Medicare Advantage plans in Alabama are comprehensive insurance policies that aim to help seniors with Medicare coverage avoid the potentially costly gaps in Original Medicare. Medicare Advantage essentially replaces your federal Medicare benefits with a private insurance policy. 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.

How Medicare Advantage Plans Work in Alabama

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. 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.

In 2022, there are up to 37 plans available in Alabama in some counties. The amount of plans available to you is dependent on your zip code. 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.

Advantage plans are 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.

Types of Medicare Advantage Plans

  • 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 that 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 providers, 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, 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 are bundled under one plan. However, keep in mind that the more coverage you add, the more expensive your plan will become.

Which Alabama 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. For help deciding, give us a call or complete our rate form here.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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