Medicare in Georgia

Medicare is a federal health insurance program for individuals with disabilities and for seniors aged 65 and older. While Medicare is an excellent option for older adults, it doesn’t always cover everything. In 2020, over 1,700,000 individuals in Georgia received Medicare benefits, and of those, around 734,000 were enrolled in a Medicare Advantage plan. This is about 16% of the state’s total population. In 2019, the state of Georgia spent approximately $10.7 billion on Medicare, which is approximately 3% of the nation’s spending on this program.

There are four parts to Medicare. Original Medicare includes Part A and Part B. Part A is often referred to as hospital insurance, and Part B is medical insurance. Combined, these two parts cover hospitalization, skilled nursing facilities, laboratory work, doctor’s office visits and some home health services. Part C plans are referred to as Medicare Advantage, which is an alternative to original Medicare. Part D covers prescription medications. Medigap is a Medicare supplement plan. It helps fill in the gaps on what was originally Medicare.

This guide provides a detailed look at Georgia Medicare, including information on how seniors can customize their coverage to pay for the services they need. It also includes a list of organizations that can help with the application process and provide additional information on other benefits and services.

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 administered by the Centers for Medicare & Medicaid Services and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Medicare Part C is also referred to as Medicare Advantage (MA). This is an alternative way for seniors to receive Medicare benefits instead of receiving coverage directly through the federal government. Medicare Advantage plans are offered by private insurance companies and make it easier to receive financial assistance for all types of medical coverage through a single entity.

Medicare Advantage covers all services covered by the Original Medicare (except hospice care which remains covered by Medicare Part A). Many Medicare Advantage Plans offer additional benefits like prescription medications, as well as dental, hearing and vision services.

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 10 Medicare Advantage Plans in Georgia

Georgia seniors have a choice between many Medicare Advantage programs. The following chart provides information on the top 10 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 2022 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.