If you're looking for additional coverage, you may want to consider joining a Medicare Advantage (MA) plan. Also known as Medicare Part C, the program has grown considerably over the past decade. In 2019, over 22 million people enrolled in a Medicare Advantage plan – that's over 34 percent of all Medicare beneficiaries. This page explains Medicare Advantage plans in Georgia and how to find the best plan for you.
What Is Medicare Advantage in Georgia?
Medicare Advantage plans in Georgia must provide the same level of coverage as Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance. Original Medicare does not include prescription medications. To get that, you need Medicare Part D.
Part C benefits are not limited to what you get with Original Medicare, though. In fact, most Advantage plans provide additional benefits. For example, around 90 percent of all MA plans include prescription drug coverage.
Georgia Medicare Advantage Plans with Prescription Drug Coverage
Medicare Advantage Prescription Drug plans (MA-PD) are also known as all-in-one plans, because they combine your Parts A, B, and D benefits in a single policy.
Other common benefits include fitness programs and routine vision care.
Who Is Eligible for Medicare Advantage in Georgia?
You qualify for Medicare Advantage in Georgia once you enroll in Medicare Parts A and B.
American citizens and permanent legal residents become eligible for Medicare once they turn 65. You may qualify before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months.
When Can You Sign Up for a Medicare Advantage Plan in Georgia?
You can first sign up for a Medicare Advantage plan in Georgia during your Initial Enrollment Period (IEP). Your IEP begins 3 months before your Medicare eligibility date and lasts for a full 7 months. So, if your 65th birthday or 25th month of disability is in June, your IEP begins on March 1 and ends on September 30.
If you missed your Initial Enrollment Period, you can sign up for Part A and/or Part B during the General Enrollment Period between January 1 and March 31. You may then join an Advantage plan between April 1 and June 30.
The Medicare Annual Enrollment Period (AEP) lasts from October 15 through December 7 and allows you to make any coverage changes you want, including joining a Medicare Advantage plan.
If you already have a Part C plan, you can make changes during the Medicare Advantage Open Enrollment Period from January 1 through March 31. Your options including switching to a new MA plan or returning to Original Medicare. If you lose your prescription drug coverage due to making that change, you may also sign up for a standalone Medicare Part D plan.
People who experience certain life events may join a Medicare Advantage plan during Special Enrollment Periods (SEPs) allow. The full list of qualifying special circumstances is on Medicare.gov.
Types of Medicare Advantages Plans in Georgia
There are four common types of Medicare Advantage plans in Georgia:
- Health maintenance organizations: HMO plans use provider networks that may include doctors, hospitals, labs, and more. Non-emergency care received out-of-network is rarely covered by an HMO. Plan members must also select a primary care doctor and get a referral to see a specialist.
- Preferred provider organizations: PPO plans also use a provider network. However, they cover out-of-network care at a higher out-of-pocket cost to the patient. You also don't have to choose a primary doctor or obtain a referral to see a specialist with a Medicare Advantage PPO plan.
- Private fee-for-service: PFFS plans set their own price points for covered services. Most use a provider network but allow members to receive out-of-network care for a higher cost. Out-of-network providers do not have to treat you, though, unless it's an emergency.
- Special needs plans: SNPs set eligibility guidelines, typically limiting membership to beneficiaries who have a specific chronic condition, live in an institution, or who are dual eligible (qualify for both Medicare and Medicaid).
How to Choose a Medicare Advantage Plan in Georgia
Consider each of the following metrics to ensure you get the best Medicare Advantage plan for your unique needs and budget:
- Coverage (including drug formulary if it's an MA-PD plan)
- Provider network
- Plan ratings
It's easy to compare Medicare Advantage plans in Georgia with our Find a Plan tool. Just enter your location information and coverage start date to see the Medicare plan options in your area.
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