You’ll likely have several plan options in your service area, but not all plans work the same way or charge the same prices. You’ll likely have to do some research and shop around to find the best one for you. We can help get you started with comparing plans.
Medicare Advantage, also called MA or Medicare Part C, are “bundled” plans that include your Original Medicare (Parts A and B) along with additional benefits. They can be a good option if you want more healthcare coverage, and a key benefit over Original Medicare is that they cap your out-of- pocket costs each year. One trade-off, though, is that you can only see doctors within your plan’s network. And note that while many MA plans have no monthly premium, they won’t always save you money over time.
In Georgia, many types of Advantage plans are available, including highly-rated options. Medicare Advantage plans are sold by private insurance companies, so availability and prices vary by where you live and what company you buy from. You’ll probably have multiple options to choose from, so it’s important to consider your healthcare and insurance needs then shop around to compare prices. There’s no objectively “best” plan—the best plan is the one that fits your health needs for the least amount of money.
Get started by using the Insurify Medicare comparison tool to look at options in your area. Our licensed insurance agents are also here to provide guidance, free of charge. Call 1 (844) 965-1378 ( TTY 711) to speak to an agent Monday to Friday, 8 a.m. to 8 p.m. EST.
There are plenty of Medicare Advantage providers in Georgia, but which one is right for you? We compiled the best plans in the state and ranked them based on several factors. Those factors including the entire cost of the plan, the variety of services offered, and the CMS rating– based on user-reported quality of care. For more information on our ranking procedure, see our methodology page.
1. Kaiser Permanente Senior Advantage Basic (HMO) - Score: 66.90
2. Kaiser Permanente Senior Advantage Enhanced (HMO) - Score: 63.19
3. HumanaChoice H5216-241 (PPO) - Score: 62.31
4. Cigna Preferred Medicare (HMO) - Score: 61.48
5. Humana Gold Plus H4141-015 (HMO) - Score: 60.23
6. Aetna Medicare Value Plus Plan (PPO) - Score: 60.23
7. Humana Honor (PPO) - Score: 58.15
8. Humana Care Extra (PPO) - Score: 58.15
Below is a brief overview of some top-rated HMO and PPO plans in Georgia, including their star ratings.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $6,400
For $0 a month and $0 deductibles, this plan offers you quite a lot. Not to mention that Kaiser often gets some of the best reviews from its customers.
This plan offers low copays for prescriptions from preferred retailers. You’ll also get low-cost office visits for preventive and primary care — just $0. Specialists are $40 a visit. Diagnostic services also clock in below the industry average.
Plus you get low-cost hearing exams, preventive dental exams, and routine vision exams.
Monthly Premium: $71
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $4,500
The higher cost in monthly premiums pays off with a lower threshold for your out-of-pocket maximum limit. Copays for prescriptions run from $0 to $18 for Tier 1 and Tier 2 drugs from preferred retailers. You’ll also get low-cost care for emergency room and urgent care visits, with urgent care just $25.
Office visits are also low, with $25 copays for specialists and $0 fo preventive and primary care. Plus, low-cost hearing exams, preventive dental exams, and routine vision exams.
Monthly Premium: $39
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $195
Out-of-Pocket Limit: $6,700
Like all PPOs, this plan offers you the flexibility of access to out-of-network care. This can be very advantageous for people with special healthcare needs or preferences. Just remember that out-of-network care is typically more expensive.
You’ll low or no copays for preventive care, primary care, specialist, and urgent care visits. You’ll also get generous coverage for hearing, dental, and vision in most areas..
Please note that in some counties, this plan lacka dental and vision care. That means you’ll need to buy stand-alone coverage for those needs.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $200
Out-of-Pocket Limit: $6,700
This plan offers low-cost prescription copays for Tier 1 and Tier 2 drugs from preferred providers. You also get $0 visits for preventive and primary care. Specialists are $40.
Though this plan doesn’t have the lowest copays we’ve seen for some care, it does offer a huge advantage we don’t see often. That’s $0 copays for preventive and comprehensive dental.Plus $0 for routine vision and hearing care.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $6,800
With this Humana plan, you’ll pay $0 to $36 in copays for Tier 1 and Tier 2 drugs from preferred retailers. You’ll also get extended stays at the hospital at a very low cost. Just cover the first 7 days at a $298 copay per day, and the remaining days are $0.
