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How Do Medicare Advantage Plans Work in Georgia?

For seniors looking to simplify their health care coverage, Medicare Advantage in Georgia for 2022 is an attractive option. Medicare Advantage plans, also referred to as Medicare Part C, are becoming increasingly popular in Georgia.

Here are a few reasons why:

  • Frequently have extra benefits such as gym memberships, vision, and meal delivery
  • Typically include prescription drug coverage
  • Eliminates the need for Medicare Supplement (Medigap) insurance

The Centers for Medicare and Medicaid Services regulate Medicare Advantage plans in Georgia, and Medicare beneficiaries have many coverage options. It’s essential to compare health plans so that you get the coverage you need for the lowest price. The following information will get you started on the road to getting the health insurance that you need.

What is Medicare Advantage in Georgia?

A Georgia Medicare Advantage plan is sometimes referred to as “replacing Medicare,” but that’s misleading. What Medicare Advantage in Georgia does is replace the way you receive your Medicare coverage.

Here’s how it works:

  • You must sign up for Original Medicare (Medicare Part A and Part B).
  • Medicare Advantage includes all of the benefits of Original Medicare.
  • Private insurance companies provide the benefits and handle claims administration rather than the federal government.
  • Plans typically have provider networks.
  • You will have out of pocket costs such as deductibles, copayments, and coinsurance.
  • Most Georgia Medicare Advantage plans include Part D coverage (known as MAPD plans or Medicare Advantage Prescription Drug plans).
  • To maintain eligibility for a Georgia Medicare Advantage plan, you must continue paying your Part B premium.

What is the Best Medicare Advantage plan in Georgia in 2022?

Finding the best Medicare Advantage plan in Georgia for 2022 depends on your finances, health condition, and the healthcare providers you use.

Best network freedom: Medicare Advantage PPO

  • Larger network
  • No referrals needed
  • Flexibility to see any provider for a higher cost-share
  • $0 to $100 monthly premium

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Has primary care physician
  • Lower out of pocket costs because uses network providers
  • Typically $0 monthly premium

Best for low income or health conditions: Medicare Advantage D-SNIP

  • Open to those eligible for both Medicare and Medicaid
  • Good for those with chronic health conditions such as end-stage renal disease
  • Includes Medicare Part D plan
  • Uses PCP, referrals, network providers

What Medicare Advantage plans are available in Georgia for 2022?

The number of Medicare Advantage plans in Georgia for 2022 varies by location. For example, Fulton County has 80 plans. Miller County has 16. Although the number varies, there are plenty of options from which to choose:

  • Local HMO: 28
  • Local PPO: 28
  • Regional PPO: 3

How much does Medicare Advantage cost in 2022?

Monthly premiums for Medicare Advantage vary depending on the service area you live in and the insurance company offering the plan. For 2022, the average premium in Georgia is $17.35.

When can I make changes to my Medicare Advantage plan?

When you join a Medicare Advantage plan, you’re locked in for 12 months (Jan. 1-Dec. 31). Although you can make changes if you qualify for special enrollment, the Annual Election Period is the primary opportunity to change your coverage.

During the AEP, you can:

  • Switch between Medicare Advantage plans
  • Change from Medicare Advantage to Original Medicare
  • Change from Original Medicare to MA
  • Coverage effective Jan. 1

When can you enroll in a Georgia Medicare Advantage plan for 2022?

Medicare beneficiaries have several options when it comes to enrolling in Medicare Advantage insurance plans for 2022.

Initial Enrollment Period

  • Best time to join
  • Lasts seven months: three months before you turn 65, birth month, three months after you turn 65
  • No underwriting required

Open Enrollment Period – AKA Annual Election Period

  • Oct. 15-Dec. 7 annually
  • Can join, change, or drop health and Part D plans
  • No underwriting required

Medicare Advantage Open Enrollment Period

  • Jan. 1-March 31
  • Can switch from one plan to another
  • Can change back to Original Medicare for your Medicare Part A and Part B benefits

Special Enrollment Periods

Special enrollment periods cover special circumstances. Here are a few examples:

  • You leave the plan’s service area
  • You become eligible for Medicare and Medicaid
  • You move into or out of an institution
  • You lose other insurance coverage or Medicaid eligibility
  • You dropped a Medigap policy when you initially joined Medicare Advantage

5-star Special Enrollment Period

Medicare uses a rating system to help beneficiaries compare health plans. A 5-star rating is the highest.

  • If a 5-star plan is available in your service area, you can change from your current plan to one with a 5 star rating.
  • You can only switch once between Dec. 8 and Nov. 30.

Special Enrollment Periods if you get “Extra Help”

  • If you become eligible for Medicare and Medicaid, you can join, drop, or change Medicare Advantage plans between January-March, April-June, and July-September.
  • If you’re enrolled in or lose eligibility for the State Pharmaceutical Assistance Program, you can join an Advantage plan with drug coverage once in a calendar year.

Our licensed insurance agents can provide more information on enrollment periods.

Are Medicare Advantage plans in Georgia “bad”?

Medicare Advantage plans provide very good coverage for Georgia beneficiaries, and they do it at a reasonable price. Because of additional coverage for perks such as wellness programs, the availability of SNPs for those with chronic health conditions, and the number of plans that include Part D coverage, the number enrolled in Medicare Advantage has steadily grown over the past two decades.

Here’s a look at the numbers:

  • Number enrolled in Medicare Advantage in Georgia: 606,211
  • Number enrolled by plan:
    Local HMO: 177,941
    Local PPO: 279,162
    Regional PPO: 143,872
  • Medicare beneficiaries enrolled in Medicare Advantage in Georgia: 42%
  • Medicare beneficiaries enrolled in Medicare Advantage nationwide: 42%

Frequently Asked Questions about Medicare Advantage in Georgia

What's the downside to Medicare Advantage plans?

  • Network restrictions which can limit your choice of healthcare providers
  • More out of pocket costs compared to Medicare Supplement plans — costs can outweigh the lower premiums
  • Extra attention needed to ensure you’re staying in network and paying copays
  • Requires annual review of plan to stay on top of change in benefits and covered drugs

Remember, your eligibility for Medicare Advantage depends on staying current on your Medicare Part B monthly premium.

What are 4 types of Medicare Advantage plans in Georgia?

  • HMO plans (Health Maintenance Organization)
  • PPO plans (Preferred Provider Organization)
  • SNPs (Special Needs Plan)
  • PFFS plans (Private Fee-for-service)

What are the top 3 Medicare Advantage plans for 2022?

  • United Healthcare 26%
  • Humana 18%
  • BCBS 15%

What Are Medicare Special Needs Plans?

  • Plans designed to meet the needs of a specific group
  • Have an SNP network for providers and drug formularies
  • Requires PCP or care coordinator and specialist referrals

Does Medicare Advantage cover drugs?

Most Medicare Advantage plans have prescription drug coverage included and are known as MAPD (Medicare Advantage Prescription Drug) plans.

Do Medicare Advantage plans use the SilverSneakers program in Georgia?

Not all plans offer SilverSneakers, but many plans offer a similar wellness option. Plans can change yearly and vary between insurance companies and counties.

Related Topics

Georgia Medicare Resources

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