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Medicare Advantage Plans in Georgia

Certain Medicare Advantage plans in Georgia help you control medical expenses and give you access to the right healthcare. If you’re only enrolled in Medicare Part A and Part B, you may still have to pay high deductibles, coinsurance, or nonpayments for covered services. Also, the best Medicare Advantage plans in Georgia, sometimes called Part C, may offer you additional benefits that will help you save money.

This overview will help you understand your Medicare Advantage plan choices, when to enroll, and what to expect. You should also be able to understand the difference between Medicare Part C plans in Georgia and Medicare Part A and Part B.

When to Enroll in Certain Medicare Advantage Plans in Georgia

You may need to pay attention to the calendar to make sure that you are ready to enroll in your Medicare Advantage plan in Georgia at the right time. These are some common enrollment times:

  • Initial Coverage Election Period: You get a chance to enroll when you first become eligible for Original Medicare.
  • Annual Election Period: Every year, you get a few months in the fall to switch your Medicare Advantage plan.
  • Special Election Periods: You may get a Special Election Period if you experience certain changes in your circumstances.
  • Medicare Advantage Disenrollment Period: During the first six weeks of the year, MA members can drop their plan, resume Original Medicare. If you only have Medicare Part A and Part B, you can also enroll in a Part D plan for prescriptions.

Otherwise, you must be enrolled in Medicare Part A and Part B to enroll in a Medicare Advantage plan in Georgia. You only have to answer one health question about ESRD, and you can find special plans to cover that health condition. Once you enroll, you will usually use your new plan card instead of the card that you got for Original Medicare.

Best Medicare Advantage Plans in Georgia

You should not assume that all of the Medicare Advantage plans in Georgia work the same. These are some highlights of popular Medicare Advantage plan types:

  • Health Maintenance Organization HMO plans:

Typically, an HMO will be a low-cost option, but it will have strict network rules. About 30% of Georgians choose an HMO.

  • Preferred Provider Organization PPO plans:

A PPO also uses a network, but it will be more flexible. Almost 70% of Georgia MA members choose a PPO.

  • Special Needs Plans SNPs:

Special Needs Plans are designed to help people manage specific conditions, like institutional conditions or chronic health conditions.

  • Dual-Eligible plans:

These plans are for Medicare recipients who also qualify for Medicaid.

  • End Stage Renal Disease ESRD plans:

These are special plans that are tailored for people who suffer from ESRD.

Beneficiaries will have the best chance of getting a $0 premium with an HMO plan. On the other hand, a beneficiary may prefer to pay a little more for the flexibility of a PPO. Also, most of these plans come with some extra benefits that Medicare Part A and Part B don’t have, like dental or vision coverage. Each beneficiary should compare Medicare Advantage plans in Georgia to find the best balance of premiums and benefits.

Almost all Medicare Part C plans in Georgia are network plans. Original Medicare doesn’t use networks, however, insurance companies may use their networks to manage costs for themselves and their members better than Medicare Part A and Part B do. Most beneficiaries do choose additional insurance to enhance their Original Medicare benefits.

Enrollment Statistics for Medicare Advantage Plans in Georgia

These are some facts about enrollment in Medicare Advantage plans in Georgia:

  • Percent of Georgian Medicare beneficiaries with a Medicare Advantage plan: 33%
  • Members of a Medicare Advantage plan in Georgia: About 500,000

View the top Georgia counties by population:

  • Fulton County, GA: 1,041,423
  • Gwinnett County, GA: 920,260
  • Cobb County, GA: 755,754
  • DeKalb County, GA: 753,253
  • Chatham County, GA: 290,501

How Does a Medicare Advantage Plan in Georgia Cover Prescriptions?

Some of the best Medicare Advantage plans in Georgia come with Medicare Advantage Prescription Drug plans, so you won’t need to enroll in Part D separately. There are a couple of things to remember when you compare drug coverage:

  • Each insurance company will provide you with a formulary, and this is a list of covered medications.
  • You will also see Prescription Drug tiers that group prescriptions into categories. For instance, you may have to pay different rates for generics, brand-names, and specialty medicine.

Network Restrictions for a Georgia Medicare Advantage Plan

You may have concerns about any network restrictions that may limit your choice of a doctor or hospital. An HMO will also make you pick a primary care doctor, and that PCP may have to give you a referral before you can visit with a specialist. A more restrictive HMO will also make you get all of your covered services with in-network providers. If you see plans that offer a $0 premium, they are probably HMOs.

With a PPO, you will pay less with an in-network doctor or hospital, but you can choose out-of-network providers if you don’t mind paying more. Premiums may also cost somewhat more, but in most cases, rates are still relatively low.

If you move out of the service area of your Medicare Advantage plan, you will get a Special Election Period that will allow you to switch to a new plan. Some PPOs may have a nationwide network that will allow you to travel, but very often, they only have local networks.

Georgia Medicare Resources

These helpful resources may help you learn more about Medicare Advantage plans in Georgia:

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