As a Medicare beneficiary living in the state of Georgia, you may have the option to enroll in Medicare Advantage (Medicare Part C), which is an alternative way to get your Medicare Part A and Part B benefits. Medicare Advantage allows you to receive your Medicare benefits through an individual health plan rather than through Original Medicare, Part A and Part B. Additional benefits under Medicare Advantage depend on the Georgia zip code you live in and on the specific Medicare Advantage plan option you enroll in.
How Medicare Advantage works in Georgia
Medicare Advantage in Georgia, like the rest of the United States, is required by the government to offer at least the same level of hospitalization and medical benefits as Original Medicare, Part A and Part B, with the exception of hospice care. Some Medicare Advantage plans in Georgia may also offer additional benefits, like routine vision or dental, hearing, and wellness programs, and some plans even offer prescription drug coverage as well. Plans that include prescription drug benefits are known as Medicare Advantage Prescription Drug plans, and they allow you to get your Part A, Part B, and Part D benefits through a single plan.
To enroll in Medicare Advantage in Georgia, as in the rest of the country, you must already be enrolled in Original Medicare, Part A and Part B. You must also live in the service area of a Medicare Advantage plan, and, in most cases, you cannot enroll in a Medicare Advantage plan if you have end-stage renal disease. There are some exceptions; for example, you may be allowed to stay in your Medicare Advantage plan if you’re already enrolled in the plan and develop end-stage renal disease (ESRD). You may also be eligible if there’s a Medicare Advantage Special Needs Plan (SNP) that targets end-stage renal disease in your service area.
As mentioned, you’ll need to have Part A and Part B to be eligible for Medicare Part C. In Georgia, just like in other states, you can first enroll in Original Medicare during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. If you qualify for Medicare because of disability, your Initial Enrollment Period is the period surrounding your 25th month of disability benefits from Social Security or the Railroad Retirement Board, starting three months before the 25th month and lasting seven months. It’s important that you sign up for Medicare Part A and/or Part B during your Initial Enrollment Period, because if you don’t, you may be subject to a late-enrollment penalty for as long as you remain enrolled in Medicare. Part B comes with a 10% higher premium for every full 12-month period that you were eligible but didn’t sign up for it. You may also face a late-enrollment penalty for Part A if you pay a premium for it.
You can still enroll in Original Medicare later, during the annual General Enrollment Period, which runs from January 1 to March 31, but be aware that you may still have to pay the late-enrollment penalty. Keep in mind that there are certain situations (like if you have group health coverage because you’re still working) where you may be able to delay Medicare enrollment and sign up through a Special Enrollment Period later, without owing a late-enrollment penalty.
Once you’re enrolled in Medicare Part A and Part B, you’re eligible for Medicare Part C. You’re first eligible to enroll in a Medicare Advantage plan during your Initial Coverage Election Period (ICEP), which typically coincides with the same seven-month period that you’re first eligible for Medicare – your Initial Enrollment Period for Part B. If you delay Part B, your ICEP starts three months before your Part B coverage starts and lasts three months.
If you don’t enroll in a Medicare Advantage plan when you’re first eligible, you’re generally limited to making changes to your Medicare coverage during set time frames. Your yearly opportunity to do so is the Annual Election Period, which runs from October 15 to December 7. In addition, if you’re already enrolled in a Medicare Advantage plan in Georgia and decide to switch to another Medicare Advantage plan, or if you want to disenroll from your plan and return to Original Medicare, you’re allowed to do so during this period, which is also referred to as the Fall Open Enrollment. Your new coverage (if you enroll in a plan) goes into effect on January 1 of the following year.
You may also be allowed to switch Medicare Advantage plans in Georgia during Special Election Periods, if you go through certain life-changing events, like losing your current coverage or moving to a new service area where your old plan may not be available. Special Election Periods in Georgia vary according to your qualifying situation.
You are also allowed to leave Medicare Advantage and switch back to Original Medicare Part A and Part B, during the Medicare Advantage Open Enrollment Period, which in Georgia (like the rest of the country) runs from January 1 to March 31 each year. During this period, you can also enroll in a Medicare Prescription Drug Plan, which works with your Original Medicare coverage to help with prescription drug costs. Lastly, you can switch from one Medicare Advantage plan to another.
Types of Medicare Advantage plans in Georgia
Medicare Advantage plans in Georgia vary, so it’s important for you to become familiar with the different types of plans available before making your selection. Medicare Advantage in Georgia may include the following types of plans:
- Health Maintenance Organizations (HMOs): An HMO requires you to visit doctors, health-care providers, and hospitals listed in your plan’s network to be covered (with the exception of emergency or urgent care). You may also need a referral from your primary care doctor to receive coverage for certain health services (for example, if you need to see a specialist).
- HMO Point-of-Service (HMO-POS): An HMO-POS plan offers more flexibility than an HMO, sometimes letting you go out-of-network for certain health services – at a higher cost sharing.
- Preferred Provider Organization (PPO*): A PPO offers even greater flexibility than an HMO-POS plan, allowing you to choose your own doctors, health-care providers, and hospitals, but again at a higher out-of-pocket cost. Your copayments and coinsurance costs will be lower when you use providers from the plan’s preferred provider network. You don’t need a primary care doctor or referrals for this type of plan.
- Private Fee-for-Service (PFFS): A PFFS plan determines how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense. Every time you receive a service, the doctor or health-care provider must agree with the PFFS plan’s payment terms and agree to contract with the plan and treat you; a provider must do this on a case-by-case basis, and just because you’ve been treated in the past doesn’t guarantee that the doctor will accept the plan in the future.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account. Every year, the plan deposits a certain amount of money into your savings account, and you can use the account to pay for your health-care expenses before you reach the plan’s deductible.
- Special Needs Plan (SNP): SNPs tailor benefits to meet the unique health needs of their beneficiaries, and you’ll need to meet the eligibility criteria that the plan targets to enroll. There are three types of SNPs, including, among others, plans for patients with chronic or disabling conditions, such as HIV/AIDS, chronic heart failure, dementia, or diabetes. SNPs are also available for people living in institutions (like nursing homes) and those who qualify for both Medicare and Medicaid.
- Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage (available separately under Medicare Part D Prescription Drug Plans if you’re enrolled in Original Medicare) into a single insurance plan. Not all Medicare Advantage plans include prescription drug coverage, but many do.
Comparing Medicare Advantage plans available in Georgia
As a Medicare beneficiary in Georgia, you may find it useful to compare all Medicare Advantage plan options available in your area.
The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different counties within the state of Georgia. You may find that some Medicare Advantage plans in Georgia offer premiums as low as $0; but always keep in mind that you must continue paying your Medicare Part B premiums, even if your Medicare Advantage plan doesn’t have a premium, in order to keep your Medicare coverage.
As mentioned, some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug plan. With all these options available in Georgia, you can see why it can be smart to compare plan options that offer the benefits and costs best suited to your personal health needs.
To start comparing Medicare Advantage plans in Georgia today, enter your zip code above for a customized list of plan options available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates. Or, to get one-on-one help finding Medicare Advantage plan options in Georgia that may fit your health needs, call eHealth directly to speak with a licensed insurance agent.
To learn more about Medicare coverage in Georgia, you can access the following resources:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.