Medicare in Alabama: Plans and Coverage (2026)

Medicare in Alabama runs on federal rules, with free SHIP counseling through the Alabama Department of Senior Services and cost-saving programs through the Alabama Medicaid Agency.1,2

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Alabama (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Alabama
• Help Paying for Medicare in Alabama
• Medicare Enrollment Periods
• Free Medicare Help: Alabama SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, check Medicare's own cost pages or ask an Alabama SHIP counselor (see Free Medicare Help: Alabama SHIP).

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are the same in Alabama as everywhere else in the country.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.6

The hospital deductible rose $60 from 2025.3 A benefit period begins the day you're admitted to a hospital or SNF and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. If you're readmitted after that gap, the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services.7 Original Medicare does not cover routine dental, vision, or hearing.8

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 for a single filer or $218,000 for a married couple, under the income-related adjustment)3
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is optional, but turning it down can cost you. Skip it without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.9

Medicare Advantage in Alabama (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage and extras like dental, vision, and hearing.8

Which plans you can choose depends on where in Alabama you live. To join a Medicare Advantage plan you need Parts A and B and must live in the plan's service area, so a plan open to someone elsewhere in the state may not be open to you.10 Check what's available at your specific address before you commit.

How These Plans Work

• You still pay the Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium at about $14 a month in 2026, and many plans charge nothing extra. Some plans go further and may help pay part or all of your Part B premium.8,3
• Plans run on networks (HMO or PPO). Confirm that your doctors and hospitals are in-network before enrolling; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.8
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.8
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap: CMS says there is no yearly limit on what you pay out of pocket unless you have supplemental coverage such as Medigap, Medicaid, employer, retiree, or union coverage.8

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions to see which plans cover them and estimate your costs. An Alabama SHIP counselor can walk through the results with you at no charge.1

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan alongside Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the coverage gap, the old donut hole, so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay until you meet your plan's deductible, which can be no more than $615 in 2026; some plans charge none, and certain insulins and vaccines are exempt from it.11
2. Initial coverage: in the standard benefit, you pay 25% coinsurance on covered drugs until your out-of-pocket spending reaches the yearly cap.4
3. Catastrophic: once your out-of-pocket spending reaches $2,100, covered drugs cost you nothing for the rest of the year.4

That $2,100 cap is the figure that matters most in Part D. The average standalone Part D premium for 2026 runs roughly $34.50 a month, though actual premiums vary by plan.3 Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help pay a $0 deductible and low copays, and some pay nothing for their drugs.12

Medigap in Alabama

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.8

Alabama uses the federally standardized Medigap plans, labeled A-D, F, G, and K-N, regulated by ALDOI.13,5 Plans C and F can't be sold to people new to Medicare on or after January 1, 2020, which means you turned 65 and got Part A on or after that date. Someone who already had Part A before then because of a disability or ESRD isn't covered by that ban, and if you were eligible before 2020 but haven't enrolled yet, you may still be able to buy Plan C or Plan F.14,13 People new to Medicare can buy Plan G instead.14 It covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.5,3

Your strongest opening is the six-month Medigap Open Enrollment Period, which begins the first day of the first month you are both 65 or older and enrolled in Part B. During that window, Alabama rule 482-1-071-.11 bars an insurer from turning you down or pricing a policy on your health.5 One limit applies: if you had less than six months of continuous creditable coverage before applying, a policy can still make you wait up to six months for coverage of a pre-existing condition treated or diagnosed in the six months before coverage began, reduced by the creditable coverage you had.5 Alabama rule 482-1-071-.12 adds guaranteed-issue rights in listed situations, such as when an employer plan that supplements Medicare ends or your Medicare Advantage plan stops serving your area.5 If you have Medicare before 65 because of a disability, ALDOI says Medigap is not guaranteed issue until a six-month period beginning the month you turn 65, a guarantee that also covers ESRD patients.5 Our Alabama Medicare Supplement guide walks through each rule.

Medigap or Medicare Advantage?

