Introduction to Medicare Advantage in Alabama (Part C)

Medicare Part C and Medicare “replacement” are alternative nicknames for a Medicare Advantage plan. Medicare Advantage plans are comprehensive insurance policies which aim to help seniors with Medicare coverage avoid the potentially costly gaps in Medicare Parts A and B. Medicare Advantage essentially replaces your federal Medicare benefits with a private insurance policy which provides as much (or potentially more) coverage. This means that if you get sick, your private insurance company will be responsible for paying out your claims; the responsibility will no longer be on the government.

Federal Regulations for Medicare Advantage

Even though you will be replacing your Medicare coverage with a private form of insurance, these policies are still heavily regulated by the federal government to make sure that you aren’t short-changed on your benefits. Your insurer is legally required to give you as much or better coverage as you would be receiving with Medicare Parts A and B. Most providers also throw in additional benefits, like vision or dental, to attract customers. It is fairly common for Medicare Advantage plans to come with a prescription drug policy also. These are called MAPD plans.

Medicare Advantage Enrollment In Alabama

Thousands of Alabama seniors are signed up for the Federal Medicare program. Of those, 24% of Medicare recipients are getting their benefits through a Medicare Advantage plan. The other 76% may prefer Medigap insurance, or have an employer plan. There are many different types of Advantage plans, and the chart below breaks them down by percentage of enrollees:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Depending on where you live, how healthy you are, and other metrics which your insurance provider might take into consideration, your Medicare Advantage costs could vary greatly. Take a look at the chart below for an estimate of what seniors in your area are paying:

Most Popular Medicare Advantage Plans in Alabama

There are almost as many Medicare Advantage plans as there are seniors to sign up for them. Plans vary by type, by the benefits they provide, and by the company who issues the policy. Most significant of these differences is the provider network and limitations. Depending on what you need, it can be a tradeoff – PPO plans are more expensive, but less restrictive, whereas HMOs have more limitations, but a lower price tag.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Make sure you get plenty of information on your Medicare Advantage plan’s network restrictions before you sign on the dotted line. The various types of networks – which include HMOs, PPOs, and PFFS networks – all have different rules on which doctors you can see, and how you can get access to medical care outside of your preferred network. You should be prepared in case you happen to fall ill while on vacation, or if one of your preferred doctors leaves your chosen network.

Doctor/Providers List

Drug, Vision and Dental Coverage

Ancillary coverage, such as drug (Medicare Part D), vision, or dental, are all options which can be added to a Medicare Advantage policy. This is what makes Part C plans so appealing to some seniors – they get access to forms of coverage that Original Medicare does not provide, and all bundled under one plan. However, keep in mind that the more coverage you add, the more expensive your plan will become.

Enrollment Options & Best Time To Enroll

With Medicare Advantage, your provider has the option to gather information about your health and decide to provide or deny you coverage based on pre-existing conditions. For most seniors, though, this isn’t a significant problem. The most challenging condition to get coverage for is ESRD (End State Renal Disease), but finding a policy is not impossible. Certain states will still permit you to be covered under certain circumstances. To learn more about your enrollment options, visit our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

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