Medicare Options in Georgia
Most Americans are automatically enrolled in Medicare coverage when they reach the age of 65. A person also becomes eligible for Medicare if they have received 24 disability benefits payments or have renal failure or ALS. Hence, Medicare plans also cover approximately 10 million people under 65.
It is crucial that you pick a health insurance plan that is both affordable and covers all your bases to keep up with the ever-increasing costs of medical treatment. Learn how a professional Medicare insurance agent in Georgia can help you choose the best plan for your needs.
Medicare Supplement (Medigap) Plans in Georgia
There is no cap on out-of-pocket expenses under Original Medicare, so most beneficiaries choose to carry supplemental coverage. Medicare Supplement or Medigap plans in Georgia are designed to cover some or all the out-of-pocket payments that Medicare members would otherwise bear.
Since Medigap coverage is quite comprehensive and cannot be combined with Medicare Advantage plans, people often go for Medigap coverage instead. As of 2019, Medigap coverage was available to 378,730 Medicare beneficiaries in Georgia. This was slightly more than one-third of the state’s Original Medicare population.
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Although private insurers provide Medigap plans, they must adhere to federal regulations. Medigap plans are governed by each state’s insurance commissioners and laws. In 2022, Georgia has 41 insurers offering individual Medigap insurance.
Medigap insurers in Georgia set their premiums in three ways:
Issue-age rating
The premiums are calculated depending on the person’s age at the time of enrollment. Enrollment premiums are usually cheaper for people under 65 than for anyone over 80. Overall rates may rise, but not in response to individual enrollees’ advancing years.
Attained-age rating
Most insurance companies around the country use the attained-age rating method. A person’s premiums go higher as they become older since the insurer can raise them depending on the enrollee’s age.
Community rating
Premiums are not affected by age in community rating. Only eight states mandate this method. Insurers tend to avoid this approach unless it is mandated.
Most insurance companies in Georgia use issue-age rating while others use attained-age rating. This is unlike what insurers follow in most states, where the attained-age rating is the most prevalent technique unless the state demands differently.
First-time Medicare enrollees in Georgia may find the process of selecting the right plan, given all these options, a bit intimidating at first. At Medicare Hope, we aim to make Medicare as simple as possible. We’ll work with you one step at a time until we find the solution that’s right for you.
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Georgia Medigap for People Younger than 65
Even if you’re disabled and under 65 and qualified for Medicare, federal rules don’t guarantee that you’ll be able to enroll in a Medigap plan. On the other hand, states are free to enact their own laws.
A guaranteed-issue Medigap policy is required by law in Georgia for everyone who enrolls in Medicare Part B, irrespective of age. Under this regulation, people who previously possessed Part B were permitted a one-time, 6-month open enrollment window, which went into effect in 2011. Everyone in Georgia now has the same six-month Medigap open enrollment period when they sign up for Medicare.
Georgia’s law states that persons under 65 can be charged higher rates but that the premium difference must be within reasonable limits. Under 65-year-olds in Georgia face much higher Medigap premiums than their older counterparts.
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Enrollees under the age of 65 in Georgia’s Medigap plans typically pay three to 10 times as much as 65 and older beneficiaries.
The expenses of disabled Medicare beneficiaries are considerably greater than the average expenditures of Medicare beneficiaries who qualify due to age. To account for the greater loss ratio, insurers hike premiums.
Georgia Medicare Advantage Plans (Part C)
Even though Georgia’s Medicare Supplement plans provide the most comprehensive coverage, users can also opt for Medicare Advantage plans in Georgia. Private companies that have a contract with Medicare provide Medicare Advantage plans. To get the lowest copays, you must commit to using the plan’s provider network of doctors and hospitals alone.
The availability of Medicare Advantage plans varies by region. For instance, in Lowndes County, Georgia, individuals get to choose from 21 Medicare Advantage plans in 2022, while people in DeKalb and Gwinnett counties have 88 options.
There are four types of Medicare Advantage plans in Georgia:
Health Maintenance Organization (HMO)
Most HMOs mandate that you use only in-network providers for all healthcare services:
- You require a PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions.
- Plans typically provide drug coverage.
- You can’t purchase separate drug coverage.
- Costs are lower if you stick to the provider network.
Preferred Provider Organization (PPO)
MedicarePPO plans have a recommended network of providers, but you can always choose out-of-network doctors or healthcare facilities for a higher price.
- No PCP or specialist referral requirement.
- Most plans cover prescriptions.
- You cannot purchase drug coverage separately.
- Higher out-of-network charges and premiums.
Private Fee-For-Service (PFFS)
PCPs and specialist referrals aren’t necessary under PFFS programs:
- You can consult any Medicare-approved doctor or healthcare facility if they agree to the plan’s terms.
- Drug coverage may be included or purchased separately.
- You’ll pay more to consult a provider who doesn’t agree with the plan’s terms.
Special Needs Plan (SNP)
SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:
- You require a PCP and specialist recommendations.
- Plans always include drug coverage.
- Anybody meeting the eligibility criteria can join SNPs at any time.
Georgia Medicare Part D
Medicare Parts A and B do not cover outpatient prescription medication. Medicare enrollees can obtain prescription coverage through Medicaid plans, their employer, or through Medicare Part D. In 2022, Georgia has 23 stand-alone Medicare Part D plans. Overall, Medicare Part D enrolment in Georgia has continuously risen as Medicare coverage has increased nationwide.
