Medicare in Georgia

Resources for Georgia Medicare Beneficiaries 

Wondering about navigating the different parts of Medicare, when and how to sign up, or how to compare and choose a Medicare plan? Never fear. Healthpilot has resources created just for you. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Receiving guidance is helpful when making decisions, especially about Medicare. As a Georgia resident, you have access to many resources, like the State Health Insurance Program (SHIP), also called the Georgia State Health Insurance Assistance Program (GSHIAP). GSHIAP has counselors all over the Peach State who work with regional nonprofits, public health organizations, and Area Agencies on Aging (AAAs) in your county to help people learn about Medicare. 

Medicare Plan Options in Georgia  

You have several Medicare options as a Georgian. People 65 and over, as well as those with disabilities, who are eligible for Medicare, can apply for Original Medicare. If you prefer more comprehensive coverage, a Medicare Advantage plan, which are available in Georgia, may be a better option. Prescription drug plans and Medicare Supplement Insurance are other popular Medicare plan options. 

Original Medicare (Parts A & B)  

When it comes to Medicare, let’s go over the basics of Original Medicare. Part A covers hospitalization, and Part B covers medical care. Medicare Part A and Part B deductibles vary per service. Part A has a per-benefit-period (each time you’re admitted) inpatient hospital deductible, and Part B has an annual deductible before Original Medicare pays for services.  

Perks of Original Medicare: 

• Original Medicare in Georgia lets you choose and access providers nationwide. 
• There are no pre-existing condition restrictions, networks, copays, or waiting periods. 

Medicare Advantage (Part C)  

Medicare Part C, another name for Medicare Advantage plans, is offered by commercial insurance companies as an alternative option to Original Medicare coverage. These plans cover at least what Medicare Parts A and B does, and the most significant feature is that they frequently contain additional benefits. Most services are controlled by a network of providers, similar to how a Health Maintenance Organization (HMO) plan works, which may require you to have a primary care physician, a referral to see a specialist, and prior authorization for certain services, treatments, and drug coverage. Other insurance options include Preferred Provider Organization (PPO), Health Maintenance Organization –Point of Service (HMO-POS), a hybrid model of an HMO and PPO, and Private Fee-for-Service (PFFS) plans. 

For further information about Medicare Advantage, please visit our Medicare Part C Resource Page. 

Medicare Prescription Drug Plan (Part D)  

Prescription drug coverage under Medicare Part D is automatically included in many Medicare Advantage plans. Additionally, you can complement Original Medicare or Medicare Supplement Insurance with a stand-alone Prescription Drug Plan (PDP) plan. Independent Part D coverage is provided by private insurance companies that have been given Medicare approval. Depending on the plan selected, there can be a yearly deductible, copay, or co-insurance for select covered prescriptions. 

Medicare Supplement Insurance (Medigap)  

Medigap, commonly known as Medicare Supplement Insurance, is purchased by some Medicare recipients in the state of Georgia. These plans exist to help fill the financial gaps of coverage left by Original Medicare. Coverage for medical treatment outside the United States, Medicare Parts A and B deductibles, and coinsurance are all examples of such gaps. 

Since Original Medicare does not cover all of your medical expenses, the Georgia Office of Insurance and Safety Fire Commissioner provides guidance on how Medicare Supplement Insurance coverage might offset out-of-pocket expenses. 

Also, it’s important to know that you cannot enroll in both a Medicare Advantage Plan and a Medigap policy at the same time. Medigap does not provide any coverage or payment for Medicare Advantage. If you have a Medicare Advantage plan and are interested in purchasing a Medigap policy, the effective date of your Medigap policy must begin the day after the Medicare Advantage plan’s termination date.  

Medicaid 

Medicaid is a public insurance program that has been around since 1965. Both the state and the federal government fund the program. Every state offers Medicaid, which is run in accordance with federal regulations. States have a lot of leeway to create and manage their own programs because the federal requirements are quite broad. As a result, Medicaid eligibility and benefits can and frequently do differ significantly among states. Medicaid was implemented to make it easier for qualified individuals with low incomes to get access to health care, like kids, parents, pregnant women, seniors, and people with disabilities. 

How and when to sign up for Medicare in Georgia

Medicare is a federally funded, government-run insurance program for those who qualify. Besides turning 65, the following criteria also qualify you for Medicare: 

• You qualify for Railroad Retirement Board or Social Security disability payments for at least 24 months, are under 65 and permanently disabled. 
• You’ve been diagnosed with End-Stage Renal Disease (ESRD). 
• You have Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Georgia and nationwide  

Here is a quick overview of the Medicare enrollment periods in which you can elect or change your Medicare Advantage plan.  

Don’t worry, Georgia Peaches, we’re almost finished. Healthpilot knows that Medicare can be challenging and that adding enrollment deadlines can be stressful. 

The good news is we will be happy to handle all of the exhausting work for you. After you answer a few questions, we will recommend the best Medicare plan for you. We even make sure you can quickly and safely enroll online. 

As long as you are a Healthpilot customer, we take care of this for you each and every year. Update your profile with any healthcare and or prescription changes, and we will provide an updated plan recommendation to fit your changing needs. Enrollment windows don’t need to be committed to memory while Healthpilot is on your side. 

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Key Stats

Some interesting facts about Medicare coverage in Georgia:   

• Georgia has 1,773,148 Medicare recipients. This means that 17% of people are covered, less than the national average of 19%. 
• About 49% of Medicare customers in Georgia are enrolled in a private Medicare Advantage program, which is more than the national average of 45%. 
• Georgia has 166 Medicare Advantage plans in 2023. In 2022, there were only 157 plans. This means that there are now 5.7% more plans to choose from. 
• In Georgia, the lowest monthly cost for a stand-alone Medicare Part D plan is $7.30. 
• And since we promised you a fun fact about Georgia: Ireland and Croatia could easily fit inside the state of Georgia with room to spare! 

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