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Medicare Advantage (Part C) Plans in Georgia

Parts C plans basically follow the form of managed-care health plans—they regulate access to medical services in exchange for offering predictable costs. The following types of Medicare Advantage plans approved for sale in Georgia:

  • Health Maintenance Organization (HMOs). All of the HMO plans available in Connecticut have an in-network provider requirement. That means that you generally must receive all covered care from the doctors, hospitals, and other health care providers who are affiliated with the plan. Exceptions include emergency care and urgent care.
  • If you are out of state, you are out of network, except for urgent or emergency care.
  • Preferred Provider Organization (PPOs). A PPO is similar to an HMO. There is a preferred network of service providers and medical facilities. However, unlike an HMO, PPO's allow members to utilize out-of-network providers and facilities, usually at a higher cost than in-network.
  • Private Fee for Service Plans (PFFS plans). Unlike HMOs or PPOs, PFFS plans set their own fees for service. PFFS plans decide how much they will pay for any covered Medicare service. Beneficiaries in a PFFS may use any Medicare-approved physician who accepts the rates set by the plan. A physician may decide to stop accepting those rates at any time, so you must check whether this is so each time you visit a medical provider before you receive services to avoid having to pay the bill out of your own pocket. Physicians who accept the terms of a PFFS plan may not charge more than 115 percent of the contracted rate. Similar to HMOs and PPOs, PFFS plans may offer benefits in addition to Original Medicare coverage such as extra days in a hospital.
  • Medicare Savings Plans. These plans combine a tax-advantaged bank savings account with a high-deductible for or catastrophic health insurance policy. These Savings Plans generally make the most sense for high-net-worth individuals in good health. Before choosing this plan, contact a state certified tax or estate-planning advisor for more detailed advice.

Special Needs Plans (SNPs). Special Needs Plans are designed—primarily—to serve people in acute-care rest homes.

GeorgiaCares emphasizes the following points about Medicare Advantage plans:
  • You still have Medicare rights and protections.
  • You must follow plan rules to avoid higher costs.
  • You can join a Medicare Advantage Plan even with pre-existing conditions, except End Stage Renal Disease (ESRD).
  • If you see a doctor who does not belong to the plan's network, your service may not be covered or your costs could be higher.
  • If the plan decides to stop participating in Medicare, you can join another Medicare health plan or return to Original Medicare.
  • Many Medicare Advantage Plans offer prescription drug coverage (Part D).
  • You do not need to buy a Medigap (Medicare Supplement Insurance) policy. With a Medicare Advantage Plan, a Medigap policy will not cover your deductibles, copayments or coinsurance.
Also, according to GeorgiaCares, you can join, switch or drop a Medicare Advantage Plan at these times:
  • Initial Enrollment Period – When you first become eligible for Medicare. The 3 months before you turn age 65 to 3 months after the month you turn age 65.
  • Annual Enrollment Period – Between January 1 and March 31, each year. However, you cannot join or switch to a plan with prescription drug coverage during this time unless you already have Medicare prescription drug coverage (Part D). You can obtain prescription drug coverage and a Medicare Advantage Plan (offering prescription drug coverage) between October 15 and December 7 of each year.

Special Enrollment Period – 1) If you move out of your plan's service area; 2) if you have both Medicare and Medicaid; 3) if you qualify for low income subsidy ("extra help"); or 4) if you live in an institution (e.g., nursing home). Other situations may qualify you for a special enrollment period.