Based in Birmingham, Alabama, Viva Health are a Medicare-approved private insurance company that offer various Medicare Advantage plans. Such plans offer the same coverage as original Medicare, plus additional benefits.
According to the Kaiser Family Foundation, more than 24 million people got Medicare benefits through Advantage plans in 2020.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
When individuals qualify for Medicare, they can enroll in either original Medicare (Part A and Part B) or a Medicare Advantage plan. A person cannot enroll in both plans at the same time.
Medicare Advantage plans, also known as Medicare Part C, must provide equal coverage to original Medicare, including:
- outpatient visits with doctors and specialists
- diagnostic tests
- preventive care, such as vaccinations
- inpatient stays in hospitals, clinics, or skilled nursing facilities
- emergency and urgent care
- some transportation
- occupational and physical therapy
- durable medical equipment, such as commode chairs and patient lifts
Unlike original Medicare, Medicare Advantage plans cap out-of-pocket expenses. They may also provide additional benefits, such as dental, vision, and hearing care.
Some Advantage plans may also include prescription drug coverage (Medicare Part D). If a person is enrolled in original Medicare, they must get a stand-alone Part D plan from a private insurance company.
Learn more about the pros and cons of Medicare Advantage plans here.
Viva Health are a private healthcare insurance company based in Alabama. Founded in 1995, they have more than 100,000 members and a network of more than 70 hospitals across Alabama. The company are an affiliate of the University of Alabama at Birmingham (UAB) health system.
The Centers for Medicare & Medicaid Services (CMS) give all Viva Health Advantage plans 4.5 stars out of a possible 5 stars, using their five-star quality rating system.
A person can use this online tool to check the star rating of a company’s Advantage plan by entering a ZIP code and filtering by the company name and desired star rating.
There are several types of Medicare Advantage plans. The four most common plans are:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
Another, less common option is a Medicare savings account (MSA), which combines a savings account with a high deductible health plan.
HMO plans
A person enrolled in an HMO plan must use an approved network of healthcare providers and choose a primary care physician from the network. The doctor acts as the first point of contact, coordinating the individual’s healthcare and providing referrals to specialists where necessary.
Using a provider from outside the network may carry a higher cost unless it is a medical emergency.
PPO plans
PPO plans also use a network of providers, but members can choose out-of-network providers with higher out-of-pocket expenses. People do not need to choose a primary care physician or request specialist referrals.
PFFS plans
PFFS plans allow people to see any doctor who accepts the plan’s rules and payment terms. Some plans have networks of providers who will treat anyone enrolled in the plan.
SNPs
SNPs are designed for people with particular health needs, and they include Part D prescription drug coverage. SNPs provide benefits to people who have certain chronic health conditions, such as HIV or cancer, live in a long-term care facility, or qualify for both Medicare and Medicaid benefits.
Viva Health offer Medicare Advantage plans in Alabama, although some plans are available only in individual counties. The company have offices, help centers, and health service providers across the state.
A person can search for Viva Health Advantage plans in their area using the company’s online plan finder tool.
Viva Health Advantage plans include:
Health Maintenance Organization (HMO)
This plan offers a network of providers across Alabama, including doctors, clinics, and pharmacies. If someone uses a provider outside the plan’s network, they commonly pay more, or they may have to cover the entire cost. The plan covers all emergency services, including out-of-network ones.
HMO Special Needs
This plan is called the Viva Medicare Extra Value plan, and it provides coverage for people who qualify for both Medicare and Medicaid. It has either a low cost or no cost.
Viva Health’s Medicare Advantage plans cover the same services as original Medicare. However, they also provide routine vision benefits and diagnostic, preventive, and comprehensive dental coverage.
Other standard benefits include:
- allowance for over-the-counter drugs
- no copay for doctor visits
- zero cost medical and diabetes testing and diabetic supplies
- out-of-pocket limit
- low cost generic drugs and a home delivery option for prescriptions
- worldwide emergency medical coverage
- Silver&Fit program, which is a fitness program for older adults
Additional benefits
Plan members also have access to Viva Health Cafes, where they can get answers to their Medicare questions.
Viva Health also provide the VCare Program — a wellness program — at no charge for people with specialized care management needs. A nurse works with the individual to help them follow their prescribed care plan, with the goal of becoming more active and independent.
The costs associated with Viva Health’s Medicare Advantage plans include monthly premiums, copays, coinsurance, and deductibles.
The table below shows the 2021 costs for some Viva Health plans at various locations in Alabama.
| Costs | Viva Medicare Prime (HMO) Montgomery County | Viva Medicare Premier (HMO) Calhoun County | Viva Medicare Me (HMO) Jefferson County | Viva Medicare Plus (HMO) Henry County |
|---|---|---|---|---|
| Monthly premium | $54 | $104 | $0 | $0 |
| PCP copay | $0 | $0 | $0 | $0 |
| Specialist copay | $25 | $15 | $25 | $30 |
| Maximum out-of-pocket limit (does not apply to Part D prescription drugs) | $5,900 | $5,500 | $6,400 | $6,700 |
People can use the government’s online tool to compare the costs and availability of Medicare Advantage plans in their area.
People can also get free, impartial advice from the State Health Insurance Assistance Program (SHIP). Volunteers who have completed training in all aspects of the Medicare program staff the SHIP offices and help people make informed decisions. If someone needs assistance from SHIP, they can call 877-839-2675 to find the nearest office.
Viva Health are a Medicare-approved private insurance company. They offer Medicare Advantage plans to residents of Alabama. People can choose from a range of HMO options.
Viva Health’s Medicare Advantage plans match the coverage that original Medicare provides and offer additional benefits, including dental care, wellness benefits, access to a 24-hour nurse line, Viva Health cafes, and the VCare Program for people with specialized care management needs.