- In 2019, there were 63 Medicare Advantage Plans available in Georgia.
- 35% of the total Medicare population in Georgia is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,328 per beneficiary in Georgia, which is 2% higher than the national average.
- Available Medicare Advantage Plans range from eight to 61 across Georgia’s 159 counties.
Medicare Advantage Plans can be a good option for people seeking all-in-one drug and medical coverage. These plans can often be more affordable than Original Medicare and supplemental insurance because the benefits are bundled. Your insurance coverage may be limited if you travel outside of your state. Medicare Advantage Plan options can vary depending on where you live, but typically there are four common plan types.
Medicare Advantage Plans in Georgia
Types of Medicare Advantage Plans
In Georgia, there are four types of Medicare Advantage Plans available to seniors. Georgia’s Medicare Advantage program is affordable and offers options, such as $0 copays for preventive care. These plans must include the same benefits as Medicare Parts A and B and may have additional benefits, such as prescription drug coverage, eye care, wellness programs, and hearing services.
Health Maintenance Organizations (HMO)
Health Maintenance Organizations provide you with access to a network of hospitals and doctors. You must seek care within this network and emphasis is placed on preventative care, including routine checkups. To get prescription drug coverage as part of your HMO, look for Medicare Advantage Prescription Drug (MAPD) plans. If your plan doesn’t include prescription drugs, you may not qualify for Medicare Part D’s drug coverage. With an HMO you typically need to choose a primary care physician, and you need a referral to see a specialist.
Preferred Provider Organizations (PPO)
Preferred Provider Organizations differ from HMOs in that you can seek care outside your network, but you will have to pay an additional cost. PPOs offer more flexibility and usually don’t require you to select a primary care physician or have a referral to book an appointment with a specialist. However, this increased freedom often comes at a price. PPO plans have higher monthly premiums than HMOs, and you hold more responsibility for your own medical care/records since you don’t have a primary care physician.
Private Fee-For-Service Plans (PFFS)
A Private Fee-For-Service Plan doesn’t restrict you to a limited network. Instead, PFFS plans allow you to seek care from any Medicare-approved provider that agrees to the plan’s terms of payment. PFFS plans determine how much they’ll pay the health care provider, and based on that, how much you pay them. If a PFFS plan doesn’t include prescription drug coverage, you can enroll in Medicare Part D.
Special Needs Plans (SNP)
Special Needs Plans limit membership, accepting only people with specific diseases or characteristics to be eligible for coverage. They offer tailored service providers and coverage choices based on the groups they serve. You typically need to use providers within the selected network with an SNP, except for urgent medical care and out of area dialysis for renal disease. Most SNPs require you to choose a primary care physician, and all SNPs must provide Medicare prescription drug coverage. You will need a referral to visit a specialist, with the exception of screening programs, such as mammograms, pap tests, and pelvic exams.
Enrollment & Eligibility for Medicare Advantage Plans in Georgia
Medicare Advantage Plans in Georgia are typically available to anyone who:
- Is enrolled in Original Medicare Part A and Part B and not enrolled in Medigap
- Is a U.S. citizen and a resident of Georgia
- Has paid Medicare payroll deductions
- Is aged 65 or older
Once you decide to enroll in Georgia’s Medicare Advantage program, you can only do so during certain periods:
- The Initial Enrollment Period begins three months prior to your 65th birthday and continues for three months after your birth date.
- The Annual Enrollment Period runs from October 15th to December 7th. During this time, you can enroll in Medicare Advantage, switch between plans, or go back to Original Medicare.
- The Medicare Advantage Open Enrollment Period takes place from January 1st to March 31st. You can switch from Original Medicare to Medicare Advantage or change Medicare Advantage Plans.
Other special enrollment periods may open up for unusual circumstances or life-changing events, such as losing your job and employee insurance coverage or moving.
Prescription Drug Coverage
Medicare Part D, prescription drug coverage, is optional and available to everyone with Original Medicare plans. If you’re enrolled in Medicare Advantage instead of Original Medicare, you need to be cautious about enrolling in a prescription drug plan because it might impact your Medicare Advantage coverage. HMOs and PPOs don’t allow you to enroll in Medicare Part D. If you do, you will be unenrolled in Medicare Advantage and switched back to Original Medicare.
To apply for a separate Medicare drug plan without forfeiting your existing coverage you must be enrolled in a PFFS, a Medical Savings Account Plan, a Cost Plan, or an employer-sponsored Medicare health plan. If you are unsure whether you can enroll in a separate drug plan, consider using community resources for assistance.
Medicare Advantage Plans in Georgia
Understanding your Medicare Advantage Plan options is essential to getting the right medical care for your situation. It’s vital to have an accurate picture of what prescription drug coverage you can enroll in with your chosen plan type. To help guide you through the application process, Georgia has several resources to help you make the right choice for your particular needs.
GeorgiaCares is the State Health Insurance Program (SHIP). Counselors are not affiliated with any insurance company and offer unbiased opinions to help you understand your plan options, review your benefits, file Medicare bills and claims, apply for financial assistance, and enroll in your chosen Medicare program.
Contact Information: Website|1-866-552-4464
Georgia State Medicare Patrol
Through Georgia SMP, you can receive education about recognizing, preventing, and reporting Medicare fraud. SMP counselors can help you examine your medical bills and statements for fraud and errors, so you can protect yourself financially.
Contact Information: Website|1-877-272-8720
Georgia Department of Human Services
The Georgia DHS assists seniors with Medicare plan decisions throughout the open enrollment period. The Department’s Division of Aging Services has counselors on hand who can answer questions about Medicare plans and assist with enrollment.
Contact Information: Website|1-404-657-5258
This advocacy group is based in Atlanta, Georgia, and aims to support seniors and Georgians with disabilities. Empowerline has free certified counselors on hand 24/7 to answer questions related to Medicare and Medicare Advantage Plans.
Contact Information: Website|1-404-463-3333
Learn More From Our Sources
- Medicare | How to get prescription drug coverage
- Medicare | Medicare Advantage Plans
- Medicare | Special Needs Plans (SNP)
- Medicare | Private Fee-For-Service Plans (PFFS)
- GeorgiaCares | State Health Insurance Department (SHIP)
- Senior Medicare Patrol |Medicare Fraud
- gov | Preferred Provider Organization
- Department of Human Resources | Division of Aging Services
- Department of Human Resources | Home and Community Based Services
- Empowerline|Your resource for aging, disability, and caregiver needs in metro Atlanta