You might not be aware, but you have a handful of options for Medicare. The literature can be confusing and we want to make sure that you know how to sign up, when to sign up, and for what plans. Knowing how Alabama Medicare impacts your other insurance coverage is important to understand as well. Let us help.
Before we get into the Alabama Medicare plans and the options you have, you should be made aware of SHIP and HICAP. In each U.S. state, there is a State Health Insurance Assistance Program (SHIP) whose purpose is to help you become familiar with your Alabama Medicare options. In Alabama, the SHIP program is called the State Health Insurance Program. If you are an Alabama resident, you can utilize this team of counselors made of volunteers for free. They are not affiliated with any insurance company and will not be able to recommend a specific plan or policy. They will, however, provide unbiased assistance as you’re getting familiar with Medicare. You can reach them through the Alabama Department of Senior Services website or by calling (800) AGE-LINE.
Now, let's get into the different Alabama Medicare plans and options that you have.
Medicare Qualifications and Enrollment Windows
Before You Turn 65
Generally speaking, you will be granted Medicare Part A and Medicare Part B benefits (Original Medicare) before you are 65 if you have been receiving Social Security Disability Income for 24 consecutive months, are living with ESRD, or have been diagnosed with ALS. In order to qualify for Medicare under these conditions, you will need to apply for it.
When You Turn 65
All U.S. residents are eligible for Medicare insurance when they turn 65. If you are approaching your 65th birthday and are not covered under yours or a spouse's’ employer-sponsored plan, are not on disability, or have not received Social Security retirement benefits. You should get Medicare information on any Medicare website and sign up for the plan that best suits you, including premiums and supplement.
Surrounding your 65th birthday, you have an Initial Medicare enrollment period that lasts for seven months. This enrollment period starts three months prior to when you turn 65, includes the month of your birthday, and goes for three months after you turn 65. During this Medicare enrollment period, you can sign up for Medicare Part A, Medicare Part B and/or Medicare Part D plans. If you do not sign up for Medicare Part A or Medicare Part B during your Initial Medicare Enrollment Period, you can sign up for them during the General Medicare Enrollment Period which is January 10 to March 31 each year, and your Medicare Enrollment benefits will begin the following July 1. Please be sure to understand your Medicare plans and options before you turn 65 as signing up for Medicare Part A or Medicare Part B outside of your Initial Medicare Enrollment Period or a Special Enrollment Period (e.g. after ending an employer health insurance plan) may require you to pay a late Medicare Enrollment penalty. See more on Medicare Part A late enrollment and penalty and Medicare Part B late enrollment penalty .
If you are already receiving Social Security retirement benefits when you turn 65, you will not need Medicare to sign up . Instead, you are automatically enrolled and you should automatically receive your red, white, and blue Medicare enrollment card in the mail to use for Medicare benefits. These benefits will become active on your 65th birthday.
If You Turn 65 and Have Employer-Sponsored Health Insurance
If you are approaching your 65th birthday and are receiving health insurance benefits from an employer or a spouse’s employer group plan, you have the option to continue your coverage or you can sign up to utilize Medicare Part A or Medicare Part B benefits. If you are covered by an employer plan and decide to wait to sign up for Medicare, you can sign up for Medicare at any time during a Special Medicare Enrollment Period. If you lose work-sponsored health insurance coverage after you turn 65, you will also qualify for a Special Medicare Enrollment Period
Example Scenario 1: You may already know that you will not receive long-term benefits after retirement. Although this may be true, you may find that your employer-sponsored insurance premiums are much lower than Medicare’s. If this is the case, you may find it financially advantageous to opt out of Medicare A and B when you turn 65 and maintain your employer-sponsored benefits. Then, once those employer-sponsored benefits stop, you can sign up for Medicare and incur the late enrollment penalty at that time.
Example Scenario 2: You may find that Medicare premiums (Part A or Part B) are lower than your employer-sponsored benefits and decide to switch over to Medicare coverage when you turn 65.
Example Scenario 3: You may be expecting to receive long-term benefits after retirement because of pension, long public service careers, or because you belong to a union. If this is you, you may want to opt out of Medicare Part A and Medicare Part B when you turn 65 and continue using your employer benefits until they are no longer available.
NOTE: Retiree health plans and COBRA do not constitute coverage based on current employment, which means you will not be eligible for a Special Enrollment Period when your retiree benefits end if you were covered under these benefits.
NOTE: Once you enroll in a Medicare program of any kind (Original Medicare or Medicare Advantage), you can no longer make contributions to a Health Savings Account. If you choose to decline Medicare coverage, AARP and CMS (Centers for Medicare and Medicaid Services ) recommend that you call or notify the Medicare office to let them know that you are declining benefits and that you have other health insurance coverage.
The AARP website has more information and may be helpful as you are exploring your Medicare options.
Alabama Medicare Plans
Original Medicare Part A Plan (Hospital Insurance)
Medicare Part A Plan will pay for hospital needs in which insurance coverage is vital: hospital visits, skilled nursing, hospice care, and home health options.
