Georgia Medicare Guide

The information below shares the basics of Medicare in Georgia. Learn how to enroll in Medicare and which options you have. 

If you’d prefer to speak with someone or have any questions about when and how to enroll and which coverage option is best for you, schedule an appointment with one of our licensed Georgia Medicare Advisors or call us now at: (888) 604-0055. 

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Georgia

• Georgia Medicare Advantage Plans

• Georgia Medicare Supplement Plans

• Georgia Medicare Part D (Prescription Drug) Plans

• Get help paying for Medicare in Georgia

• Medicare Eligibility and Enrollment Steps

A Snapshot of Medicare in Georgia

There are 1.8 million Medicare beneficiaries in Georgia, making up 17% of Georgia’s total population. 20% of Georgia Medicare beneficiaries are dually eligible, meaning they’re on both Medicare and Medicaid.

Enrollment in Medicare Advantage vs. Original Medicare in Georgia

Medicare beneficiaries have a choice between staying on Original Medicare (Part A & Part B) or switching to Medicare Advantage. If they choose to stay with Original Medicare, beneficiaries can also enroll in a Medicare Supplement plan to significantly reduce their out-of-pocket costs. Which coverage options are best for you depends on your specific situation, so it’s best to speak with a licensed Medicare agent who can help you understand the pros and cons of every option available to you.

53% of Georgia Medicare recipients are on Original Medicare (with or without additional coverage) and the other 47% are on a Medicare Advantage plan (source).

Georgia Medicare Advantage Plans

Medicare Advantage (also known as Medicare Part C) provided by private insurance companies to give beneficiaries an alternative to Original Medicare. Many Medicare Advantage plans have low or no additional premiums, but you will still continue to pay your Original Medicare premiums. Advantage plans are required to provide at least the same coverage as Original Medicare. 

Unlike Original Medicare, Medicare Advantage plans have out-of-pocket maximums to provide Medicare beneficiaries with some financial protection for catastrophic costs. Additionally, they generally offer additional benefits, including:

• Dental, vision, and hearing benefits

• Flex cards

• Free gym memberships

• Transportation to and from doctor appointments

• Part B premium reduction programs

Be careful in choosing a Georgia Medicare Advantage plan specifically for these added benefits. You want to be sure your healthcare needs, including the doctors you prefer and the prescriptions you take, are covered first! You should also be aware of some of the drawbacks that come with Medicare Advantage plans. These include:

• Limited provider networks

• Preauthorization requirements

• Higher out-of-pocket costs when compared to coverage from Original Medicare + Medigap

47% of Georgia Medicare beneficiaries choose to enroll in one of the 110 Medicare Advantage plans available statewide. Plan availability varies by zip code. For example, Fulton County has 60 Medicare Advantage plans available from ten insurance carriers and Bibb County has 45 plans available from eight carriers (in 2023). To hear about Medicare Advantage plans available in your zip code, schedule a free consultation with one of our licensed Georgia Medicare agents or call us today at (888) 604-0055. 

Georgia Medicare Supplement Plans

Original Medicare only covers about 80% of costs. Medicare Supplement (also known as Medigap) plans pair with Original Medicare to help cover the 20% of costs that Medicare doesn’t. They don’t provide coverage for additional healthcare services, but they do significantly reduce your out-of-pocket costs. Many Medicare beneficiaries choose to pair a Medicare Supplement plan with their Original Medicare coverage.

When compared to Medicare Advantage plans, Medigap plans have some big benefits, including:

• You can see any doctor that accepts Medicare (about 90% of doctors nationwide)

• You don’t need prior authorization for covered services

• Your out-of-pocket costs are significantly reduced, regardless of which of the ten plan types you choose

Plan G, generally considered the best Medicare Supplement plan type, covers almost all of your out-of-pocket costs (you just have to meet your Part B deductible). Our lead advisor, Ari Parker often shares, “My mother’s outpatient knee replacement would have cost $8,000 out of pocket had she not secured Medigap insurance. Instead, on her Plan G, she reached the $233 Part B annual deductible and did not owe a penny more.”

