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 trusting their health to the Federal Medicare program. Of those, 36% of Medicare recipients are receiving their medical benefits through Medicare Part C (Medicare Advantage). The other 64% seem to have chosen Medigap insurance or have an employer plan.
|Plan Type||Enrollment Percentage|
|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
How do our Medicare Plan ratings work? Like many things, they’re based on a five star review system. Depending on how effective a plan is, it will receive up to a maximum of five stars. The number of stars it earns reflects the quality of its healthcare services, its chronic condition management, and its customer satisfaction (or lack thereof). This star rating helps you know which companies are worth investing your money in, and which ones are not well-suited to help you manage your health care needs.
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.
Where you generally need to get your care and services from for:
- HMO Plans – In general, HMO plans require you to seek care and services only from those providers in your plan’s network. However, there are exceptions. If you need emergency care, if you need out-of-area urgent care, or if you need dialysis from a facility which is out of your area, you should be covered. If you have a POS HMO plan, which is short for point-of-service, your healthcare provider may give you permission to go out of network for very specific services – just keep in mind that you will probably have to pay more for your medical care as a result.
- PPO Plans – Preferred Provider Organization plans, unlike Health Management Organization plans, put an emphasis on the “preferred”. They have certain doctors, hospitals, and facilities they would prefer you receive care from, but you can really go anywhere you want that accepts your insurance. Granted, getting care from a preferred provider will usually cost you much less. But getting care from out-of-network sources will still be cheaper than it would be with an HMO plan.
- PFFS Plans – Getting care from any doctor, other healthcare provider, or hospital under a Private Fee-For-Service plan can be a little tricky. Most (but not all) Medicare-approved sources of care will agree to your plan’s payment terms, and thus agree to treat you. But if they don’t agree to your plan’s payment terms, you may get rejected. Like a PPO plan, you can choose to go out-of-network if they do agree to treat you. But you’ll likely be paying more than you would if you had stayed in network.
- Special Needs Plans – A Special Needs Plan is similar to that of an HMO plan in its restrictiveness. But you can go outside of your Medicare SNP network for emergency or urgent care. If you have ESRD and need to get dialysis outside of your network, this is also permitted. But it’s best to stay in network when and where possible because the specific network of doctors and facilities included in an SNP plan is tailored towards patients with special, specific needs like yours.
Finding a doctor who accepts your Medicare Advantage plan:
- HMO Plans – As with a regular Medicare plan, you will be limited to which doctors and facilities you can visit with a Medicare Advantage HMO plan. The only exceptions are emergency care, urgent care out-of-area, and out-of-area dialysis.
- PPO Plans – Here again are more similarities between Medicare plans and Medicare Advantage. You have the freedom to get care from any doctor or facility which will accept your insurance, regardless of whether or not they’re in your network. But there are cost savings benefits frequently associated with staying in network.
- PFFS Plans – PFFS plans and Medicare Advantage are yet again basically identical to a regular Medicare plan. If you find a provider who is willing to agree to your plan’s payment terms and agree to treat you, you can go out of network without any severe financial penalties. Staying in-network is still generally considered to be much less expensive, though.
- Special Needs Plans – Similarly to that of a typical Medicare plan – and a typical Medicare HMO plan, at that – SNPs under Medicare Advantage have strict restrictions on going out of network unless it’s emergency care, urgent care, or out-of-area end-stage renal disease dialysis.
For your convenience, Medicare.gov has an easy and efficient database you can search to see if your preferred doctor(s) and facilities are included in your plan.
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.
- Medicare Advantage plans are not required to offer vision coverage, but many providers offer to let their customers purchase it and add it to the policy. Your plan membership details will explicitly state whether or not you must use network providers in order to get vision care.
- The same goes for dental coverage. Whether or not you can go out of network will depend on the plan you choose. If you choose a plan with dental coverage, make sure you consult your Medicare Advantage insurance agent for more info on in- and out-of-network dentists.
Enrollment Options & Best Time To Enroll
Recent changes in the law have made it easier for Medicare-qualified seniors to enroll in a Medicare Advantage plan – even if they have problematically expensive pre-existing conditions. For most seniors, though, 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.
Which Medicare Advantage Plan Is Best for Me?
For the best plan your money can buy, it’s important to sit down and think about what your medical needs will be in the future. That way, it’ll be easier to find a plan that best suits your health care needs for an affordable price. Don’t forget to consider the company’s financial stability, customer service, and reputation.
Comparing quotes between different Medicare insurance providers before you make a final decision is more important than it is with most other types of insurance. This is because special enrollment periods make it difficult to change providers if you aren’t happy with your plan.