Medicare Advantage Plans in Georgia

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many Georgia plans offer extra benefits such as dental, vision, hearing, telehealth, fitness memberships, and even over-the-counter (OTC) benefits.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65. Some may qualify earlier due to disability or conditions like ALS or ESRD.

Important enrollment periods include:

• Initial Enrollment (3 months before to 3 months after your 65th birthday)
• General Enrollment
• Special Enrollment

Late enrollment or missing premium-free coverage qualifications may lead to penalties.

What Types of Medicare Advantage Plans Are Available in Georgia?

Georgia offers the following MA plan types:

Health Maintenance Organizations (HMOs)

• Require use of in-network providers (except in emergencies)
• Primary care physician required
• Referrals needed for specialists

Preferred Provider Organizations (PPOs)

• Allow out-of-network care at higher costs
• Typically do not require referrals

Private Fee-for-Service (PFFS)

• Any provider who agrees to plan terms can be used
• Some plans include a provider network

Special Needs Plans (SNPs)

• C-SNPs: For chronic conditions like diabetes, HIV/AIDS, or heart disease
• I-SNPs: For institutionalized individuals or those needing nursing care
• Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid; often offer low-cost care, drug coverage, dental, and care coordination

Note: Medical Savings Account (MSA) plans are not currently available in Georgia.

What Are Your Prescription Drug Options with Medicare Advantage?

Most Medicare Advantage plans in Georgia include Part D drug coverage. Exceptions include MSAs and some PFFS plans.

If your MA plan does not include prescription coverage, you may:

• Enroll in a standalone Part D plan (only allowed with certain plan types)
• Face a penalty for late enrollment if you don’t have creditable coverage

How Do You Choose a Medicare Advantage Plan?

Before enrolling, make sure you understand Medicare Advantage costs:

• Premiums: Some Georgia plans have $0 premiums; others charge a monthly fee
• Deductibles, Copays & Coinsurance: These vary by plan
• Out-of-Pocket Maximums: Each plan has a cap on annual spending for covered services
• Extra Benefits: Plans may offer dental, vision, hearing, OTC benefits, telehealth, and more

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday
• Annual Open Enrollment (Oct 15–Dec 7): Switch, drop, or join an MA plan
• General Enrollment (Jan 1–Mar 31): If you enrolled in Part B during this period
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare
• Special Enrollment: Triggered by qualifying life events such as:
  • Moving out of your plan’s area
  • Losing job-based coverage
  • Plan discontinuation
  • Specific health conditions

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in Georgia?

• Georgia SHIP Program (GeorgiaCares): Offers free Medicare coverage counseling
• Georgia SMP Program: Educates beneficiaries on avoiding healthcare fraud
• Georgia Department of Insurance: Handles Medicare complaints
• For low-income residents, Georgia Medicaid may help with costs. Visit medicaid.georgia.gov or call 877-423-4746. Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans (Medigap) are standardized policies that help cover costs left by Original Medicare, such as deductibles, coinsurance, and copayments.

• Requires enrollment in Medicare Parts A and B
• Best time to enroll: Within six months of enrolling in Part B (guaranteed issue)
• Plans don’t cover drug costs—you’ll need a separate Part D plan
• There are 10 standardized plans; Plan G is the most popular and growing fastest
• Plan F is not available to those newly eligible after 2020
• Offers predictable costs, no referrals, and nationwide provider access

Learn more about Medicare Supplement plans in Georgia.

Next Steps

If a Medicare Advantage plan in Georgia is right for you, compare available plans in your ZIP code. Review provider networks, drug coverage, and out-of-pocket costs to select the plan that best fits your needs—then be ready to enroll during your eligible period.