Medicare in Georgia

The federal Medicare program provides health coverage for seniors aged 65 and over, as well as certain disabled adults. Original Medicare delivers services in three parts, known as A, B and D. Part A is the inpatient hospital benefit seniors are automatically enrolled in at age 65, Part B is the optional outpatient benefit that covers office visits, transportation and medical supplies, and Part D is the prescription drug benefit. Seniors with a qualifying work history typically pay no monthly premium for Part A, though there is a standard deductible due for each inpatient stay. Part B beneficiaries pay a monthly premium that changes somewhat from year to year. Part D premiums and copays vary, which encourages many enrollees to cover their unpaid out-of-pocket expenses with Extra Help or a Medigap policy. 

Medicare Advantage Plans are sometimes called Part C, which can be confusing for new enrollees. Unlike Parts A, B and D, Medicare Advantage Plans are issued by private insurance companies and offer some very flexible terms. By law, all authorized MA Plans in Georgia must offer the same coverage as Parts A and B, though these are rolled together into a single monthly premium. Many Medicare Advantage options also include drug coverage and non-Medicare services such as dental, vision and hearing aid benefits.

In 2023, more than 1.8 million seniors in Georgia participated in at least one Medicare program, at an annual cost of over $10.2 billion in 2021. In 2022, participation was split evenly between Original Medicare and Medicare Advantage enrollees, but 6% growth in 2022-23 has pushed Medicare Advantage into the majority choice for Georgia seniors, with 53% of Medicare-eligible seniors currently enrolled. This is a higher rate than the 48% national participation, despite the 6.9% annual growth of Medicare Advantage nationwide. 

This guide explains many of the details of Medicare in Georgia, along with helpful information seniors can use to plan their care. The goal is to help seniors and their families find high-quality senior health care and Medicare options that work for them.

Options for Medicare Coverage in Georgia

Traditional Medicare is sufficient for some seniors; however, it may not be enough to cover those with special needs. Aside from the original Medicare, there are additional parts that add coverage for services like hospitalizations and prescription coverage. Seniors may also choose to receive their Medicare plan through a private insurance company to receive a broader range of coverage.

Original Medicare (Parts A & B)

Original Medicare is open to seniors aged 65 and over, along with disabled adults and hospice patients. Seniors with a qualifying work history of at least 10 cumulative years of payroll contributions are automatically enrolled in Part A with a $0 monthly premium at age 65. After this, they pay a $1,600 deductible for each hospital admission and 20% of costs beyond that. Part B comes with a standard monthly premium of $164.90 and a $244 annual deductible. After these deductibles are met, both Part A and Part B pay 80% of the remaining costs for authorized care.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Part C, or Medicare Advantage, is the most popular way for Georgia seniors to access their Medicare benefits. In Georgia, Medicare Advantage is available in HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PFFS (Private Fee-for-Service) and SNP (Special Needs Plan) options, depending on the beneficiaries’ needs and the plan provider’s offerings. Unlike Original Medicare, Medicare Advantage participants are not eligible to enroll in a Medigap plan, though low-income participants may qualify for dual enrollment in Medicaid.

Who Should Consider Medicare Advantage

Many seniors can benefit from a Medicare Advantage plan:

• Those who prefer receiving benefits all in one plan
• Individuals who prefer to have better control over their out-of-pocket expenses
• Seniors who are comfortable with managed care 
• Those who are looking for extra benefits like dental or vision care

The Top Medicare Advantage Plans in Georgia

Georgia seniors have a choice between many Medicare Advantage programs. The following chart provides information on the top insurance companies in the state that offer coverage, the enrollment numbers and the average monthly cost of premiums. It also includes what type of plans each company offers and gives a Medicare star rating.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Georgia

Understanding the different parts of Medicare can be challenging for most seniors and their loved ones, whether this is the first time applying or if they’re making changes to an existing account. The following programs and services can provide assistance in navigating the available choices and determining which plans best suit your individual needs.