Alabama Medicare Advantage Plans Explained
The advantages of Medicare Advantage (MA) plans are found in what they can cover that Original Medicare cannot. Specifically, the MA plans available in Alabama can include minor healthcare benefits such as prescriptions, vision, hearing, dental, fitness, telehealth, and more. In contrast, Original Medicare only covers major medical healthcare services.
Many people love the extra benefits they get with their MA plan. However, before you jump in with both feet, take the time to fully understand the trade-offs. The extra benefits and perks are nice, but they come at a cost. Specifically, when you join a Medicare Advantage plan in Alabama you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the plan be a gatekeeper and fully control your access to doctors and other healthcare providers.
Original Medicare vs. Medicare Advantage
One way to better understand how different Original Medicare is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance. So, let's do that.
The Pros and Cons of Alabama Medicare Advantage Plans vs Original Medicare
- With Medicare Advantage you must use Alabama healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved provider of your choice.
- If you travel and have a medical emergency, Medicare Advantage covers you. However, if you are a snowbird and winter or summer in another state, non-emergency doctor outside of your plan's network won't be covered.
- All Medicare Advantage plans sold in Alabama protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
- Most Medicare Advantage plans come bundled with a Alabama Medicare Part D plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
- With Original Medicare your costs (copays, coinsurance, etc) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
Medigap vs. Medicare Advantage
Three of the most common questions we get are:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's answer these three questions right now.
Why Alabama Medicare Advantage Plans are Bad
People that claim Medicare Advantage plans are bad simply misunderstand what they are and how they work. Over 20 percent of all Medicare beneficiaries in the state of Alabama choose Medicare Advantage and like the care they get. However, these plans are not suitable for everyone.
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people and for people who qualify for both Medicare and Medicaid.
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.
What are the Disadvantages of Alabama Medicare Advantage Plans?
We have already highlighted the issue of doctor choice in Medicare Advantage. If this is not an issue for you, then consider the financial differences.
With Medicare Advantage you pay a little each month (with some plans you pay nothing). This is the monthly premium. But you also pay a copay when you use most medical services, and they add up fast. However, with traditional Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.
When Should I Consider Medigap Instead of Medicare Advantage?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.