage offers two options: a stand-alone plan or coverage as part of your Medicare Advantage plan, also known as an MA-PD plan. In Alabama, you can switch to a Medicare Advantage prescription plan if your current insurance plan doesn’t provide this coverage. You’ll be able to do this during a special enrollment period from October 15 to December 7. However, if you’re eligible for a Special Election Period, you may be able to switch anytime during the year.
Looking for Drug Coverage?
You have two options for prescription drug coverage: a stand-alone plan, or as part of your Medicare Advantage plan.
How Do You Choose Medicare Advantage Plans?
Make sure you’re picking the right MA plan for your needs. Let’s look at some of the major factors in this decision.
All plans cover Medicare Part A (hospital services) and B (preventive and outpatient services), or Original Medicare. Additional benefits can include:
- Vision, including exams, contacts and glasses fittings.
- Dental, including routine dental care and supplies.
- Telehealth, including medical office visits, consultations, and psychotherapy.
- Other perks such as access to fitness programs and hearing aids.
First off, think about premiums. There are zero-premium plans, which carry no monthly cost. In exchange for no premium, though, you might have higher out-of-pocket costs for services.
The plans that require monthly premiums vary in cost. You can evaluate these costs at the Medicare site.4
Other costs — which vary by plan — include:
- Coinsurance, which is the percentage that you pay for services. Most Original Medicare charges 20% coinsurance.
- Copays, which are a set amount that you pay for most services.
- Deductibles, which is the portion you need to pay for services before your insurance kicks in.
- Maximum out-of-pocket costs, which in 2020 can be up to $6,700.
No matter what, you’ll still have to pay your Medicare Part B premium ($148.50 a month in 2021).
You’ll save money on your medical costs by staying with in-network providers.
When and How Do You Enroll in Medicare Advantage?
In Alabama, there are multiple agencies that can help you enroll in Medicare Advantage, including the State Health Insurance Assistance Program, or SHIP. You can also find plans directly through the Medicare website.
A few terms to know:
- The initial enrollment period, when you’re first eligible for Medicare, is a seven-month window that begins three months before you turn 65 and ends three months after you turn 65.
- The annual election period, or Open Enrollment Period, is the time when you can join a Medicare Advantage plan, add prescription drug coverage, switch plans, or go back to Original Medicare. This runs from October 15 to December 7.
- The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. This is when you can switch to a different MA plan either with or without prescription drug coverage.
- The Medicare general enrollment period also runs January 1 to March 31, with coverage beginning July 1.
- The special enrollment period allows you to enroll under certain circumstances, including:
- Loss of coverage, such as losing Medicaid eligibility
- Gain of coverage, such as qualifying for employer or union coverage
- Plan changes, such as Medicare termination of a current plan’s contract
- Other special circumstances, such as a chronic condition that would be best served by another plan
How Much Do Medicare Advantage Plans Cost in Alabama?
Medicare5 Advantage plans in Alabama start at a monthly premium of $7.30 without prescription drug coverage (approximately $87.60 per month with prescription drug coverage) and range up to $25.60 per month (approximately $307.20 with drug and premium cost combined).
What If You Want to Change Your Medicare Advantage Plan?
If you’re already enrolled in Medicare Advantage, you can switch to your desired plan during the above enrollment periods.
What Are Alternatives to Medicare Advantage?
You have a few options besides a Medicare Advantage plan:
- PACE:6 Programs of All-Inclusive Care for the Elderly. PACE offers all-inclusive medical and social services to those who meet the following conditions:
- 55 or older
- Nursing-home care eligibility
- Ability to live safely in a community
- Live in a PACE service area
- Original Medicare only. Keep in mind this won’t provide prescription drug, vision or dental coverage, and you likely won’t have a cap on out-of-pocket costs.
- Medicare Supplement plan. Also known as Medigap, this plan, provided by a private insurance company, can help pay costs not fully covered under Original Medicare.
- Medicare Supplement with a Part D plan. This is Medigap with prescription drug coverage.
What Are Medicare Resources in Alabama?
- State Health Insurance Assistance Program.7 Also known as SHIP, this program is a volunteer-run, unbiased counseling service that helps beneficiaries enroll in Medicare.
- Alabama Department of Insurance.8 This is a comprehensive resource offering information about the state insurance marketplace.
- Medicaid.9 Also known as the Medicare Savings Program, this joint federal and state program provides coverage to nearly 73 million Americans who need help because of a limited income, disability, or other factors.
If a Medicare Advantage plan best fits your needs and your budget, reach out to an enrollment agency or to Medicare to find an insurance company. Make sure you’re picking the level of coverage and the costs that work for you before you sign up.