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Medicare in Georgia

October 6, 2016

If you are a Medicare beneficiary living in Georgia, you have options in how you receive your Medicare benefits.  Indeed, there is more to consider than just the federally run health program, Original Medicare, consisting of Medicare Part A (hospital insurance) and Part B (medical insurance).  Original Medicare is available to eligible beneficiaries in every state, including Georgia. But there are alternative ways to receive Medicare benefits from private insurance companies, and it is worth your while to understand what these options are in and how they work in Georgia so that you can decide on the Medicare coverage that best suits your personal needs.  Read on to learn more about your Medicare coverage options in Georgia.

Original Medicare for Georgia beneficiaries

Original Medicare consists of two parts: Medicare Part A covers inpatient hospital stays and hospice care; Medicare Part B covers doctor’s visits and preventive services such as annual wellness exams. Many U.S. citizens and permanent legal residents who have lived in the U.S. for at least five consecutive years aged 65 or older qualify for Original Medicare, Part A and Part B, as do people under the age of 65 with certain qualifying disabilities.

Some Medicare beneficiaries in Georgia may be  enrolled in Medicare Part A automatically at age 65, as long as they receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). People under the age of 65 can also be enrolled, if they receive SSA or RRB disability benefits for 24 consecutive months. You receive your red, white, and blue Medicare card by mail approximately three months before your coverage is effective.  Your Medicare card has printed on it your Medicare number, along with the applicable Part A and/or Part B of the Medicare program in which you are enrolled. You’ll also get a “Welcome to Medicare” packet containing educational information concerning the program, including instructions on how you can opt out of Medicare Part B. Because most people pay a monthly premium for Part B, you have the option to decline this coverage. However, you need Part B to enroll in other Medicare programs, such as Medicare Part C (Medicare Advantage) and Medicare Part D (prescription drug coverage).  You may be subject to a late enrollment penalty if you delay your enrollment in Medicare Part B.

If you’re not automatically enrolled in Original Medicare, you can enroll during the following enrollment periods:

  • Initial Enrollment Period (IEP): This is the period when you’re first eligible to enroll in Medicare. It lasts for seven months, beginning three months before you turn 65, including the month you turn 65, and ending three months later.
  • General Enrollment Period (GEP): This is the annual enrollment period that runs from January 1 to March 31. If you missed the opportunity to enroll in Medicare during your Initial Enrollment Period, you may enroll during the General Enrollment Period. You may have to pay a late enrollment penalty for Part A and/or Part B if you didn’t sign up when you were first eligible.
  • Special Enrollment Period (SEP): Only under certain circumstances may you sign up for Medicare Part A or Part B outside the IEP and GEP periods. Medicare recognizes certain life-changing situations that qualify you for a Special Enrollment Period (SEP). For example, If you’re covered under a group health plan and delay Part B enrollment, you can sign up for Part B using an 8 month SEP when your group coverage ends, thus avoiding a Part B late enrollment penalty. You may qualify for a Special Enrollment Period in other situations –if you are relocating outside Georgia, becoming eligible for both Medicare and Medicaid, qualifying for the Extra Help program, moving into or moving out of a skilled nursing facility.

You can register for Medicare by going to your local SSA office, registering online, or calling:

  • Call Social Security at 1-800-772-1213 (TTY users call 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
  • If you worked for a railroad, call the RRB at 1-877-772-5772 (TTY users call 1-312-751-4701) Monday through Friday, from 9AM to 3:30PM.

Medicare private insurance in Georgia

While Original Medicare Part A and Part B are administered by the federal government, you can also receive your Medicare coverage through private insurance companies approved by Medicare doing business in Georgia.  The availability of plans providing Medicare coverage in Georgia may vary by county.  Similarly, the plan premiums may vary by insurance company as well as type of coverage.

Medicare Part C: Medicare Advantage.  Medicare Advantage plans are offered by private insurance companies that have contracted with Medicare to provide your Medicare benefits.  Medicare Advantage plans provide coverage that matches Part A and Part B (with the exception of hospice care, which remains covered under Part A), and may offer vision, dental, or hearing coverage as added benefits not available under Original Medicare.

Many Medicare Advantage plans include prescription drug coverage as well. These are known as Medicare Advantage Prescription Drug (MAPD) plans, and they represent an alternative way to receive all of your Medicare coverage through a single Medicare plan.

Medicare Supplement plans (also called Medigap) are available to Medicare beneficiaries in Georgia.  If you decide to stay with Original Medicare (Part A and Part B), another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Statewide in Georgia (as in many other states) Medicare Supplement plans offer a number of standardized benefits, identified by letter. Standardized benefits means that benefit plans of the same letter offer the same benefits no matter which insurance carrier offers the plan, although some companies may offer additional innovative benefits.  Premiums can differ widely between insurance companies offering the same benefit plan so it’s a good idea to shop for the best value in terms of coverage and cost. Note:  Medicare Supplement plans cannot be combined with Medicare Advantage plans.

Medicare Part D prescription drug coverage may be available to you from a Medicare Advantage Prescription Drug plan, as discussed above, or from a stand-alone Medicare Part D Prescription Drug Plan.   A Medicare Part D Prescription Drug Plan works alongside your Part A and Part B coverage. Whether you obtain your Medicare prescription drug coverage through a Medicare Advantage Prescription Drug plan or from a standalone Medicare Part D Prescription Drug Plan, the insurer will have a formulary, which is a list of prescription medications covered by that plan.  Formularies vary by plan, so it is a good idea to check to see if your medication is on the plan’s formulary.  Also, the formulary can change at any time.  You will receive notice from your plan when necessary.  

Georgia resources for Medicare beneficiaries

Medicare.gov offers a list of educational resources for health organizations in Georgia. For your convenience, we have included the resources below.

  • State Health Insurance Assistance Program (SHIP): Toll-free number 1-866-552-4464 | TTY users call 1-404-657-1929. Service representative are available to speak with you from 9:00 AM to 3:00 PM, ET, Monday through Friday. | Website
  • National Institute on Aging Information Center: Toll-free number 1-800-222-2225 | TTY users call 1-800-222-4225 | Monday through Friday, 8:30AM to 5PM ET |Website

Learn more about how Medicare plans work in Georgia, including:

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.