Alabama Medicare Plans

Coverage and Benefits for Alabama Medicare Plans

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 Alabama medicare plans 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.

The very basic foundation of Medicare is Medicare Part A, which is the first series of benefits you will receive once you qualify for Medicare. Part A benefits cover medical costs associated with hospital stays, hospital treatment, and longer-term care. Part B covers expenses that occur outside of a hospital – such as yearly checkups, flu shots, medical supplies, and outpatient treatments. You don’t have to accept or purchase Part B benefits if you don’t want to – however, most people find that Medicare Part B is a highly affordable option compared to similar forms of health coverage.

Medicare Part C is also known as Medicare Advantage. An advantage plan is basically an identical health insurance plan offered by a private insurance company instead of the federal government. But don’t worry – you will still receive the exact same coverage as you would from Medicare Parts A and B. It would just be coming from a different source. It is illegal for any private company to offer a Medicare Advantage plan which does not have these benefits. Prescription drug plan Part D is optional too, but you can only purchase it if you choose to purchase Medicare A & B. Medicare Part A beneficiaries cannot purchase Part D prescription drug coverage unless they also purchase Medicare Part B.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

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
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

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.

Alabamians have seen their health care costs steadily rise over the last several years. Unfortunately, it doesn’t look like this trend is turning around anytime soon. In order to protect yourself from paying exorbitantly high healthcare costs during your golden years, you’re going to have to make sure you get the most affordable and comprehensive healthcare coverage available to you. But that can be tricky when it comes to Medicare.

You have a few options when it comes to supplementing Original Medicare. Some retired individuals and couples choose to go for a Medicare Supplement Plan (Medigap). many people prefer these plans because their standardized and easy to understand compared to other insurance policies. They provide benefits which Medicare Part A & B do not for a relatively low monthly premium. They are provided by private companies, but they work with the government to make sure you get the care you need at an affordable cost.

There are lots of gaps in Medicare benefit coverage which can sneak up on you if you’re not careful. If you do need to stay in a hospital for more than a few days, for example, you could be expected to pay for most or all of those costs. There’s also limited coverage for blood transfusions in Medicare Part A. Part B can be even more confusing if you don’t read the fine print. If you don’t supplement your Medicare coverage in order to protect yourself from these gaps, you could end up with tens of thousands of dollars in medical costs at a time when you can least afford to pay for them.

If you decide to protect yourself with a Medicare supplement insurance policy, the best choices available are either Medigap, or Medicare Advantage. Both of these are, in one way or another, offered by private companies. But they will work closely with the government to make sure you get the promised benefits that you are owed after a lifetime of hard work.

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

What is the Difference Between Medicare Advantage and Supplement?

Unfortunately, understanding the differences between the two can be pretty confusing. When it comes to Medigap, you will still mostly be dealing with the government directly to get your Medicare Part A & B benefits. Your Medigap insurance provider only has to step in when it comes to Original Medicare coverage gaps. They can also help you pay your part B premiums and assist you in resolving claims that Medicare refuses to honor. Unfortunately, Medigap plans cannot offer prescription drug coverage.

One thing Medigap has going for it, though, is simplicity. No matter where you live, the Medicare Supplement Plan you choose will be the same. There are 10 plans available, designated by letter. The most popular one is Plan F, but you don’t have to choose it if you don’t want to. It doesn’t matter if you live in Alabama or Massachusetts; the plans will be the same everywhere you go. This is good for snowbirds since they won’t have to worry about which doctors and hospitals in what state will accept their insurance. As long as you get care from an entity who accepts Medicare, you’re covered.

Medicare Advantage works a little bit differently. A Medicare Advantage plan comes from a private insurance company, just like you would get from your employer or from purchasing your own insurance before the age of 65. When you have a claim, you submit it to that company first. Your premium is largely subsidized by the federal government, and your plan must adhere to the law and offer you the same benefits you would get from Original Medicare coverage. But if there’s a dispute about your claim, it can be harder to fight the company if you don’t feel that you are getting the coverage they’re contractually obligated to give you.

Medicare Advantage is a bit more volatile, financially speaking. There are pre-approval processes you must pass in order to qualify for the policy you want. They can change and review your coverage on an annual basis and either drop you or substantially raise your premiums if they feel it is in their financial interests. If you travel frequently, it can be difficult to know for sure which doctors and hospitals do and do not accept your insurance. This can get dangerously expensive in an emergency when you don’t have time to look up an in-network provider.

We have a chart on this page which helps explain answers to some of the most common Medicare Advantage and Medigap questions. We implore you to take a look if you feel that any of your questions have not been answered so far. After you feel like you’ve made a decision on whether or not a Medigap supplement is right for you, let us know – and we’ll help you find an affordable quote on a policy from a provider near you.

 

Questions

Medicare Advantage

Medicare Supplement

How are expenses covered under each plan?

Depending on average healthcare costs in your area, you may be required to pay a monthly premium. the government will subsidize most of that premium; in some areas it may subsidize 100% of it.

Your plan F premium covers all of your medical expenses between Medicare and your Medigap plan. Less comprehensive plans may require a separate premium, coinsurance payments, and co-pays

Will I still have to pay for Part B?

Yes

Yes

What will it cost me?

It depends on many different factors: how much the government subsidizes your premium, and any coinsurance or co-pay costs your insurance company may charge you.

Regardless of the plan you choose, you will be required to pay a monthly premium. Less comprehensive plans will be less expensive then more comprehensive ones.

What will the plan cover?

All Medicare Advantage plans must offer the exact same benefits of Medicare part A and Medicare Part B by law. Some plans offer additional types of coverage, like pharmacy prescriptions, vision, and more. It depends on where you live, and what you can afford to pay for.

It largely depends on the plan you choose. Plan F, for example, covers all of the Medicare coverage gaps 100% and even pays your Part B premium for you. Other options will cover less depending on your needs and which plan you choose. Unfortunately, it will not cover prescription drug coverage.

Is it easy to budget my health care expenses?

If your health is relatively stable, it’s easier to budget on a Medicare Advantage plan than if you require frequent and expensive medical care.

There are very few out-of-pocket expenses associated with Medigap insurance plans. And they only raise their premiums when the government raises your medicare premiums.

Is my plan guaranteed? Or can it be cancelled?

Unfortunately, Medicare Advantage plans are not guaranteed. Since their issues by private companies, they can be cancelled at any time at the company’s discretion as long as the company is acting within the confines of the law.

Your plan may be canceled if you fail to pay your premiums on time or if the company goes bankrupt. Otherwise, you’re guaranteed for life.

Do I have to clear a pre-approval or pre-certification process?

Yes, there is a pre-approval or pre-certification process for Medicare Advantage. And if you have many health issues, you are less likely to pass.

Qualifying for Medicare Parts A & B automatically qualifies you for a Medigap policy.

Am I limited to specific doctors or hospitals?

In order to keep costs down, your Medicare Advantage provider will limit the network of doctors and hospitals you are allowed to visit. Getting care outside of this network will cost substantially more.

You are allowed to get medical care from any doctor, hospital, or other entity which accepts Medicare.

What type of plan is best for me?

If you have recently qualified for Medicare, if you are in relatively good health, and if you live in a large city with many different doctor and hospital choices, Medicare Advantage could end up being cheaper. But this isn’t always the case.

If you’re looking for comprehensive coverage, if you live in an area where medical care is limited due to population density, and if you are on a stricter budget, Medigap maybe a better solution. This is especially true if you can’t afford to be restricted to a small network of doctors and hospitals.

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.

Useful Contacts


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.

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