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Medicare in Georgia

Get peachy keen on Medicare plans in Georgia, from costs to what they cover

Reviewed by: Eboni Onayo, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Georgia is a federal program available to all legal U.S. residents aged 65 and older.

  • Original Medicare’s Parts A and BOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). cover hospital and medical services. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Georgia is an alternative that often bundles other services and Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies..

  • The cost of Medicare plans in Georgia are based on standard costs and personal details like your income and work history.

 

Scenic mountains, world-class beaches and championship golf. Big city life and quiet country living. No matter your tastes, it’s understandable if Georgia is on your mind.

But how much do you think about your Medicare in Georgia? Do you understand your plan? Are you enrolled in Original Medicare or Medicare Advantage in Georgia? Do you know all the differences?

We’re here to help and answer common questions about Medicare in Georgia.

Who is Eligible for Medicare in Georgia?

All legal U.S. citizens aged 65 and older are eligible for Medicare. You may also be eligible to enroll in Medicare plans in Georgia if you’re younger than 65 and receive Social Security benefits due to a disability. Those who have received retirement benefits from the Railroad Retirement Board (RRB) may also be eligible before 65.

If you have Lou Gehrig’s Disease (ALS), you’re eligible to receive Medicare in Georgia the first month you receive disability benefits. Those living with End Stage Renal Disease (ESRD) also may receive coverage before 65.

How Much is Medicare in Georgia?

Figuring out how much you’ll pay for Medicare plans in Georgia starts with understanding a few standard costs. But what you’ll end up paying depends on several factors, including your health, needs, budget and even income. To help figure out how much Medicare in Georgia costs, here’s the standardized pricing for Parts A, B and D in 2021. Whether you’re looking at Original Medicare or Medicare Advantage plans in Georgia, these three parts will come into play when choosing your plan.

Medicare in GA: Part A

Premium:

  • Typically no-cost if you or your spouse worked 10 or more years
  • You or your spouse worked between 7.5 and 10 years: $259 a month
  • You or your spouse worked fewer than 7.5 years: $471 a month

Deductible:

  • $1,484 each plan period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in GA: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in GA: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

How Do I Apply for Medicare in Georgia?

Are you approaching 65? There are several ways to enroll in Medicare in Georgia through the Social Security Administration, including:

  • On the Social Security website [1]
  • By visiting a local Social Security office [2]
  • Over the phone by calling Social Security 1-800-772-1213 (TTY: 1-800-325-0778)
  • Railroad workers may need to sign up for Medicare in GA through the Railroad Retirement Board (RRB). Call the RRB at 1-877-772-5772 for more information.

When are the Enrollment Periods for Medicare in GA?

Knowing when to sign up for Medicare plans in Georgia is as important as how. Whether you’re enrolling for the first time or want to change your existing plan, there are specific enrollment periods to sign up for Medicare in Georgia. Here is when they are and how they work:

Initial Enrollment Period (IEP)

Approaching 65? The IEP is your first chance to sign up for Medicare in GA. Your IEP begins three months before your birth month, and ends three months after. So, if you were born in June, your IEP begins March 1 and ends Sept. 30.

Already enrolled in Medicare in Georgia?

If you are a Medicare beneficiary, put these dates on your calendar:

Medicare Part C & D Open Enrollment Period

Want to swap drug plans or change from Medicare Advantage in Georgia to Original Medicare (or vice versa)? The Open Enrollment Period for Medicare Advantage and Medicare drug coverage is held each year from Oct. 15 to Dec. 7.

Medicare General Enrollment Period

Did you miss your Initial Enrollment Period? Use the General Enrollment Period to enroll in Medicare in Georgia. Held annually from Jan. 1 to Mar. 31.

Medicare Advantage Open Enrollment Period

Do you have Medicare Advantage in Georgia? Switch back to Original Medicare or change your Part C plan during this enrollment period from Jan. 1 to Mar. 31.

What Qualifies You for Medicaid in Georgia?

Medicaid is not the same thing as Medicare. Medicaid is a state-run program for people who can’t afford Medicaid. In Georgia, there are Medicaid programs to provide health insurance to low-income adults and families. To be eligible, you’ll need to meet several requirements, including age and income. [3]

What Are the 4 Types of Medicare?

Georgia has four main types of Medicare. They are Original Medicare (Parts A and B), Medicare Advantage (Part C) and Medicare Prescription Drug Plan (Part D). Georgians with Original Medicare can also consider Medicare Supplement Insurance (Medigap). Here’s an overview of each:

Original Medicare (Parts A and B)

Original Medicare plans in Georgia start with Parts A and B. Each covers different things for Georgians with Medicare.