On the other hand, stand-alone Medicare Part D enrollment has decreased in Georgia since Medicare Advantage participation has grown faster than Original Medicare enrolment. By late 2021, 552,959 Georgia residents had stand-alone Medicare Part D coverage.
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Comparing Medicare Advantage Plans in Georgia
By 2020, 1,027,293 Georgia residents had enrolled in Medicare Advantage. With so many options available, choosing one that covers all your needs can be difficult. Make sure you discuss all your requirements with a Medicare Insurance agent before making a decision.
Consider the following factors when evaluating your Medicare options:
Provider Network
Many Medicare plans require you only to consult providers within the plan’s network. Your medical costs may rise if you do not stay within the network of providers that you have contracted with. Find out if the physicians and hospitals you’re considering are part of the network to save money on medical bills.
Amount of Coverage Required
Think about the goals you want to achieve with your plan. Medicare Advantage and Medigap plans typically cover additional dental, vision, and hearing benefits that are not included in the original Parts A and B. When shopping for insurance, maintain a list of desired benefits so you can choose a plan that fulfills all of them.
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Check Plan Ratings
The Centers for Medicare & Medicaid Services (CMS) annually releases Part C and Part D performance data. Check these ratings before the open enrollment period begins.
Out-of-Pocket Expenses
Out-of-pocket costs include deductibles, copayments, and coinsurance. If you stick to the plan’s provider network, these expenses are the most that you pay yourself. You can use our plan finder tool to compare the pricing of different plans in your area.
Monthly Premium
Since you must pay the Part B deductible even if you don’t exercise your benefits, Medicare Advantage and Supplement plan premiums add to your monthly budget. You’ll need access to at least one no-premium plan that offers adequate prescription coverage to keep your expenditures low.
For enrollees under 65 years of age, premiums are an essential factor when evaluating Medicare Advantage and Medigap plans. Since the latter have higher premiums but lower copays, discuss which is better for you with your Medicare insurance agent.
Drug Coverage
Prescription medicine is often costly, so you want to ensure your plan covers your medical expenses. Consult the policy’s formulary to determine if and how much your drugs will cost. Ask your physician if there is a substitute or generic option for a medication that is not on the list.
Deductibles, Coinsurance & Copays
You are responsible for these expenditures when you use Medicare benefits. Before signing up for a plan, make sure you understand all the specifics about the hospital and medical coverage. Everything from doctor’s appointments to prescription medication falls under this category.
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Freedom to Travel
Before you choose a plan, consider how much coverage you’ll need when traveling. It’s always good to have a plan that provides travel coverage, especially if you often expect to leave your coverage area. Unlike Medicare Advantage, Medigap plans do not restrict you to a provider network. Hence, beneficiaries who travel for work or other reasons prefer Medigap plans.
Medicare Eligibility in Georgia
You must be at least 65 years old to be eligible for Medicare benefits. In Georgia, people under 65 can also apply for Medicare supplement policies. Patients of chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), also qualify for Medicare at any age.
Medicare Enrollment in Georgia
Medicare will register you automatically if you have received at least four Social Security or Railroad Retirement Board payments before your 65th birthday. Otherwise, you can apply online or mail your application to your local Social Security Office. We recommend going the online route since it is a much quicker process.
Enrollment in Medicare is open during the following time frames:
Initial Enrollment
This is a 7-month period that includes the month of your 65th birthday, the three months before it, and the three months after. If you enroll before turning 65, your coverage will begin during your birth month. Your insurance coverage will be delayed if you register after this time period.
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Note: Without adequate prescription drug coverage, you risk paying a lifetime Part D late fee if you fail to enroll in Part D by the deadline. Even though Part D membership is optional, there may be a penalty for enrolling late.
General Enrollment
If you missed your initial enrollment window, you could sign up for Original Medicare, Medicare Advantage, and Part D Plans from January 1 to March 31. To avoid a late enrollment fee, sign up as soon as possible.
Open Enrollment
This is a 3-month period from October 15 to December 7 when you can switch between Original Medicare and Part C Plans, make changes to your current plan, or enroll in a Part D plan.
Special Enrollment
A special enrollment period is granted to beneficiaries who lose their insurance coverage or their eligibility changes due to unforeseen circumstances (job loss, relocation, etc.)
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Why Should You Choose Medicare Hope Insurance Agents?
At Integrity Now Insurance Brokers, our Medicare Insurance Supplement Agents are licensed through America’s Health Insurance Plan (AHIP). We have years of experience in the health insurance industry, so you can count on us to handle all your Medicare needs. Our clients include elderly folk, youth with disabilities and chronic illnesses, and others struggling with their medical bills.
Medicare’s insurance marketplace is continuously expanding to be more inclusive. Existing plans also undergo revisions and cutbacks. You don’t have to worry about keeping track of all these changes. We’re here to take care of everything.
A Medicare insurance agent in Georgia will review your healthcare needs and weigh all your options. This includes figuring out if a Medicare Supplement Plan or a Medicare Advantage Plan is best for you.
All our services are offered free of charge. We will help you compare quotes and find the best Medicare insurance plan for your needs for no cost on your part. We have all the information you need to start living debt and stress-free.
Call us for a free consultation with one of our representatives and get started today!
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