Primary care and preventive care visits come with a $0 copay. It’s just $30 to see a specialist. Hearing, preventive dental, comprehensive dental, and routine vision are also covered.
Monthly Premium: $20
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $195
Out-of-Pocket Limit: $7,550
Though on the surface this plan may seem expensive — with a monthly premium and drug deductible— it’s not. What you pay for upfront, you get back when you use the plan.
For example, you’ll get $0 copays for Tier 1 and Tier 2 prescriptions when you use a preferred retailer. And you get $0 copays for preventive care doctor’s visits, preventive dental, and routine vision.
Plus low-cost diagnostic services, mental health copays, and a robust wellness program.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: n/a
Out-of-Pocket Limit: $6,700
First, we should acknowledge that this plan does not cover prescriptions. To get coverage, you’ll need to purchase a stand-alone Part D plan. However, this plan does offer a ton of flexibility. That’s because it covers out-of-network care. Though it’s at a higher rate, typically 35 percent coinsurance, this makes your network as large as the entire health system.
But in-network benefits are great. You’ll get $0 preventive care visits, and pay just $20 to see your primary care physician. You also get low-cost diagnostic services. And you have basic hearing, preventive dental, and routine vision covered at low or no cost.
Monthly Premium: $0
Health Plan Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Limit: $7,550
With $0 premiums and $0 deductibles, this plan keeps costs relatively low across the board. Plus, Humana has one of the largest healthcare networks in the state.
You’ll find low-cost prescription copays especially when you use preferred providers. You also get low-cost doctor’s visits, hearing exams, preventive dental, and routine vision. And you have the option to go out-of-network if you want to, just remember you’ll pay a higher cost.
Take note of the key enrollment periods:
Initial Enrollment Period: This is the seven-month window that begins three months before you turn 65, includes the month you turn 65, and ends three months later.
Open Enrollment Period: From October 15 through December 7, you can join, switch, or drop Medicare health and drug plans. This is the only time you can sign up for a Medicare Advantage plan without going through medical underwriting.
Medicare Advantage Open Enrollment: From January 1 to March 31, if you already have Medicare Advantage, you can switch to a different plan or back to Original Medicare. But you can’t sign up for an Advantage plan for the first time.
Disenrollment Period: From January 1 to February 14, you can drop your MA plan and switch to Original Medicare. If you do this, you’ll have until February 14 to also join a Medicare prescription drug plan.
Special Enrollment Periods: These occur if you move out of your plan’s service area, if you have both Medicare and Medicaid, if you qualify for Extra Help, or if you live in an institution like a skilled nursing facility.
When you’ve compared options, understand your chosen plan’s rules and costs, and are ready to enroll, visit the plan’s website to see if you can enroll online. (Each plan must also offer the option of filling out a paper form to enroll.) You can also call the provider you want to join.
See Also: What Age Does Medicare Start?
You’re eligible if you:
are a U.S. citizen or permanent resident of Georgia
are enrolled in Original Medicare Part A and Part B
have paid Medicare payroll deductions
You must live in the service area of the plan you buy.
You may also be eligible for a Medicare Advantage plan if you receive a pension from the Railroad Retirement Board or Social Security or if you have a disability or a chronic illness, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease ( ESRD ).
Note that certain Medicare Advantage plans, like special needs plans, might have additional eligibility requirements.
Can People Under 65 Who Have Disabilities Buy Medicare Advantage Plans in Georgia?
Yes, though plan availability varies by where you live. To be eligible for an MA plan before age 65, you must first qualify for Original Medicare. This generally requires that you’ve been collecting Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for at least 24 months. One exception is for ALS patients, in which case the 24-month waiting period is waived and you’re automatically enrolled in Original Medicare the first month that you receive disability benefits.
The Social Security Administration determines whether or not you meet the requirements for disability payments, which in turn can make you eligible for Medicare.
Read More: What Is Medicare Advantage and Is It Right for You?