Original Medicare Part B Plan (Medical Insurance)
Medicare Part B Plan covers medical issues in which insurance coverage is vital: doctor services, outpatient needs, lab tests, imaging, DME, home care, and more.
Medicare Advantage Plan (MA) - Part C
Alabama Medicare Advantage is an alternative to Medicare Part A or B. This plan is provided through private insurance companies that have been contracted by Medicare to provide the same services that you would receive through your traditional plan. The plan also allows for additional coverage items to be included like chronic conditions, dental, vision, and nursing home care. You have to first be enrolled for Medicare Part A/ B and be in the covered service area to qualify for a Medicare Advantage program. In Alabama, a quarter of those that receive Medicare benefits opt for a Medicare Advantage plan.
Medicare Rx Plan - Part D
Alabama Medicare Part D is a program for prescription drugs that provides additional coverage. You will most likely need to specifically sign up for Medicare Part D after you enroll in traditional Medicare. While you are automatically enrolled in Medicare Part A and Part B when you turn 65, you have to specifically sign up for Part D. In order to be eligible, you must first be enrolled in Medicare, then you can find the program that matches your service area. Keep in mind that you can be responsible for penalties if you do not carry the appropriate prescription drug coverage. Almost half of Alabama’s Medicare beneficiaries are enrolled in a supplemental prescription drug program. The premiums for the plans available will range from $18 to $117 per month.
Now that we’ve talked through the different plans, let’s get to answering some of the questions you may have about Medicare:
What conditions are covered under Medicare?
Medicare Part A covers services that are considered medically necessary to treat a condition or diagnosis. As an example: SNF, long-term care, hospice, home health, hospital stays, and any lab tests, surgeries or DME items required as a result of a condition, are covered if related to a treatment plan.
Medicare Part B, on the other hand, covers preventive services or medically necessary items required to complete a diagnosis. This includes ambulance services, mental health assistance, clinic visits, prescriptions, and obtaining a second opinion.
Medicare Prescription Drug coverage will depend on the formulary, which places drugs in different tiers. Each level will have a defined coverage amount and the formulary can be changed throughout the year.
How do I get Medicare?
- Go to Medicare.gov.
- Decide which Alabama Medicare Plan you want. Choices may include Original Medicare Plan A and B and Medicare Advantage Plan, depending on your qualifications.
- Decide whether or not you will need prescription drug coverage (Medicare Rx Plan - Part D) or Medigap.
- Decide if you want supplemental coverage.
What is a Medicare health plan?
Medicare health plans consist of Medicare coverage offered through a private company that is contracted with Medicare to provide services. These Medicare health plans will usually be in the place of traditional Medicare Part A and B.
What is a Medicare Medical Savings Account (MSA)?
Medicare Medical Savings Account (MSA) Plans are a consumer-directed Medicare Advantage Plan. This basically means that as the consumer, you have a bit more control over what your insurance money goes toward. These MSA plans are similar to a traditional Health Savings Account (HSA) in that you can put money into a special savings account to pay for healthcare costs. The downside is that these savings accounts are typically combined with high-deductible insurance plans. This deductible amount varies by plan.
Medicare Cost Plans are only available regionally if you have Medicare Part A and Part B and need to receive services from a provider that is out of network.
Programs of All-Inclusive Care for the Elderly (PACE) is a program that advocates for home health services. It allows the elderly to stay in their home longer before going to a long-term care facility. It will cover services such as adult day care, home care, meals, occupational therapy, social services, respite care, transportation, and caregiver training.
Medication Therapy Management (MTM) Program is offered through Medicare as an educational benefit. The program provides detailed training on the specific medications that the patient is taking and outlines an action plan to help ensure compliance.
What is Medigap and what does it do?
Medigap exists to help cover the out-of-pocket expenses related to your Part B coverage (and some Part A depending on the coverage definitions). When a claim is sent to Medicare, they will automatically send it to your Medigap insurance.
Is there cost assistance for Medicare?
There is not a cost associated with purchasing traditional Medicare, but there are options for additional coverage via Medicaid, Medicare Savings Programs, PACE or prescription drugs if deemed that co-payments or deductibles are difficult to meet. In addition, if a patient chooses to purchase an advantage plan or Medigap plan, there are out-of-pocket costs associated that are dependent on what has been purchased.
How does Medicare work with my other insurance?
If you have another insurance, it will almost always be billed before Medicare. The primary payer will pay their portion of the claim first and then bill the remaining amount to Medicare as the secondary payer, who will pay their portion next. The remaining balance will move into patient responsibility.
What is the State Health Insurance Assistance Program (SHIP) called in Alabama and how do I get a hold of them?
The SHIP program in Alabama is called the State Health Insurance Program. This group of counselors are trained on private and public benefits and they provide comprehensive, coordinated, and statewide counseling for elderly Alabama residents. These staff members will not recommend a policy or plan, but they will provide unbiased assistance and information.
Where can I get help or more information about Medicare?
Alabama Medicare FAQs