You cannot use both at once. A Medigap policy can't pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.8 Choose Medigap and you stay on Original Medicare, which in most cases needs no prior approval for covered services.7 Choose Medicare Advantage and most plans, especially HMOs, generally require you to use in-network providers except for emergencies, and may require prior authorization; in exchange, every plan caps your in-network out-of-pocket costs (no more than $9,250 in 2026) and most add extras like routine dental, vision, and hearing.8 The lock isn't permanent. If you join an Advantage plan for the first time and go back to Original Medicare within 12 months, federal law gives you a trial right to buy a Medigap policy and a separate drug plan.8 For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Alabama

If you're on a fixed income, two programs can reduce your Medicare costs.

Medicare Savings Programs

Alabama runs its Medicare Savings Programs through the Alabama Medicaid Agency. The state uses the standard federal income tiers, and it applies no resource (asset) test to these programs, so eligibility turns on income alone. The three tiers are the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI) programs.2

QMB is the most generous tier, covering your Part B premium plus your deductibles and coinsurance. Federal law prohibits providers from billing a QMB enrollee for that cost-sharing.2 Alabama applies no resource (asset) limit to any of the three programs, so eligibility is based on income alone.2 The income figures are tied to the Federal Poverty Level and rise each year; the 2026 Alabama limits above took effect in February. Those published limits already include the $20 monthly general income exclusion, so they sit $20 above the bare poverty-level figure.2 They are the federal standards, not a cutoff to screen yourself against: SSA tells staff to encourage people to apply even when income looks somewhat higher, so an Alabamian a little over these amounts should apply and let the agency decide.2 QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next year.2 You apply directly through the Alabama Medicaid Agency at medicaid.alabama.gov, and enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help.2 For a fuller walk-through of the three tiers, the income math, and the application itself, see our guide to Alabama's Medicare Savings Programs.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, helps pay Part D premiums (up to a regional benchmark amount), deductibles, and copays for people with limited income and resources.12 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now receives the full subsidy.12

• Income limit (2026): about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC. Those are one- and two-person figures; the limit rises if family members you support live with you, and Social Security leaves some income out of the count, so apply if you're close.12
• Resource limits: $18,090 for an individual, $36,100 for a married couple living together. The lower $16,590 and $33,100 limits apply only if you tell Social Security none of your resources will go toward funeral or burial expenses. Your home and car don't count.12
• If you already qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically2
• QDWI, the Medicare Savings Program for people who lost premium-free Part A after returning to work, pays the Part A premium but does not carry Extra Help with it, so a QDWI enrollee has to apply to Social Security for Extra Help separately2,12

Apply through Social Security at its Extra Help application page, or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask to set up an appointment to apply.12,15

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Alabama as every other state.16

Changes made during Annual Open Enrollment take effect January 1. If you start collecting Social Security at least four months before you turn 65, you're enrolled in Parts A and B automatically; otherwise, you sign up through Social Security.16

If you delay Part B with group health coverage based on your own or a spouse's current employment, an 8-month Special Enrollment Period follows once that job or coverage ends, whichever happens first. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. Miss it, and unless another Special Enrollment Period fits (for example, your employer or plan gave you wrong information about signing up on or after January 1, 2023), you wait for the General Enrollment Period and may owe a late penalty of 10% per 12-month delay, for as long as you keep Part B. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17,9

Free Medicare Help: Alabama SHIP

You don't have to sort this out alone, and you don't need to pay a broker. Alabama's State Health Insurance Assistance Program (SHIP) is a program of the Alabama Department of Senior Services (ADSS), and the counseling itself happens locally, through your Area Agency on Aging. Its counselors and volunteers give free help, aren't affiliated with any insurance company, and won't try to sell you insurance.1

Alabama SHIP counselors can help you:

• Understand your Medicare benefits and what each part covers1
• Work out which Part D drug plan fits your prescriptions, and weigh Medicare Advantage against Medigap1
• Apply for the Medicare Savings Programs and Extra Help1
• Sort out Medicare claims and appeals1

To reach the SHIP in your area, call 1-800-243-5463 (1-800-Ageline), which connects you to your local Area Agency on Aging and Aging & Disability Resource Center. The Alabama Department of Insurance's senior health insurance page sends callers who need more help to that same number.1

Learn More

Find personalized help comparing your Medicare plan options in Alabama at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.