Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage provides a cost-effective way for seniors aged 65 or older and younger individuals with qualifying disabilities to get the health care coverage they need. Medicare Advantage plans, often referred to as MA plans or Medicare Part C, take the place of Original Medicare. These plans must provide the same coverage as traditional Medicare plans, but they often offer more perks than Original Medicare. The federal government offers Original Medicare to qualifying recipients, but Medicare-approved private insurance companies offer Medicare Advantage plans. Because MA plans bundle several types of health care coverage together, recipients often have lower out-of-pocket costs than they would with Original Medicare.
Alabama’s Medicare Advantage recipients have steadily grown, as they have nationwide. In 2020, the state had more than a million Medicare beneficiaries, and nearly 45% of them chose Medicare Advantage over Original Medicare. This percentage was significantly higher than the national average, which was 38% that year. In 2021, the rate of Medicare Advantage recipients had grown to nearly 50%. The percentage rose again to just over 54% of the 1,065,866 Medicare recipients recorded in Alabama during the 2022 plan year. The average monthly Medicare Advantage premium remained relatively unchanged, rising from $11.19 in 2021 to $11.21 in 2022, but the number of available plans increased from 82 to 91.
This guide provides a comprehensive overview of Medicare Advantage plans in Alabama, including how these plans work and what’s covered compared to Original Medicare. It also includes eligibility requirements, top providers in the state and how beneficiaries can find plans in their area.
The Top 10 Medicare Advantage Plans in Alabama
Seniors and disabled persons in Alabama potentially have access to several types of Medicare Advantage plans, with numerous insurance providers serving multiple areas of the state. The table below compares the top 10 most popular Medicare Advantage providers statewide based on their total MA plan enrollment. Because each provider typically has multiple plans available, the table calculated their total enrollment by combining the enrollment numbers of all the plans each provider offered.
The table also provides a range of costs for the plans included in the enrollment totals to allow for cost comparisons. It includes the provider’s Medicare star rating to show how they ranked based on plan performance and feedback from member satisfaction surveys. The information used for this table is current as of April 2022. Medicare recipients can also visit Medicare.gov to get up-to-date information on the plans available in their area.
Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield
Blue Cross Blue Shield of Michigan
How Medicare Advantage Plans Work in Alabama
Depending on the insurance provider and the beneficiary’s geographic location in Alabama, they could have several MA plan options or just a handful. Since private insurers offer Medicare Advantage plans, their plans may be unique to the areas they serve or the intended recipients. There are four primary types of plans available in Alabama’s Medicare Advantage program. Health Maintenance Organizations (HMOs) are typically the most common, followed by Preferred Provider Organizations (PPOs). Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNO) may have limited availability statewide.
What Medicare Advantage Plans Cover in Alabama
Medicare Advantage takes the place of Original Medicare, so MA plans must provide the same Medicare Part A and Part B coverage. Part A covers inpatient/hospital coverage, and Part B covers outpatient/doctor services. Most MA plans also cover Part D prescription drug coverage, which Original Medicare recipients must purchase separately. Even better, MA plans usually provide coverage for various additional perks such as vision care, wellness programs, hearing aids, telehealth and dental care. More than 90% of nationwide MA plans offered these and other health-related benefits in 2022.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Alabama
Beneficiaries who qualify for Original Medicare also qualify for Medicare Advantage because the eligibility requirements are identical. Applicants must be aged 65 or older or younger if they have a disability that qualifies them at an earlier age. Disabled persons who’ve received Social Security Disability Insurance payments for two years or more qualify for Medicare. Individuals diagnosed with end-stage renal disease, also known as kidney failure, or Lou Gehrig’s disease, also known as ALS, qualify for Medicare Advantage, as well.
To be eligible for Medicare Advantage in Alabama, applicants must have Medicare Parts A and B. They must also be U.S. citizens or authorized immigrants. If they’re applying for an SNP, they must meet additional plan requirements. Like Original Medicare, beneficiaries can only join a Medicare Advantage or switch an existing plan during specific enrollment periods. Those periods are detailed below.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
Through Alabama’s State Health Insurance Assistance Program, volunteers and counselors help seniors select the best Medicare health insurance and prescription drug plans for their needs. Advisers can explain the specific benefits available to seniors within their region, answer questions and help seniors file claims and appeals. Along with providing information on Medicare options, volunteers and counselors are knowledgeable about long-term care options, home health care services and Medigap. Because they’re not tied to any one insurance company, they can provide unbiased information and guide seniors to more resources. Counseling sessions are confidential, and counselors may also give informative presentations to groups upon request.
Alabama seniors can reach SHIP counselors and volunteers by calling 1-800-AGELINE (1-800-243-5463), where they’re directed to their local Area Agency on Aging and their Aging and Disability Resource Center.
KEPRO is Medicare’s Beneficiary and Family-Centered Care Quality Improvement Organization. Alabama Medicare beneficiaries can contact KEPRO or visit its website if they need to file a complaint or appeal their Medicare services or coverage. Through its Immediate Advocacy program, KEPRO representatives, including social workers, can contact Medicare providers and facilities directly to help quickly resolve a senior beneficiary’s complaint or concern. This can mean helping a senior schedule a doctor’s appointment or better understand their treatment plan. KEPRO has a help line dedicated to beneficiaries, and its website lists additional resources Alabama seniors can access for aging-related services, filing complaints against health care facilities and providers, potential Medicare fraud and insurance counseling.
Seniors can call KEPRO toll-free at 888-317-0751 or dial the local number at 813-280-8256. They can also send communication to KEPRO’s mailing address at 5201 West Kennedy Boulevard, Suite 900, Tampa, FL 33609.
Alabama Department of Senior Services
The Alabama Department of Senior Services, also known as Alabama Ageline, provides seniors with a useful website outlining information on the state’s many senior services and senior programs. The department oversees Alabama’s Area Agencies on Aging and ADRCs, and its website includes information on upcoming events such as senior caregiver workshops and brochures on SHIP, Alabama Cares and SenioRX programs. The site also contains information on programs that help seniors with disaster preparedness, employment training and obtaining legal services.
Individuals can contact the Alabama Department of Senior Services by calling 1-800-AGELINE (1-800-243-5463), emailing [email protected] or visiting the office at 201 Monroe Street, Suite 350, Montgomery, AL 36104.
Area Agencies on Aging are organizations spread throughout Alabama that serve seniors in specific counties. They provide free Medicare counseling through Alabama’s SHIP program and also offer related services such as educational presentations and prescription assistance to help seniors receive their medications for free or at a low cost. They also provide Aging and Disability Resource Centers that offer seniors and their loved ones a wealth of information on aging and health care resources and benefits available throughout the state.
A full list of Alabama’s Area Agencies on Aging, their contact information and counties served can be found on the West Alabama Aging website here.
The Central Alabama Aging Consortium provides home- and community-based services to eligible seniors and their loved ones in Montgomery, Autauga and Elmore counties. The Consortium’s Aging and Disability Resource Center assists seniors in learning about and understanding benefits they may be eligible for throughout the state. Seniors can also connect with SHIP volunteers to learn about their Medicare options and long-term insurance. Other services include nutrition counseling and a Care Transitions program to help seniors adjust as they move back home from an institution or hospital.
Local seniors can call 334-240-4670 to reach the ADRC or call the main line at 334-240-4680. They may also visit the Central Alabama Aging Consortium in person at 2500 Fairlane Drive, Suite 200, Montgomery, AL 36116 or email [email protected].