Medicare Advantage Plans In Alabama

Fact Checked
Published: 6/4/2021

When you turn 65, you can get hospital and medical insurance through the federal government's Original Medicare program or Medicare Advantage. Medicare Advantage Plans offer the same medically necessary services covered by Original Medicare with extra benefits such as vision, hearing, dental, fitness, and prescription drugs.





  • In 2019, there were 49 Medicare Advantage Plans available in Alabama.
  • 37% of the total Medicare population in Alabama is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $10,731 per beneficiary in Alabama, which is 6% higher than the national average.
  • Available Medicare Advantage Plans range from seven to 37 across Alabama’s 67 counties.

Delivered by private insurers, each Medicare Advantage Plan must provide Part A and B coverage for hospital stays, physician services, diagnostic tests, and screenings but can vary in terms of health-related benefits. The cost of a Medicare Advantage Plan includes premiums, deductibles, copays, and other out-of-pocket spending. It’s a good practice to review your insurance coverage annually to ensure it continues to meet your health needs.

Medicare Advantage Plans in Alabama

Types of Medicare Advantage Plans

Your choice of plans depends on where in Alabama you live, but you should have multiple options. The most common types of Medicare Advantage Plans are HMO, PPO, PFFS, and SNP. Insurance companies participating in Alabama’s Medicare Advantage program are under contract with Medicare and must work within the federal government’s guidelines.

Health Maintenance Organizations (HMO)

HMO plans have agreements in place with health care providers in your service area and require you to use doctors and hospitals within the plan’s network. Your costs generally aren’t covered if you use an out-of-network provider. HMOs limit your access to specialist physicians unless a primary care doctor determines you should see one.

Preferred Provider Organizations (PPO)

PPOs also have agreements with certain health care providers that make it less expensive for you. Unlike an HMO, you’re free to use out-of-network providers, but it usually costs you quite a bit more. With this type of plan, you can coordinate your own care and don’t need to select a primary care physician. PPOs cover the services of a specialist even if you don’t have a referral.

Private Fee-For-Service Plans (PFFS)

With a PFFS, you can see any health care provider who agrees to the plan’s payment terms. Each PFFS plan determines the fees it’s willing to pay to a provider and what your copay or coinsurance amounts will be. Therefore,  not all providers accept every plan. Some may agree to treat you for certain services and not others. Some PFFS plans have networks to make it more convenient for you to locate doctors and hospitals that always accept the plan’s terms. You’re not required to have a primary care physician and are free to see specialists when enrolled in a PFFS.

Special Needs Plans (SNP)

Alabama residents with chronic illnesses may be able to enroll in an SNP. These plans are customized to cover care related to a specific condition, such as diabetes mellitus, stroke, HIV/AIDS, cardiovascular disease, or end-stage liver disease. SNPs typically work with doctors and treatment facilities that specialize in the condition and may require you to have a care coordinator or primary doctor to oversee your care. SNPs aren’t available in all service areas.

Enrollment and eligibility for Medicare Advantage Plans in Alabama

Eligibility

You can join a Medicare Advantage Plan if you have Original Medicare Part A and Part B. The federal government automatically enrolls you in Original Medicare if you’re aged 65 and receiving Social Security benefits — or if you have a disability and have been receiving Social Security disability benefits for two years. You can only qualify for Medicare Advantage Plans offered in your service area, and you can’t be enrolled in Medicare Supplement Insurance (Medigap) at the same time.

Medicare introduced new rules for 2021 allowing individuals with end-stage renal disease to enroll in Medicare Advantage Plans.

Enrollment

You can join a Medicare Advantage Plan or move between Medicare Advantage Plans during specific periods:

  • Initial Enrollment Period. When you’re first eligible for Medicare, you have an initial enrollment period that begins three months before the month you turn 65 and lasts for seven months. During this time, you can leave Original Medicare and join a Medicare Advantage Plan.
  • Annual Open Enrollment Period. If your coverage needs aren’t being met, you can make changes during the annual open enrollment period that runs from October 15th through December 7th. You may move between Original Medicare and Medicare Advantage, or between Medicare Advantage Plans.
  • Annual Medicare Advantage Enrollment Period. This yearly enrollment period from January 1st to March 31st applies only to those enrolled in a Medicare Advantage Plan. You may switch MA plans or return to Original Medicare during this time.

Additionally, you may qualify for a special enrollment period under certain circumstances, for example, if you’re no longer eligible for coverage through work, Medicaid, or an SNP.

Prescription drug coverage

Prescription drug coverage is available to you no matter how you receive your Medicare coverage. If you’re in Original Medicare, you can combine your insurance with a Part D prescription drug plan from a private insurer. If you have Medicare Advantage, you can choose a plan that includes prescription drug benefits, or if you have a PFFS plan, you can add a separate Part D plan. While drug coverage isn’t mandatory, you can incur a late enrollment penalty if you join a prescription drug plan after your initial enrollment period. Even if you don’t need prescription drug coverage right away, you may want to choose an MA plan that includes this benefit to avoid penalties later if your health care needs change.

Medicare Advantage Resources in Alabama

Before you enroll in a plan, be sure you understand your options and how the coverage works so you don’t have unexpected obstacles when seeking care. Here are some agencies and organizations in Alabama that can assist you in getting information about Medicare.

Alabama State Health Insurance Assistance Program (SHIP)

SHIP is a joint initiative of the Alabama Department of Senior Services and the Area Agencies on Aging. Its team of insurance counselors and volunteers can answer Medicare questions, help you compare plans, and assist with benefits, claims, and appeals.

Contact Information: Website | 800-243-5463

Alabama Medicaid

This state-run agency administers support to low-income individuals who qualify for Medicare. Contact Medicaid about programs that offer financial assistance with Part A and B premiums and deductibles, such as Medicare Savings and Qualified Medicare Beneficiary programs.

Contact Information: Website | 334-242-5000

Alabama Department of Insurance

The Alabama Department of Insurance helps protect consumers who have purchased insurance. It also has online resources about Medicare Supplement Insurance and long-term care insurance.

Contact Information: Website | 800-433-3966

Area Agency on Aging (AAA)

Each county in Alabama is served by a local AAA. Services may vary in your location but typically include assistance with Medicare programs, legal counseling, and discounted prescription medication programs.

Contact Information: Website | 800-243-5463

United Way Area Agency on Aging of Jefferson County

The AAA in Jefferson County supports older adults in Birmingham and nearby communities. It runs a Senior Medicare Patrol program to help you review Medicare Summary Notices and understand your health care bills. It also offers a legal assistance program to help protect your rights related to Medicaid and Medicare.

Contact Information: Website | 800-243-5463

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