PolicyScout’s Guide to Medicare Advantage Plans in GeorgiaFind out which Medicare Advantage plans are available in Georgia and how you can apply.
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With all the different Medicare Advantage plans and providers, finding the right health care policy can be difficult.
In this article, you'll learn how to find the best private Medicare health coverage with our guide to Medicare Advantage plans in Georgia.
What Is Medicare?
The federal government’s Medicare program aims to provide over-65s, people with disabilities, and those that suffer from ESRD (End-Stage Renal Disease) and ALS (Lou Gehrig’s disease) with health cover.
The Medicare Parts Explained
Medicare is divided into different “Parts” that separate expenses and coverage for medical services, tests and items.
Medicare Part A insurance covers hospital expenses and is for treatment you receive as an inpatient.
Medicare Part B insurance pays for outpatient or general medical expenses as well as preventative services.
Medicare Part C, also known as Medicare Advantage, are private health insurance plans that offer the same coverage as Original Medicare (Part A and B cover).
They often cover Part D prescription drug costs and offer additional benefits, such as dental, hearing, and vision expenses.
Medicare Part D insurance covers self-administered prescription drugs. For example, medication for blood pressure, back pain, or chronic conditions.
Your Medicare Coverage Options in Georgia
There are a few different ways to get Medicare cover in Georgia once you become eligible. If you are new to Medicare, you can get Original Medicare, Medicare Advantage, or Medicare Supplement Insurance.
Medicare Supplement Insurance are health plans that help pay for out-of-pocket expenses and other costs that Original Medicare doesn’t cover. These plans are only available to people who don’t have Medicare Advantage.
Part D Plans, also known as a Medicare Prescription Drug Plan (PDPs), are stand-alone drug plans that help people pay for prescription drug costs.
Terms you should know:
Monthly Premium is the fee you pay to be a member of Part D drug plans, Medicare Advantage, or Medicare Supplement Plans.
Deductibles are amounts that beneficiaries have to pay before their Medicare insurance starts.
Coinsurance is the portion of medical costs that beneficiaries have to pay for medical treatment, services, and tests.
Copayments are set amounts that people have to pay for services, tests, and items.
Out-of-pocket costs are any expenses that aren’t covered by Medicare or a private health insurance company.
Medicare Advantage plans are private health policies that you can purchase as a Medicare beneficiary. These plans have the same benefits as Original Medicare and often cover other medical expenses that Original Medicare doesn’t pay for.
There are two main types of Medicare Advantage plans available in Georgia:
MA (Medicare Advantage without prescription drug coverage) - These plans do not offer prescription drug coverage and only cover Medicare Part A and Part B expenses.
MA-PD (Medicare Advantage with prescription drug coverage) - These are Medicare Advantage plans that offer coverage for prescription medication (Part D) expenses.
Understanding the different MA and MA-PD plan structures
Many Medicare Advantage plans have unique structures which can influence costs, benefits, and coverage. Here are some of the different MA and MA-PD plan structures:
Health Maintenance Organization (HMO) plans provide health insurance through a specific network of healthcare providers, and you are only covered for service in-network.
HMO point-of-service (HMO-POS) plans cover some health care costs outside your network, but premiums and copayments are usually higher than HMO plans.
Preferred Provider Organization (PPO) plans allow you to see any provider that accepts insurance. You don’t need a referral from your primary physician to get specialist help.
Private Fee-for-Service (PFFS) plans allow members to see any health care provider enrolled in Medicare who accepts your plan.
Special Needs Plans (SNPs) are for people with specific needs or diseases. For example, these can be people who live with chronic conditions or live in assisted living facilities.
Medicare Advantage in Georgia
Medicare Advantage plans in Georgia have grown steadily over the past decade, with just under half of all Medicare beneficiaries in the state being members of a Medicare Advantage plan.
The penetration rate is a good indicator of Medicare Advantage membership growth. The penetration rate looks at the amount of Medicare-eligible people who have joined a Medicare Advantage plan.
For example, if ten people are eligible for Medicare and four have a Medicare Advantage plan, the penetration rate is 40% (4 out of 10 people).
In Georgia, Medicare Advantage had a 46.3% penetration rate in 2021. This means that for every 100 Medicare-eligible people, around 46 of them had a MA or MA-PD health plan.
This graph shows how quickly Medicare Advantage membership is growing in Georgia.Total Number of Medicare Beneficiaries in Georgia: Medicare Advantage, 2014 - 2020
According to the Kaiser Family Foundation, the number of people on a MA or MA-PD plan in Georgia has almost doubled from 400,000 to 780,000 in the last six years.
Similarly, the number of Medicare Advantage plans in Georgia has increased:
In 2021, there were 148 Medicare Advantage plans available to Medicare beneficiaries.
In 2022, there will be 157 MA and MA-PD plans offered in the state.