  • Part A: helps cover your hospital stays. This also includes inpatient services at nursing homes, skilled nursing facilities, some home health and hospice care.
  • Part B: provides your medical coverage for medically necessary and preventive care

Medicare Advantage Plans (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

Medicare Part D (Prescription Drug Plan)

Part D is stand-alone prescription drug coverage. Original Medicare plans in Georgia will need to add Part D separately, while many Medicare Advantage plans have it included with their coverage.

Medicare Supplement (Medigap)

Medigap, or Medicare Supplement Insurance, is a group of optional, stand-alone policies for people enrolled in Original Medicare plans in Georgia. Medigap can be used to cover the out-of-pocket costs that come with using Parts A and B Medicare plans in Georgia. Interested in Medigap? Start by learning how they’re priced and what they cover.

What Are the Top 5 Medicare Plans?

There are many different ways to receive Medicare plans in Georgia. You can mix and match Original Medicare, Medigap and Part D in several ways — and that’s before you even get to Medicare Advantage plans in Georgia. To figure out the top 5 Medicare plans in your area, don’t rely on other peoples’ rankings. Instead, start with your needs and see which plans fit you.

  • Pros and Cons: Get a jump start by understanding a major decision you need to make — Original Medicare or Medicare Advantage plans?
  • Enrollment checklist: Develop a plan based on your budget and coverage needs
  • Medicare Star Rating System: See how others grade the providers and plans in your area
  • Pro Tips: Little-known tips to make signing up for Medicare in Georgia easier
  • Contact GoHealth: Still have questions about Medicare plans in Georgia? The licensed insurance agents at GoHealth walk through your options in your area and discuss your details. The goal is to offer the impartial advice and honest answers you need.

What is the Most Popular Medicare Advantage Plan?

A plan’s value isn’t in how many people are enrolled, but how well it works for you personally. To help, here are the types of Medicare Advantage plans in Georgia:

What is the Downside to Medicare Advantage Plans?

The answer here is completely personal. Original Medicare and Medicare Advantage plans in Georgia each have different coverage details to be aware of, and a downside for one person may be an advantage for another. But the most common trade off is this: Original Medicare enrollees can see any doctor that accepts Medicare, but typically have higher out-of-pocket costs. Those with Medicare Advantage often have lower costs but are limited to a provider network for care. Check out our page on the Pros and Cons of Original Medicare and Medicare Advantage.

If you need help seeing where the downsides are for you, give GoHealth a call. Our licensed insurance agents will go through your details and find options that work for your needs. The only downside? You won’t spend hours doing it yourself.

Medicare in Georgia by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,589,372 people are enrolled in Medicare in Georgia. The total number of beneficiaries enrolled in Medicare Advantage in Georgia is 666,676. The previous year, 606,744 enrolled in Medicare Advantage. Medicare Advantage participation in Georgia went from 39.28% to 41.95% year over year. If you’d like to dive deeper into how Medicare in Georgia breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Georgia
1,589,372
Beneficiaries with Part A & Part B
666,676
Medicare Advantage Beneficiaries
41.95%
Medicare Advantage Participation Rate
54.61%
% Female
45.39%
% Male
1.01
Average HCC Score
$10,177.22
Actual Per Capita Costs
18.14%
% Eligible for Medicaid
31.94%
% of Beneficiaries with an Emergency Department Visit
18.54%
Hospital Readmission Rate
74.65%
% Non-Hispanic White
20.12%
% African American
1.97%
% Hispanic
3.26%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Georgia Medicare Resources & Contacts

Beneficiaries spend an average of $10,177.22 each year on Medicare in Georgia. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Georgia-based resources, like these, may be able to help:

GeorgiaCares State Health Insurance Assistance Program (SHIP)

1-866-552-4464
1-404-657-5285

https://aging.georgia.gov/georgiacares-ship

What should I know about GeorgiaCares?

Apply for Georgia-based financial assistance programs for help with Medicare costs

Georgia Medicaid

1-877-423-4746
1-404-657-5468

https://medicaid.georgia.gov/

What should I know about Georgia Medicaid?

Health insurance support for low-income adults, seniors and families

Georgia Department of Human Services

1-844-694-2347

https://dhs.georgia.gov/

What should I know about the Georgia Department of Human Services?

DHS can connect you with your area’s Agency of Aging and find resources for hunger, dementia, and more.

Georgia Department of Veterans Service

1-404-656-2300

https://veterans.georgia.gov/

What should I know about the Georgia Department of Veterans Service?

Learn more about your benefits, get educational opportunities and receive housing help.

Nationwide Resources

Speak with an insurance agent that is licensed in Georgia about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in GA, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.