MA plans are regulated by the Centers for Medicare & Medicaid Services (CMS), and they must cover everything that Original Medicare Part A and B cover.
Most Medicare Advantage plans come bundled with a Medicare Part D plan for prescription drug coverage. Each plan has a list of covered prescription drugs, called a formulary. The company may change the formulary at any time, but you’ll be notified in advance.
(Note that MA plans that don’t include a prescription drug coverage may prohibit you from buying a stand-alone Medicare prescription drug plan, so be sure to read the details carefully before choosing your health plan.)
Many MA plans include additional benefits, like vision, hearing, and wellness programs. MA coverage only extends to healthcare providers in the plan’s network, so if you’re considering one of these plans, call each of your providers and ask them what insurances they accept. The plan’s network limitations may be difficult for people who travel frequently or live in more than one state.
Your costs will vary by where you live, what plan you choose, and the health services you need. It’s important to consider everything that may contribute to the full cost of a plan—not just monthly premiums but deductibles, co-payments / coinsurance, and other out-of-pocket expenses, too. Each plan can charge differently, so be sure to read the complete description of benefits before enrolling.
Note too that while some MA plans have $0 monthly premiums, they also have higher deductibles and co-pays and won’t necessarily save you money in the long run.
You’ll also still be paying your Medicare Part B premium ($148.50, or more depending on your income), along with any premium for your Advantage plan (which in Georgia averaged $14.84 for 2021).
And to minimize your costs, it’s important to see healthcare providers in your plan’s network. If you see a provider who isn’t in your plan’s network, your service may not be covered and your cost for the visit or service could potentially be very high.
One benefit of Medicare Advantage plans, though, is that many come with an annual out-of-pocket maximum. You will never spend more than this amount on Medicare-approved expenses, no matter how much care you receive (as long as you stay in-network).
Georgia Medicare Advantage options include:
Health Maintenance Organization ( HMO ): While HMO plans are the most common and the least expensive MA options in Georgia, they have some limitations. You’re required to use only healthcare providers in the plan’s network for services to be covered. You’ll also need a referral from your primary care provider to see specialists.
Preferred Provider Organization ( PPO ): While these plans also have a network of providers, you can see out-of-network providers at a higher cost, and your out-of-pocket maximum is usually higher for out-of-network services. You can generally see specialists without a referral. One unusual aspect of some Georgia PPO plans is that they work in neighboring states like South Carolina.
Private Fee-for-Service ( PFFS ): These aren’t used much because they pay fixed prices for services and procedures rather than negotiating with the plan. Providers have the choice to accept the terms of the plan or decline.
Special Needs Plans ( SNP ): These are coordinated care plans specifically for people who live in an institution, are also eligible for Medicaid or have a disabling chronic condition (specified by CMS). These plans are designed to meet the unique healthcare needs of those populations, such as including a larger network of specialists or customized drug formularies for certain conditions. Generally, Medicare enrollees with end-stage renal disease aren’t allowed to enroll in a Medicare Advantage plan, but in some service areas, there are SNPs targeting ESRD patients.
The Extra Help and Medicare Savings Programs are available for Georgia Medicare beneficiaries with limited income and resources. You can find out if you’re eligible by contacting your State Health Insurance Counseling and Assistance Program (SHIP).
You cannot have both a Medigap (Medicare Supplement Insurance) policy and a Medicare Advantage Plan at the same time.
Before you decide on a health plan, think about your current and potential future health needs and compare those to all your Medicare options, including Medicare Advantage. Be sure to think about the total cost of a plan, including deductibles, co-pays, and other out-of- pocket costs, as well as the plan’s annual out-of-pocket caps. The best plan is the one that fits your needs—including provider access and prescription coverage—for the best price.
And since Medicare Advantage plan costs vary, it’s critical to compare prices before you buy. The Insurify comparison tool can get you started, and you can talk to our licensed insurance agents for additional guidance.
You can also get assistance from GeorgiaCares, a partnership between the Georgia Department of Human Services (DHS) and the Division of Aging Services (DAS), which provides free, unbiased Medicare assistance. They can be reached at 1 (866) 552-4464.
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