Medicare in Georgia
Written by: Aaron Garcia
Reviewed by: Eboni Onayo, Licensed Insurance Agent
Medicare in Georgia is a federal program available to all legal U.S. residents aged 65 and older.
Original Medicare’s Parts A and B cover hospital and medical services. Medicare Advantage in Georgia is an alternative that often bundles other services and Part D .
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.
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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
- Typically no-cost if you or your spouse worked 10 or more years
- You or your spouse worked between 7.5 and 10 years: $274 a month
- You or your spouse worked fewer than 7.5 years: $499 a month
- $1,556 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
- $170.10 monthly and up (income-based)
- $233 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare in GA: Part D
- Income-based; varies by plan
- No more than $480 in 2022
Copayments & coinsurance:
- Plan- and drug-specific
Are you eligible for cost-saving Medicare subsidies?
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
- By visiting a local Social Security office
- 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 extra benefits and savings do you qualify for?
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.
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.
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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:
- Health Maintenance Organization (HMO): With an HMO, you’ll have a primary care physician and a provider network to maintain your care.
- Preferred Provider Organization (PPO): PPOs require primary care physicians but you can see in-network providers without referrals.
- Private Fee-for-Service (PFFS): Providers are paid by the service in PFFS plans.
- Special Needs Plans (SNP): condition-specific plans designed to care for certain diseases or health issues. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
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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
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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.
Are you paying extra for dental, vision and hearing benefits?
Georgia Medicare Resources & Contacts
Beneficiaries spend an average of $10,567.56 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:
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.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status