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Medicare in Alabama

February 10, 2022

Medicare in Alabama

Navigating Medicare can feel extremely difficult, and you may find yourself with a lot of questions about the different types of coverage and how they can impact you. Medicare is a federal program that provides healthcare benefits for people who are 65 and older, as well as younger individuals with qualifying disabilities or end-stage renal disease.

As of 2021, more than eight million Alabama residents are enrolled in some type of Medicare plan, including:

  • 5.3 million Medicare Advantage beneficiaries
  • 2.9 million Prescription Drug plan beneficiaries

Do you qualify for Medicare? What benefits does Medicare offer? Are there different Medicare plans? Many people, as they reach the age or criteria to qualify for Medicare, find themselves struggling to determine what steps they need to take next. Fortunately, sorting out questions about Medicare may prove less challenging than you initially thought. Take a look at these answers to common Medicare questions.

Who Qualifies for Medicare in Alabama?

In Alabama, US citizens or permanent residents qualify for Medicare if they meet necessary eligibility criteria. In order to qualify, you must meet at least one of the following:

  • You are at least 65 years old
  • You are not yet 65, but you are permanently disabled and receive disability payments or benefits through another source
  • You have end-stage renal disease.
  • You have Lou Gehrig's disease, which is also known as ALS, or amyotrophic lateral sclerosis

If you do not yet meet these criteria, you may not be eligible for Medicare in Alabama. However, as your 65th birthday approaches, it may be time to start planning what you will need when you're ready to apply. Most Medicare beneficiaries across the country qualify as a result of their age. In Alabama, however, around 22% of Medicare users qualify, not because of their age, but because of a specific disability.

How Old Do You Have to Be to Get Medicare in Alabama?

Alabama residents qualify for Medicare when they reach age 65. Only under specific circumstances can you qualify for Medicare before 65: if you have end-stage renal disease or Lou Gehrig's disease, or if you are permanently disabled for other reasons. If you have questions about Medicare eligibility, you can always ask a benefits advisor, who can give you more information about whether you might qualify.

How Do I Apply for Medicare in Alabama?

If you have already applied for Social Security disability benefits or retirement benefits, it will serve as an application for Medicare at the same time. Many people will automatically get Part A coverage from Medicare once they are eligible since they have already retired and received the benefits they need. However, if you want to sign up for Part B coverage, for which you will have to pay a premium, you may need to sign up directly.

If you automatically qualify for Medicare Part A due to your Social Security disability benefits or retirement benefits, you will get a Part A welcome package, which includes your hospital insurance, about three months before your Medicare coverage is due to start. On the other hand, if you want Part B insurance, you will need to sign up for it. If you do not automatically qualify for Medicare Part A, or you need to make sure that you sign up before you turn 65, you will need to create a My Social Security Account. Call the Social Security Administration at 1-800-772-1213 to start setting up your account.

What Medicare Plans are Available in Alabama?

Medicare offers multiple plan types you can choose from in order to select the coverage that best fits your specific needs.

Part B

On the other hand, Part B offers coverage for a wider range of services, including:

  • Doctors' services
  • Outpatient care
  • Medical supplies
  • Preventative services
  • Some mental health services, including both inpatient and outpatient services
  • Durable medical equipment

Unlike Part A, you will have to deliberately sign up for Part B. You may need to opt-in within three months of turning 65 or face increased premium costs as a penalty if you want to sign up later in that year. Generally, there is an open enrollment window each year between October 15 and December 7, during which Medicare recipients can decide that they want to opt-in to additional coverage or change their current coverage. Part B will require you to pay for your Medicare coverage.

Medicare Part D Coverage

Part D coverage is the Medicare drug coverage. It is designed to provide coverage for a wide range of prescription drugs that you may need to take, lowering your prescription drug costs. Part D is optional and is usually added to other types of Medicare coverage. If you have Medicare Part D, you may find that it substantially lowers your overall prescription drug costs. Original Medicare does not offer help with many prescription drug costs, which means recipients may find themselves paying out of pocket for many of those expenses. Medicare Advantage plans may also require you to enroll specifically in Part D coverage in order to receive much-needed prescription drug coverage for your medications.

Like other types of Medicare coverage, you can choose to opt into Part D coverage within three months of turning 65 or during the open enrollment period between October 15 and December 7 each year. You can also choose to change your coverage during open enrollment each year, allowing you to continue to adapt your Medicare plan to your changing needs.

Medicare Advantage

Medicare Advantage provides insurance coverage very similar to Original Medicare, but instead of using insurance coverage provided by the federal government, Alabama residents who opt for a Medicare Advantage plan will receive coverage through private insurers. Medicare Advantage usually applies to a smaller network of providers, rather than offering the nationwide access you can expect through Medicare. Some providers, however--including a number of specialists that you may see on a regular basis--may not accept Original Medicare patients, but may accept Medicare Advantage patients.

It's important to carefully consider the advantages and disadvantages of Medicare Advantage versus Original Medicare. You may want to carefully consider the providers available in your area. Under a Medicare Advantage plan, you can choose the types of coverage you need most while omitting coverage that does not typically apply to you. Because you can create a more highly customized plan, you can often keep your premium payments lower.

Medicare Supplement (Medigap)

Medicare Supplement or Medigap is exactly what it sounds like: insurance that stands in the gap for Original Medicare and helps cover some of the out-of-pocket healthcare costs. Most often, Medigap covers things like copays, coinsurance, and deductibles.

Medigap coverage is available when you turn 65 and enroll in Original Medicare. During that period, you can choose to enroll in Medigap without having to worry about medical underwriting that could change your eligibility or the premiums you might have to pay based on current medical conditions. Federal regulations do not mandate Medigap coverage for people under the age of 65 who otherwise qualify for Medicare.

Contact Us to Learn More About Medicare and Medicare Advantage in Alabama

Do you have more questions about Medicare coverage in Alabama? Whether you are 65 or nearing 65 or you have a disability that makes you eligible for Social Security disability payments and, therefore, for Medicare, we can help. Contact us today for more information about Medicare plans in your area.

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