Medicare Advantage (MA) launched in 2006, courtesy of legislation passed in 2003. Designed to improve beneficiaries' healthcare options, the Medicare Modernization Act also brought us Medicare Part D prescription drug coverage. As in the rest of the country, private insurance companies provide Medicare Advantage plans in Alabama.
What Is Medicare Advantage?
Also known as Medicare Part C, Medicare Advantage plans provide the same benefits you get with Original Medicare. However, most MA plans offer additional coverage as well. For example, around 90 percent of Advantage plans include prescription drug coverage. Known as Medicare Advantage Prescription Drug plans (MA-PD), these policies bundle your Original Medicare and Part D benefits into a single plan.
Other common additional covered services include:
- Fitness programs
- Hearing aids
- Routine vision and dental care
Not all MA plans provide the same benefits, so compare plans carefully. Please note that, even if your Medicare Advantage plan has a monthly premium, you are still responsible for your Medicare Part B premium.
Types of Medicare Advantages Plans in Alabama
There are four main types of Medicare Advantage plans in Alabama. They are:
Health Maintenance Organizations
HMOs use a provider network that includes doctors, labs, hospitals, clinics, durable medical equipment (DME), and more. Most HMOs only cover services received from an in-network provider unless it's an emergency. However, some HMOs offer a point-of-service (POS) option, which allows members to use out-of-network providers for a higher out-of-pocket cost.
If you join an HMO, you'll need to choose a primary care physician. This doctor will coordinate all of your care, including providing referrals to see a specialist. Please note that networks change periodically, as providers enter and exit the plan.
Preferred Provider Organization
PPOs are similar to HMOs in that they use a provider network to help manage costs. However, members can use an out-of-network provider – they just have to pay a bit more. Preferred provider organizations also do not require choosing a primary care physician or referrals to see a specialist.
PFFS plans determine how much they'll pay for services, with plan members shouldering the rest of the cost. These plans also use a provider network, although you can see an out-of-network provider for a higher cost.
If you join a PFFS plan, no network provider can refuse to treat you, even if you've never used that provider before. However, if a provider has not contracted with the plan, they may refuse to treat you unless it's an emergency.
Special Needs Plans
SNPs are limited to people who meet certain qualifications. Plans set their own membership guidelines, but common restrictions include:
- Having a chronic health condition, such as diabetes, end-stage renal disease (ESRD), HIV/AIDS, dementia, or chronic heart failure
- Living in a certain type of institution, such as a nursing home
- Being dual eligible, i.e. qualifying for both Medicare and Medicaid
SNPs coordinate services and usually require members to have a primary doctor to manage their care, including specialist referrals.
When Can You Sign Up for a Medicare Advantage Plan in Alabama?
You can join a Medicare Advantage plan in Alabama during the following enrollment periods:
- Initial Enrollment Period (IEP): Your IEP begins 3 months before you become eligible for Medicare and ends 7 months later. So, if your 65th birthday or 25th month of collecting Social Security disability benefits occurs in April, your IEP opens on January 1 and closes on July 31. You may join an Advantage plan at any point during your Initial Enrollment Period.
- General Enrollment Period: If you didn't enroll in Medicare Part A and/or Part B during your IEP, you can sign up during General Enrollment from January 1 through March 31. However, your window to join an Advantage plan doesn't open until April 1; it closes on June 30.
- Annual Enrollment Period: AEP lasts from October 15 through December 7 and allows Medicare beneficiaries to make any desired changes to their coverage – including joining or leaving a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (OEP): Only current Medicare Advantage plan enrollees can take advantage of the OEP, which lasts from January 1 through March 31. During OEP, you may either switch to a different Advantage plan or return to Original Medicare. You can also buy a standalone Part D plan if making that change results in you losing your prescription drug coverage.
Finally, Medicare provides Special Enrollment Periods (SEPs) for beneficiaries who experience certain life events, such as moving or losing their coverage. Find the full list of qualifying special circumstances on Medicare.gov.
How to Choose a Medicare Advantage Plan in Alabama
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Alabama. Just enter your location information and estimated coverage start date to review the Medicare plans available in your area.
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