If you are a Georgia resident and researching possible Medicare plan options, read our guide for more information about 2020 Medicare Advantage plans in your state.

By Grace Kisirkoi
Updated June 29, 2020

Key Takeaways:

  • Medicare Advantage plans in Georgia are an alternative to Original Medicare.

  • With Medicare Advantage plans, you have the options to bundle your basic Part A and Part B benefits with vision, dental, prescription drugs, and other additional benefits in one plan.

  • Costs of Medicare Advantage plans vary widely according to your location, health needs, and whether you see in-network or out-of-network providers.

  • Some Medicare Advantage plans uniquely address certain special needs and disabling conditions.

What Types of Medicare Advantage Plans Are Available in Georgia?

You can enroll in a Medicare Advantage (Part C) plan in Georgia with $0 premium costs. Private insurance companies provide Part A and Part B benefits by contracting with Medicare. The table below summarizes common benefits you may receive from an Medicare Advantage plan in Georgia:

Original Medicare Benefits

Supplemental Benefits

Extras

Part A: This covers inpatient hospital care.


Part B: This covers doctor visits and approved outpatient care.

MA plans must provide these benefits at minimum.

Part D: Your prescription drugs can be covered under Part D benefits.


Dental and vision: You may add dental and vision plans to your MA plan.


Hearing: This usually includes hearing tests and aids

SilverSneakers: This is a fitness program.


Transport to your doctor visits.


Adult day care for social support.


Over-the-counter drugs at discounted rates

Having an understanding of MA plan types will help you pick the right one for your health care needs. Below we describe the most common plan types you may find in Georgia.

Health Maintenance Organization (HMO) Plans

As a general rule, Health Maintenance Organization (HMO) Plans require you to go to in-network providers for your care. However, the plans make exceptions in case of emergencies, or when you need urgent care while traveling outside your area of coverage.

With an HMO plan, you will need to choose a primary care doctor. If you need to see a specialist, your primary care doctor usually gets you a referral. However, some procedures (such as an annual mammogram screening), do not need a referral.

Preferred Provider Organization (PPO) Plans

Preferred Provider Organization (PPO) plans usually offer some flexibility. This means that you can get care from any doctor, healthcare provider, or hospital. However, you will pay more. You usually pay less if you see providers that are within your PPO network. Unlike a HMO plan, you don't have to choose a primary care doctor, or get a referral to see a specialist if you are in a PPO plan.

Private Fee-for-Service (PFFS) Plans

You usually get more flexibility with private fee-for-service plans (PFFS) than HMO plans. This is because PFFS plans allow you to see health specialists without a referral. Additionally, PFFS plans determine what they will pay the provider, and what you will pay out of pocket.

It is therefore important to establish that the provider or specialist you visit accepts your PFFS plan and charges the amounts approved by your insurance provider. Not all healthcare providers agree to PFFS plan terms consistently, so be sure to confirm costs at every visit. In the event of emergencies, doctors, hospitals, and other providers must treat you.

Special Needs Plans (SNPs)

Membership to Special Needs Plans (SNPS) is limited to people with certain chronic illnesses or disabling conditions. Qualifying illnesses and conditions include:

  • End-stage renal disease (ESRD)

  • HIV/AIDs

  • Chronic heart failure

  • Dementia

  • People who need long-term care in a facility or a home

SNP plans customize the benefits to the special needs of beneficiaries. If you have one of these plans, you must get your care from providers within SNP networks. Exceptions are made during emergencies, or for individuals with ESRD who need dialysis while out of the area covered by SNP plans. For care from a specialist, you must get a referral except for:

  • Annual mammogram screening

  • Routine pap tests within network

  • Routine Pelvic exams

These plans also bundle customized prescription drug plans.

find a medicare plan that fits your budget

What are the Costs of Top Medicare Advantage Plans in Georgia?

The costs of Medicare Advantage plans vary widely by:

  • Premiums

  • Coinsurance

  • Deductibles

  • Copayments

  • Rates of in-network versus out of network providers

  • Whether you get extra help to pay for your plan

If you are in the market for an MA plan in Georgia, it is important to think about:

  • Your health care needs

  • The plans' benefits

  • The experience and satisfaction of current beneficiaries

We sampled plans within Atlanta, Georgia counties and summarized them on the table below. For the sake of our analysis, we chose all-in-one plans with vision, dental, hearing, and prescription drug coverage.

Our ranking took into account the plans' star ratings and premium amounts. Star ratings are standardized by the Centers for Medicare and Medicaid (CMS). These ratings give an overview of the plan's quality and performance, with 5 being the highest. The below plans have at least a 4-star rating in 2020.

MA Plan Star Rating

Costs

(Excluding the standard Medicare Part B Premium of $144.60 in 2020)

Extra Benefits

Humana Gold Plus H4141-015 (HMO)

Rated 4/5

$0: Monthly premium

$0: Health care deductible

$0: Prescription drug plan deductible

$5,900: Maximum you pay for care from in-network providers

Vision

Dental

Hearing

Transportation

Fitness

Worldwide emergency

Over-the-counter drugs

Telehealth

Humana Gold Plus H4141-17 (HMO)

Rated 4/5

$8: Monthly premium

$0: Health care deductible

$0: Prescription drug plan deductible

$6,700: Maximum you pay for care from in-network providers

Vision

Dental

Hearing

Transportation

Fitness

Worldwide emergency

Over-the-counter drugs

Telehealth

HumanaChoice H5216-145 (PPO)

Rated 4/5

$34: Monthly premium

$0: Health care deductible

$75: Prescription drug plan deductible

$6,700: Maximum you pay for care from in-network providers

$10,000: Maximum you pay for care from out of network providers

Vision

Dental

Hearing

Transportation

Fitness

Worldwide emergency

Over-the-counter drugs

Telehealth

UnitedHealthcare Nursing Home Plan 2 (PPO *I-SNP)

Rated 4.5/5

$25.30: Monthly premium

$0: Health care deductible

$435: Prescription drug plan deductible

$1,800: Maximum you pay for care from in-network providers

$5,100: Maximum you pay for care from out of network providers

Vision

Dental

Hearing

Transportation

Over-the-counter drugs.

*This plan is an Institutional SNP. It provides cover to people who live in a nursing home or those who need care at home

These plan rates are based on 2020 rates in Atlanta, Georgia counties. Besides these MA plan costs, you will also pay the standard Medicare Part B premium of $144.60.

Do you still have questions about your Medicare options? Connect with a licensed Medicare insurance agent who can help guide you through additional enrollment choices and any additional information you need to make the best choice for your health and budget needs.

Grace Kisirkoi works in higher education and is a writer who specializes in finance.