Medicare Plans in Alabama – Coverage and Benefits
Any Alabama resident over the age of 65 has the option to enroll in the federal Medicare program. Specifically, this covers Medicare Part A and Medicare Part B (otherwise known as “traditional” Medicare). Although Medicare plans in Alabama are structured to provide a comprehensive medical care package for retirement-age citizens, the odds are pretty good that there will still be out-of-pocket expenses associated with the “gaps” in Original Medicare. For those who need additional coverage to fill these gaps, there are several different options which will be discussed in detail below.
Anyone with a minimum 10 year employment history (equal to 40 quarters) can get Medicare Part A for free. Otherwise, enrollees may be required to pay a premium fee. On top of those potential costs, Part B comes with its own separate, mandatory premium which all Medicare enrollees are required to pay. For detailed information on premium costs for Parts A and B, contact the Alabama Social Security Office.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Alabama Medicare Insurance Programs
There are a significant number of Medicare beneficiaries in Alabama: 881,686, to be exact. Of those, just under one quarter (24%) are accessing their Medicare benefits through Medicare Advantage plans (sometimes called Medicare Part C). A slightly larger percentage of Alabamans (25.3%) are choosing instead to protect themselves from excessive medical expenses through a Medigap or Medicare supplemental insurance policy. The remaining 51% of Alabama Medicare recipients are likely covering their Medicare gaps through their employer’s plan, a private plan, or simply relying on Parts A and B alone while hoping for the best.
Important: The following information applies ONLY to seniors who are already enrolled in Medicare Parts A & B. If you are not yet enrolled, please visit MyMedicare.gov today.
Who Do So Many Alabama Residents Need Additional Coverage?
The cost of quality health care is on the rise, and it isn’t going down any time soon. While Medicare Parts A and B are fairly comprehensive, they can’t pay for everything. And the seemingly little things that they don’t pay for can sneak up on you. If you aren’t prepared, they can wreak havoc on your fixed income. You can see some examples of this in the table below:
|Medicare Part A Costs||Medicare Part B Costs|
Supplemental health insurance is a great way to make sure that you don’t end up being a victim of bad luck. There are several different options you can explore for filling your Medicare coverage gaps. Below are some of the most trusted options for managing your Medicare coverage benefits and ensuring you get the most comprehensive plan available.
Alabama Coverage Choice #1: A Medicare Supplement Plan
Medicare supplement plans are more commonly referred to as “Medigap” plans. With one of these, you won’t have to worry about the “gaps” in traditional Medicare, because your Medigap plan will cover it for you. Currently, there are 10 federally approved plans available for purchase. Alphabetically, these plans are: A,B,C,D, F, G, K, L, M, N. The Medicare Modernization Act recently eliminated plans E, H, I, and J back in 2010. The great thing about Medigap plans is that all 10 of them offer identical forms of coverage and benefits, regardless of your state. Only the thing that changes is the price, based on your exact location and your Medigap insurance provider.
Here’s what type of coverage you can expect from each plan:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$116||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$118||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$105||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$104||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$70||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$97||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$69||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$76||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$45||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$97||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Alabama Coverage Choice #2: A Medicare Advantage Plan
This is more commonly referred to as a Medicare Replacement Policy, or Medicare Part C. Now pay close attention, because some of the finer details of MA (Medicare Advantage) can get a little confusing. If you switch from Traditional Medicare to MA, a private insurance company will take over your health care management; it will no longer fall under the government’s responsibility. However, you will still be eligible for all of the Traditional Medicare benefits (or more, if you have a comprehensive MA policy). Your private MA insurance company is legally required to offer “equal or greater” coverage than Traditional Medicare.
It is not uncommon for Medicare Part C to include extra benefits, such as vision, dental, prescription drugs, or more. While some retirees enjoy the convenience of having all their benefits under the same plan, there is a trade-off. Such plans often come with very restrictive networks, which may hamstring your ability to get the quality health care that you need. Whether your Part C plan comes with an HMO or a PPO, your options could be significantly limited.
Medicare Advantage plans can be categorized as either an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). Here are the highest rated HMO and PPO Medicare Advantage (a.k.a. Medicare Part C) plans in Alabama:
Top HMO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||Cigna-HealthSpring Advantage (HMO)||Health Only||$0.00||$0|
|$0||VIVA Medicare Plus (HMO)||Health and Drug||$0.00||$125|
|$0||VIVA Medicare Select (HMO)||Health Only||$0.00||$0|
Top PPO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||HumanaChoice R5826-065 (Regional PPO)||Health Only||$0.00||$0|
|$828||HumanaChoice R5826-001 (Regional PPO)||Health and Drug||$69.00||$40|
More about Medigap Supplement vs. Medicare Advantage in Alabama
We’ve set up the following table based on all of the differences and similarities of Medicare Advantage vs. Medicare Supplement insurance. Hopefully, it will help clear away some of the confusion:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
Helpful Alabama Medicare Resources
If you still have questions, we’ve included a phone number directory below. It has some invaluable contact information for resources on Medicare and Medicare supplemental policies. To resolve unanswered questions, you can contact your State Health Insurance & Assistance Program, your local Social Security Office, and more.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.