Medicare Advantage Plans in Georgia

• Many plan choices: Medicare Advantage Plan availability varies by county, but there are 110 plans available in Georgia overall in 2022.
• They are popular: About 42% of all Georgians eligible for Medicare choose a Medicare Advantage Plan.
• Every resident has ample options: The average number of plans available per recipient is 35.

You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.

With 110 Medicare Advantage Plans available in Georgia, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:

• Monthly premium: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
• Plan network: You may need to use doctors and providers who are within a plan’s network. Before choosing a Medicare Advantage Plan, think about the doctors and facilities (including pharmacies) you prefer to use, then check if the plan offers coverage at those locations. Some plans may provide out-of-network coverage, but this usually comes at a higher cost.
• Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles, and these may change only once per year on January 1.
• Copayments and coinsurance: Copayments or coinsurance are how much you pay for each service or doctor’s visit, such as $20 per doctor visit. Each Medicare Advantage Plan sets its copayment or coinsurance amount that can differ from what you would pay through Original Medicare.
• Out-of-pocket maximum: Each Medicare Advantage Plan sets a yearly limit on the maximum amount you’d be responsible for paying for services covered by Medicare. Once you reach this limit, you won’t have to pay anything for the services you receive covered by Part A and Part B in that year.
• Additional coverage: Most Medicare Advantage Plans also provide prescription drug coverage and often include additional benefits that Original Medicare won’t cover, such as vision, dental, and hearing. Plans may provide even more benefits, like discounted gym membership or transportation to doctor’s visits. Medicare Advantage Plans can also tailor their benefits to the specific needs of particular chronically ill beneficiaries.

Medicare Advantage Plans in Georgia are a popular option for many seeking Medicare coverage. There are numerous plans to choose from in each of Georgia’s counties, with an average number of 35 plans available per recipient.

With so many options – some highly rated – around 42% of Medicare recipients in Georgia opted for Medicare Advantage plans in 2020.

Understanding Medicare Advantage Plan Types:

• HMO: Health Maintenance Organization plans generally provide coverage only at in-network providers except in medical emergencies. You usually need to have a primary care physician who can give you a referral to see specialists. Most HMO plans include prescription drug coverage.
• HMO-POS: HMO-POS plans are HMO plans with a Point of Service benefit for out-of-network providers. In these plans, you may be able to use out-of-network providers for certain services but may pay more for your care if you do.
• PPO: Preferred Provider Organization plans have a network of healthcare providers and facilities where your care will cost less. You can use out-of-network providers as well, but your care will cost more. You usually do not need a primary care doctor to get referrals to see specialists or receive treatment. Most PPO plans include prescription drug coverage.
• PFFS: Private Fee-for-Service plans allow you to use any Medicare-approved provider. Some PFFS plans have networks of providers where you can receive lower-cost care. You don’t need referrals to see specialists in PFFS plans, but prescription drugs are not always covered.
• SNPs: Special Needs Plans are for beneficiaries with specific diseases or characteristics. These plans tailor benefits and providers to the special needs of the group they serve. You are generally limited to the network of providers the plan offers and need a primary care doctor and get referrals to specialists. All SNP plans include prescription drug coverage.

Enrollment and Eligibility for Medicare Advantage Plans in Georgia

You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:

• You’ve received Social Security Disability Insurance or Railroad Board Disability Annuity for 24 months
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
• You have End-Stage Renal Disease

When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.

• Your IEP begins three months before the month you turn 65 and extends for three months after the month you turn 65. During this period, you can enroll in a Medicare Advantage Plan. If you join before the month you turn 65, your coverage will begin the first day of the month you turn 65. If you enroll in the three months after turning 65, your coverage will begin the first day of the month after you enroll.
• If you miss your IEP, you can sign up for Medicare during the General Enrollment Period from January 1 to March 31.
• After you enroll in Medicare, you can enroll in or make changes to your Medicare Advantage Plan coverage during the Medicare OEP from October 15 and December 7 of each year. During this time, you can change from Original Medicare to Medicare Advantage, switch to a different Medicare Advantage Plan, or change from Medicare Advantage back to Original Medicare.

Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.

There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.

Medicare Enrollment Periods

Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Georgia Medicare Advantage Plan to use.

Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.

Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.

• CMS.gov Medicare Advantage and Other Health Plan Enrollment | Last accessed December 2021
• HHS.gov | What is Medicare Part C? | Last accessed December 2021
• KFF.org | A Dozen Facts About Medicare Advantage in 2020 | Last accessed December 2021
• KFF.org | Medicare Advantage 2021 Spotlight: First Look | Last accessed December 2021
• KFF.org | Medicare Advantage Enrollees as a Percent of Total Medicare Population | Last accessed December 2021
• KFF.org | Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021 | Last accessed December 2021
• Medicare | Health Maintenance Organizations (HMO) | Last accessed December 2021
• Medicare | How do Medicare Advantage Plans Work? | Last accessed December 2021
• Medicare | Part B Late Enrollment Penalty | Last accessed December 2021
• Medicare | Preferred Provider Organizations (PPO) | Last accessed December 2021
• Medicare | Special Circumstances (Special Enrollment Periods) | Last accessed December 2021
• Medicare | Special Needs Plans (SNP) | Last accessed December 2021
• Medicare | Understanding Medicare Advantage and Medicare Drug Plan Enrollment Periods | Last accessed December 2021
• NCQA Health Insurance Plan Ratings | Ratings in Georgia | Last accessed December 2021