The best time to enroll in a Medicare Supplement plan is when you first enroll in Medicare, during the Medigap Open Enrollment period. During this period, you cannot be denied coverage, regardless of your age or any pre-existing medical conditions. Outside of this time, insurance companies can ask you questions about your health history and you could be denied acceptance into a plan.

Georgia Part D (Prescription Drug) Plans

Georgia Medicare beneficiaries can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage (MA+PD plan) or through one of 24 stand-alone Part D plans available in Georgia. The exact number of plans available to you will be based on your zip code. The average monthly premium for a Medicare Part D stand-alone drug plan in Georgia is $39.31.

When choosing your drug plans, be sure to check that all of your prescriptions are covered. Even if you don’t currently use any prescriptions, you should enroll in one of the cheaper prescription drug plans to avoid the Part D late enrollment penalty. 

Get help with prescription drug costs with Medicare’s Extra Help Program

If you have limited income and resources, you may be eligible for the federal Extra Help program that helps with Part D costs. If you meet any of the following conditions, you’ll qualify for Extra Help automatically:

• You receive full Medicaid coverage from Georgia

• Georgia helps pay your Part B premium

• You get Supplemental Security Income (SSI) benefits

If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need help, you can speak with one of our Georgia Medicare Advisors who can help you with the application process.

Get help paying for Medicare in Georgia

Extra Help only provides Medicare beneficiaries with financial aid for prescription costs. These two government programs help low-income individuals pay for other Medicare expenses. 

Medicaid

Georgia’s Medicaid program is run by the Georgia Department of Community Health. If you are aged, blind, or disabled, you may qualify for Georgia’s Aged, Blind, and Disabled Medicaid (ABD) Program. 

You’re eligible for ABD Medicaid in Georgia if you meet the following criteria:

• You’re 65 or older (aged), totally disabled, or blind

• You’re a US citizen or were lawfully admitted to the US for permanent residence before August 22, 1996

• You’re a resident of Georgia

• You agree to assign health insurance benefits to the Georgia Department of Community Health

• You meet the financial criteria for income and assets

Medicare Savings Programs

Medicare Savings Programs are available nationwide for low-income Medicare beneficiaries, but each state operates theirs slightly differently as part of their Medicaid programs. There are four Medicare Savings Programs in Georgia:

Qualified Medicare Beneficiary (QMB) Program

Eligible individuals will have their out-of-pocket Medicare expenses covered, including premiums, deductibles, and coinsurance.

Specified Low-Income Medicare Beneficiary (SLMB) Program

Eligible individuals get their Part B premiums paid for.

Qualifying Individual (QI) Program

The QI program has the same benefits as the SLMB program, but has a higher limit. Eligible individuals get their Part B premiums paid for.

Qualified Disabled Working Individual Program (QDWI)

Eligible individuals get their Part A premiums paid for.

You can apply for these programs at www.gateway.ga.gov, and if you need help, reach out to us for assistance.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

Georgia Medicare Eligibility and Enrollment Steps

Georgia has the same Medicare eligibility requirements as every other state in the US. If you meet one of the following conditions, you are eligible to enroll in Medicare:

• You’re 65 or older

• You have certain disabilities, like End-Stage Renal Disease or ALS

Three key steps for Georgia Medicare enrollment:

1. Enroll in Original Medicare (Part A & Part B)

2. Choose your supplemental coverage

3. Medicare Supplement (Medigap)

4. Medicare Advantage (Part C)

5. Part D (drug coverage)

6. Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.

Medicare can feel complex, but it doesn’t have to! We specialize in helping those eligible for Medicare understand their options, enroll in the best coverage for their specific needs, and get the best value from Medicare. Schedule a free consultation or call us today (888) 604-0055 to ask questions and get the support you need to enroll in Medicare.