- Just over a million Alabama residents are enrolled in Medicare.
- More than 46 percent of Alabama Medicare beneficiaries select Medicare Advantage plans.
- Alabama residents can select from between 12 and 40 Medicare Advantage plans in 2021, depending on their county.
- In Alabama, access to Medigap plans is limited for enrollees under age 65. (The state does not require insurers to offer plans to people under 65, and only two insurers do so.) But 43 insurers sell plans to those 65+.
- Almost a third of Alabama’s Medicare beneficiaries have stand-alone Part D prescription coverage. (Another 44% have Part D coverage integrated with Medicare Advantage.)
- Per-enrollee Medicare spending in Alabama is slightly higher than the national average.
Medicare enrollment in Alabama
When it comes to determining which Medicare coverage is right for your situation, there’s a long list of factors that you can and should consider.
As of September 2020, there were 1,060,082 people enrolled in Medicare in Alabama. That’s more than 21 percent of the state’s total population, compared with a little less than 19 percent of the United States population enrolled in Medicare. Alabama’s higher-than-average Medicare enrollment is due in part to the fact that a higher-than-average number of people under the age of 65 are enrolled in Medicare in Alabama.
Medicare covers most Americans who are age 65 or older, and it also covers disabled Americans under the age of 65. Nationwide, 85 percent of Medicare beneficiaries are eligible due to their age, but in Alabama, just 78 percent of Medicare beneficiaries are eligible due to being at least 65 years old. For the other 22 percent, Medicare enrollment is due to disability (including ALS or kidney failure, as well as any other disability that has lasted at least two years).
Alabama is tied with Arkansas, Kentucky, and Mississippi for the highest percentage of disabled Medicare beneficiaries in the country. If we also consider the U.S. territories, 31 percent of Medicare beneficiaries in American Samoa are eligible due to a disability, and Puerto Rico is tied with Alabama, with 22 percent of Medicare beneficiaries eligible due to disability.
Learn how Alabama Medicaid can provide financial assistance to Medicare beneficiaries with limited income and assets.
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Medicare Advantage in Alabama
Medicare Advantage is an alternative to Original Medicare, provided by private insurers instead of directly by the federal government. It covers all of the benefits of Original Medicare (ie, hospital care and medical/physician care), albeit with different out-of-pocket costs and access to medical providers.
And most Medicare Advantage plans also provide helpful additional healthcare benefits, such as Medicare Part D coverage for prescription drugs, plus extras like dental and vision coverage. But provider networks tend to be much more limited and localized with Medicare Advantage, unlike Original Medicare’s nationwide access to providers. There are pros and cons to either option.
Thirty-seven percent of Alabama Medicare beneficiaries were enrolled in private Medicare Advantage plans in 2018. Nationwide, the average was 34 percent. The remaining 66 percent of the state’s Medicare beneficiaries had opted instead for coverage under Original Medicare. But by September 2020, more than 46 percent of the people with Medicare in Alabama were enrolled in private plans (ie, Medicare Advantage, as opposed to Original Medicare). The increase in Medicare Advantage enrollment has been a steady trend in most states over the last several years.
The availability of Medicare Advantage plans depends on where a person lives. There are 67 counties in Alabama, and the number of Medicare Advantage plans for sale in each county for 2021 ranges from 12 to 40, depending on the county. It’s not a coincidence that the most populated counties have a higher number of available plans, as insurer service areas tend to be concentrated in areas where there is a large population.
Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual window each fall, from October 15 to December 7. During this window, Medicare beneficiaries can switch from one Medicare Advantage plan to another, or from Medicare Advantage to Original Medicare or vice versa (note that there is no annual enrollment window for Medigap plans; medical underwriting is necessary in most cases in order to enroll in a Medigap plan after a person’s initial enrollment window).
There’s also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plans and enroll in Original Medicare instead.
Medigap in Alabama
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket healthcare costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.
There are 43 insurers that offer Medigap plans in Alabama as of 2020.
Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans, and insurers can’t use medical underwriting to determine eligibility or premiums. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.
The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but Alabama is not among them. In Alabama, Medicare beneficiaries who are under 65 can apply for a Medigap plan, but coverage is not guaranteed issue and insurers can use medical underwriting to determine whether to issue a policy and at what price.
There are two insurers in Alabama that offer Medigap plans to enrollees who are under age 65 (Blue Cross Blue Shield of Alabama and United American Insurance Company). They offer just a few plan options, with premiums are substantially higher than premiums for similar plans for a person who is 65.
A person who has Medicare prior to age 65 as a result of a disability does qualify for an open enrollment period, upon turning age 65, during which they can select any Medigap plan, guaranteed-issue, from any insurer offering plans in their area.
People under age 65 who are eligible for Medicare also have the option of enrolling, with standard premiums, in a Medicare Advantage plan. As of 2021, this includes people with end-stage renal disease, who were ineligible to join most Medicare Advantage plans prior to 2021.
Medicare Part D in Alabama
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or one of several stand-alone Medicare Part D plans.
As of September 2020, there were 318,344 Medicare beneficiaries in Alabama who were enrolled in stand-alone Medicare Part D plans. In addition, more than 466,000 Medicare beneficiaries in Alabama have Part D prescription coverage that’s integrated with their Medicare Advantage plans.
For 2021 coverage, there are 32 stand-alone Part D plans available in Alabama, with premiums ranging from about $7 to $139 per month.
Medicare Part D enrollment is available when a beneficiary is first eligible for Medicare, and also during the annual open enrollment period in the fall (October 15 – December 7; the same enrollment window that applies to Medicare Advantage plans). This window is an opportunity for Medicare beneficiaries to change their Part D coverage, with any plan changes taking effect January 1 of the coming year.
Medicare spending in Alabama
In 2018, Original Medicare spent an average of $10,731 per beneficiary in Alabama. That’s based on data that were standardized to eliminate differences in payment rates from one area to another, but it was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees.
The national average that year was $10,096 per enrollee, so Medicare spending in Alabama was 6 percent higher than the national average. On the extreme ends of the spectrum, per-beneficiary Medicare spending was highest in Louisiana ($11,932) and lowest in Hawaii ($6,971).
How does Medicaid provide financial assistance to Medicare beneficiaries in Alabama?
Many Medicare beneficiaries receive assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Alabama includes overviews of these programs, including long-term care benefits, Medicare Savings Programs, and eligibility guidelines for assistance.
Where to turn for additional help with Medicare in Alabama
If you have questions about filing for Medicare benefits in Alabama, Medicare eligibility in Alabama, or Medicare enrollment in Alabama, you can contact the Alabama State Health Insurance Assistance Program.
You can also reach out to the Alabama Department of Insurance for assistance with Medigap plans in Alabama. The Department of Insurance also oversees the agents and brokers who offer health coverage in Alabama, and can provide assistance and information in a variety of health coverage situations.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.