If you are enrolled in Medicare Parts A and B , a Medicare Advantage plan is an alternative in Georgia.
Medicare Advantage (Part C) replaces Parts A and B while providing at least the same coverage and often additional coverage like hearing and vision.
While Original Medicare has a set cost structure, prices vary with Medicare Advantage, which generally offers an affordable option when you see in-network providers.
You have the option to switch to Medicare Advantage in Georgia when you are enrolled in both Parts A and B for the first time.
You also can enroll in Medicare Advantage during the Medicare Open Enrollment Period, also called the Annual Enrollment Period (AEP).
If you’re a U.S. citizen living in Georgia who is at least 65 years old, you are eligible for Medicare.
And if you’re eligible for Medicare, you’re eligible for Medicare Advantage.
Medicare is a federal program offering health insurance to all who qualify in the form of Parts A and B of Original Medicare. If you have Parts A and B, you qualify to switch to a Medicare Advantage plan offered by a Medicare-approved private insurance company that replaces Original Medicare while offering at least the same coverage as Parts A and B, and often offering more.
In 2023, every Georgia resident on Original Medicare has access to a Medicare Advantage plan with a $0 monthly premium.
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Since Medicare Advantage plans in Georgia offer at least the same coverage as Parts A and B of Original Medicare, it’s a good idea to review what Parts A and B cover.
- Commonly called “hospital insurance,” Medicare Part A provides coverage for inpatient hospital stays, usually without requiring a monthly premium .
- Commonly called “medical insurance,” Medicare Part B provides coverage for outpatient services and needs like doctor visits and durable medical equipment. Part B usually requires a monthly premium.
You will get at least those coverages If you switch to a Medicare Advantage plan in Georgia.
Differences between Medicare Advantage and Original Medicare
In Georgia, Medicare Advantage and Original Medicare cover you in different ways. Medicare Advantage plans provide coverage within a specific network in Georgia, while Original Medicare is accepted nationwide by any provider that accepts assignment .
In part because private insurance companies contract with a network of local providers to offer coverage for those on Medicare Advantage in Georgia, Medicare Advantage plans are able to provide more coverage than Original Medicare at affordable rates.
The following aren’t offered by Original Medicare but are provided by at least some Medicare Advantage plans in Georgia:
- Dental coverage
- Vision coverage
- Hearing coverage
- A stipend for over-the-counter supplies
- Transportation for routine medical appointments
- An out-of-pocket maximum (offered by all Medicare Advantage plans)
Nationwide, the average monthly premium for a Medicare Advantage plan in 2023 is $18. Some Medicare Advantage plans have no monthly premium, and some go a step further and help pay some of your Part B deductible.
While Medicare Advantage (Part C) replaces Original Medicare as your plan, your Medicare coverage is still regulated by the federal Medicare program, and you are still responsible for your Part B premium. In 2023, the standard monthly premium for Part B is $164.90. You also are still responsible for your Part A deductible, but 99% of people don’t have a Part A deductible because they have paid Medicare taxes for at least 10 years.
The cost structure for Original Medicare in terms of deductibles as well as the formula for coinsurance and copayments is standard across the board, although what you pay will vary based in part on what your provider charges. The cost structure for Medicare Advantage in Georgia varies from plan to plan, although there are a couple of constants:
- Every Medicare Advantage plan provides the protection of an out-of-pocket maximum, which — as the name suggests — spells out the maximum money you’ll have to pay “out of pocket” over the length of the plan (usually one year). This can provide peace of mind by defining the worst-case scenario. Original Medicare doesn’t have an out-of-pocket maximum.
- Every Medicare Advantage plan, regardless of the uniqueness of its cost structure, offers coverage at least equal to Parts A and B of Original Medicare. For example, Part A covers inpatient hospital stays and Part B covers medically necessary durable medical equipment. That means Part C covers both of those things, though your related out-of-pocket costs may vary depending on your particular plan.
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You are eligible for Medicare Advantage in Georgia if you have enrolled in both Parts A and B of Original Medicare.
Still, you need to know when you can enroll and how to enroll.
In a nutshell, your first chance to enroll in a Medicare Advantage plan in Georgia arrives when you are first enrolled in both Parts A and B.
- If that’s during the Initial Enrollment Period that surrounds your 65th birthday, you have until three months after your birthday month to switch to Medicare Advantage.
- If that’s during the annual General Enrollment Period that runs from January 1 to March 31 each year, you’ll have the option from April 1 to June 30 to switch to Medicare Advantage.
- If that’s during a Special Enrollment Period, then you have the option during that period to switch to Medicare Advantage.
If you didn’t take advantage of any of those initial windows to switch to Medicare Advantage, you always have the option to do so every year during the Annual Enrollment Period (also called the Medicare Open Enrollment Period) from October 15 to December 7.
When you are eligible to switch to Medicare Advantage, a GoHealth licensed insurance agent can guide you through the process.
The majority of Medicare Advantage plans in Georgia include prescription drug coverage.
Medicare Advantage allows you to bundle Part D drug coverage. Original Medicare allows you to add a stand-alone Part D drug coverage.
Part D drug coverage is administered by private insurance companies with guidance from the Medicare program. A GoHealth licensed agent can help you find a Medicare Advantage plan in Georgia with drug coverage or find a stand-alone drug plan to pair with Original Medicare.
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