Want to find out what plans are available in your county? Enter your zip code and find out today. If you need any assistance, feel free to give our team of expert Medicare consultants a call to discuss your options.
Key Facts about Medicare Advantage in Georgia
Learning about Medicare in your state can help you understand what you can expect when joining a private health plan.
Here are some key takeaways you should consider about Medicare in Georgia:
In 2021, the average monthly premium for Medicare Advantage plans in Georgia was $14.31.
According to the CMS, there are 1,813,198 Medicare-eligible beneficiaries in Georgia. Approximately 869,582 are members of an MA or MA-PD plan.
All Medicare-eligible people in Georgia can get Medicare Advantage cover and can buy a $0-premium Medicare Advantage plan (This means that these plans don’t charge members a monthly premium to join).
However, you will still have to pay your Medicare Part A and Part B premiums when you sign up for a $0-premium plan.
A large number of physicians accept Medicare in Georgia. Of the 25,531 registered physicians in the state, only 269 opted out of Medicare (This amount is a little over 1%).
This means that if you are a Medicare beneficiary, chances are you’ll be able to find a physician who will treat you and accept Medicare rates.
Which Health Insurance Companies Offer Medicare Advantage in Georgia?
There are 12 different health insurance providers that offer Medicare Advantage plans in Georgia, including:
Anthem Blue Cross and Blue Shield
Clear Spring Health
Sonder Health Plan, Inc.
How to Choose a Medicare Advantage Plan in Georgia
If you’re considering a private health plan, use these tips to find a provider and plan that suits your medical needs.
1. Check if your provider offers plans in your area. Many people don’t realize that Medicare Advantage providers have different plans for different counties.
For example, in 2021 in Upson County, Georgia there are 28 Medicare Advantage plans to choose from. However, in Whitfield County, Georgia, there are only 11 Medicare Advantage plans.
2. Decide if you want to get an MA-PD (Medicare Advantage Prescription Drug) or MA (Medicare Advantage) plan.
3. Look at the costs associated with the plan you would like to sign up for and check if you can afford your plan when the price goes up because of inflation.
4. Ensure that you can cover the monthly premiums and out-of-pocket costs (costs your plan won’t cover), such as deductibles, coinsurance, and copayments.
5. You should also research the plan's and health insurance company's Medicare star rating. For good measure, make sure you find out what other third-party reviewers, such as ConsumerAffairs and JD Power, say about the plan that you would like to buy. See which Medicare Advantage providers offer excellent service, benefits, and coverage in 2022.
What are Medicare Star Ratings?
The Center for Medicare and Medicaid Services releases an annual report on the quality and performance of plans and providers. They do this through a scoring system called the Medicare Star Ratings.
Each plan and provider will receive a score of out five, which tells beneficiaries how well the plan performed in the year.
Here’s what the different star ratings mean:
⭐⭐: Below average
If you want to learn more, read our guide to Medicare Star Ratings. You can check out your plan’s current star rating by visiting the Medicare.gov website. Simply search for your county, find your plan, and check the number of stars it received.
6. Ask around and check with friends or family who have Medicare about their experiences using a particular provider or plan.
7. Speak to a licensed Medicare insurance agent about the plan’s benefits, perks, and coverage. You’ll be able to see if the plan is the right one for you.
8. Compare your options before making a final purchase. Check to see if there are other providers in your area that offer similar coverage and plans.
Important Enrollment Dates for Medicare in Georgia
There are certain times of the year when you may join or change your health insurance policy. When you've chosen the best plan for you, it's essential to understand when you can and should enroll.
Here are the enrollment dates to remember if you want to join an MA or MA-PD plan in Georgia:
Initial Enrollment Period
This is your first chance to sign up for Medicare once you are eligible and begins three months before your 65th birthday. During the IEP, you can sign up for Medicare Parts A and B or join a Medicare Advantage plan or Prescription Drug Plan.
General Enrollment Period
From January 1st to March 31st, you can sign up for Parts A and B, as well as a Medicare Advantage Plan if you missed your Initial Enrollment Period.
Open Enrollment Period
The Open Enrollment Period runs from October 15th to December 7th. You’ll be able to join a Medicare Advantage plan or switch Medicare Advantage plans. Any changes you make to your Medicare coverage will take effect from January 1st.
Special Enrollment Period
This period refers to specific situations where you can enroll outside the regular enrollment periods (for example, if you move states or if your healthcare coverage under an employer ends). The dates for the Special Enrollment Period are different for each person.
For more information, read our guide to Medicare Open Enrollment Period 2022.
How Can I Find Out More about My Health Care Options?
If you’re interested in learning about Medicare and your health care options, our Medicare Hub is a great place to start. You’ll be able to find out about costs, enrollment, coverage, and benefits all in one place.
We also have a team of experienced Medicare consultants to assist you with your questions.
If you need one-on-one help with your health coverage, we can provide expert guidance and assistance on all Medicare-related topics.