Medicare Advantage Plans in Alabama

Getting started with Medicare:

Medicare is the most extensive government national health insurance program in the United States. It’s health insurance designed for people aged 65 and older. 

What are the parts of Medicare?

• Medicare Part A (Hospital Insurance): covers hospital (inpatient, formally admitted only), skilled Nursing (only after officially admitted to a hospital for a minimum of three days, and Hospice services. You can receive Part A for free if you’ve worked for ten years (40 quarters) and have paid enough Medicare taxes. Otherwise, you’ll have to pay the monthly premiums for Part A.

You may purchase Part A if you don’t qualify for the free Part A of the premium. In 2023, the Part A premium for those who have to pay is $506 per month. (Source: https://www.medicare.gov/)

• Medicare Part B (Medical Insurance): It covers outpatient services, including some providers’ services, outpatient hospital charges, medical supplies, and preventive services. 

• Medicare Part C (Medicare Advantage): It is alternatively called Medicare Advantage. The federal government pays a fixed fee per enrollee to insurance companies, which then offer the essential services of Original Medicare, payments to care providers, and often additional benefits. Usually, Part C also includes medications. Medicare Advantage Plans have a Maximum Out of Pocket for medical spending, but original Medicare doesn’t. 

Now that you learned about the parts of Medicare, we will dig deeper and explore your options in this article about the Medicare Advantage plan in Alabama.

Understanding Medicare Advantage plan in Alabama

Medicare Advantage plans offer some essential differences that set them apart from Medicare parts A and B of the Original Medicare.

Plans must provide the benefits as original Medicare. They may include additional health services such as routine hearing, dental and vision, and fitness club memberships, to name a few.

Private insurance companies offer Medicare Advantage plans. Different Medicare Advantage plans are available depending on your insurance provider and location.

Types of Medicare Advantage Plans in Alabama

There are four types of plans available under Alabama’s Medicare Advantage program. Each one offers a different level of flexibility in its network of care providers, and their price varies.  

• Health maintenance organization (HMO): You usually need to receive all services from in-network providers. You’ll need a primary care physician (PCP), referrals to specialists, and approval from your insurance company to accept specific treatments or procedures. Some prescriptions will also require pre-authorization. It’s also best to ensure that your favorite doctor is in the network.

Drug coverage is usually included. You’ll need to review your plan’s benefits to see if the drugs you take are covered. You can’t have standalone drug insurance if you have a Medicare Advantage Plan. 

• Preferred Provider Organization (PPO): PPO members can use in-network and out-of-network providers, including hospitalizations. You can select doctors or hospitals from outside the network at a higher cost. You usually pay less when you use in-network providers. 

• Special Needs Plans (SNPs): The plan is for people with specific conditions and includes care coordination and services tailored to their particular needs. 

• Private Fee-for-Service Plans (PFFS): These plans offer Medicare benefits that can cover out-of-pocket expenses not covered by original Medicare. It does not require you to see only in-network healthcare providers.

Other less common types of Medicare Advantage Plans that may be available in Alabama: 

• HMO-POS Plan (Point-of-Sale): This type offers the same features as an HMO plan. But there is a big difference. HMO POS plans allow members to see some specialists (in network) without a Primary Care Provider referral.

• Medicare Medical Savings Account (MSA) Plan: MSAs are similar to HSAs (health savings accounts).

When should you sign up for Medicare Advantage plans in Alabama? 

Suppose you want to enroll in an Alabama Medicare Advantage plan. In that case, you must enroll in Medicare Parts A and B. You cannot use both a Medigap plan and a Medicare Advantage Plan, so if you have a Medigap plan and you enroll in MAPD, your Medigap plan will not work. Enrollment is available for people who have both Parts A and B.

Open Enrollment Period: The Medicare Advantage, open enrollment period, will allow you to change from one Medicare Advantage to another or stop Medicare Advantage entirely. The Enrollment takes place between January 1 and March 31.

• Special circumstances (Special Enrollment Periods): 

You can change your Medicare Advantage and Medicare prescription drug coverage when certain events occur. These events, called SEPs, include when you move or lose other coverage.

How to choose or compare the best Medicare Advantage plan in Alabama 

If you live in Alabama, consider these factors when comparing Medicare Advantage plans:

• Monthly premium: You might have access to at least one zero-premium plan with drug coverage. Any monthly premiums will be an addition to your Part B monthly premium, affecting your monthly cash flow.

• Maximum Out-of-pocket: This is the maximum amount you’ll spend on services covered by Medicare, not including premiums, deductibles, and drug costs. The MOOP is crucial if you wind up in the hospital, need Cancer treatments, or have a chronic illness.

• Provider network: Make sure your doctors, hospitals, and pharmacies are connected to the network to keep costs as low as possible. 

• Deductibles, coinsurance & copays: These costs are also known as cost-sharing. 

• Drug coverage: Check if your medications are in the plan’s formulary list. Also, check how much they cost each time you fill a prescription.

• Additional benefits: You must consider which additional benefits are most important. Most plans require you to use network providers and may charge additional premiums for more comprehensive coverage. 

Consider how often you seek medical help. Remember to plan for future care and that your needs may change over time. Consider which plan fits your budget. Remember to consider deductibles, copayments, and the Maximum Out of Pocket, in addition to the monthly premium. 

Find a local Broker in Alabama.

Are you ready to sign up? Use our website to find a certified and licensed Medicare representative near you: https://CertifiedMedicareAgents.com

Why choose the Medicare Certified Agent Directory?

The Medicare Certified Agent Directory doesn’t sell your information to multiple insurance agents looking for “potential customers.” You can control who contacts you, and you can be sure that several agents won’t contact you. 

Two Types of Medicare agents or broker

• Independent agent: You can choose from various policies when you work with an independent Medicare insurance agent, 

• Captive agents: Captive agents are usually experts in all the options their particular company offers.

Why work with an independent Medicare agent?

• They can advise you to find the program that best suits your needs.
• Choosing the best Medicare insurance for your needs and current status can be confusing. The broker’s job is to save you time by comparing plans for you and making a recommendation. 
• Brokers know the options in general and can help you decide faster than you can.
• Medical underwriting: When you buy Medicare supplement insurance, Medicare agents can help check if you meet all the insurance requirements.
• They can help you with your contract renewal.
• Brokers’ services are free to you!

Originally Published on https://www.certifiedmedicareagents.com/blog/

Katherine Kline Podcaster, Blogger

I host the Rock Your Retirement Show, which is about Lifestyle, not money or insurance! I started the show in 2016 before anyone knew what a podcast was, and now it's had over one million downloads. At this point, there is a lot of information in our back catalog and we try to release an episode every month.

I'm a retired Financial Advisor (after 25 years) and now I try to have fun with my husband, my dog, and my friends.

I'm also the founder of CertifiedMedicareAgents.com, a site that brings insurance agents together with people who are looking for help with Medicare.