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Medicare Advantage Plans in Georgia

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Medicare Advantage Plans in Georgia

Medicare consists of Parts A, B, C, and D. Parts A and B combined are referred to as Original Medicare, which includes hospitalization and general healthcare coverage. Part C refers to Medicare Advantage plans, which replace Parts A and B with bundled coverage that often has extra benefits, such as vision, dental, and possibly prescription drug coverage. Part D is the stand-alone prescription coverage offered by Medicare. Georgia seniors who opt for a Medicare Advantage plan get similar levels of care to what's provided through Original Medicare, but the plans are administered through a third-party insurance company. While Medicare premiums are set by the federal government, out-of-pocket costs vary for each Medicare Advantage Plan.

Throughout Georgia, there are 63 Medicare Advantage plans available, but they’re offered at the local level, so not all counties have the same plans available.

Medicare Advantage Plans in Georgia

Types of Medicare Advantage Plans

In Georgia, there are four types of Medicare Advantage plans, with HMOs and PPOs being the most commonly available. PFFS plans are offered in a few Georgia counties, so this option may not be available in your area. SNPs serve Georgia residents throughout the state, but enrollment is limited by strict eligibility criteria.

Health Maintenance Organizations (HMO)

HMOs are some of the most common Medicare Advantage plans, in part due to their affordability. These plans work by providing a network of healthcare professionals who handle all aspects of your care. You’re required to use in-network care providers or pay the cost out-of-pocket with a few exceptions, such as emergency and urgent care situations. You must select a primary care doctor when enrolled in an HMO and obtain all specialist referrals through that doctor. HMOs tend to be the most restrictive type of Medicare Advantage plan, but they usually cost less.

Preferred Provider Organizations (PPO)

PPO plans work with a network of healthcare professionals to offer comprehensive care. They operate similarly to HMOs, but with more flexibility. In a PPO, you can select in- or out-of-network doctors and hospitals, and the insurance will cover either. (Note: Providers are not obligated to accept PPO plans. Check each provider before scheduling services.) However, costs are generally higher for out-of-network services. PPO networks are often larger than HMO networks, and there’s no need to select a primary care doctor or obtain referrals before making appointments with specialists.

Private Fee-For-Service Plans (PFFS)

PFFS plans operate differently than PPOs and HMOs. The insurance company sets a reimbursement rate for services and a share of the cost for members. When enrolled in this type of plan, you can go to any healthcare provider who accepts the payment terms for your plan. Some PFFS plans offer a provider network with service guarantees, and healthcare providers outside that network may not agree to the terms or be willing to treat you, except in an emergency situation. And be aware that a doctor or hospital may stop taking your insurance at any time, with little notice.

Special Needs Plans (SNP)

SNPs offer benefits and services tailored to enrollees with specific care needs, conditions or illnesses. SNPs may accept individuals living in a nursing home or who require a nursing home level of care, eligible for both Medicare and Medicaid, or diagnosed with a disabling disease or illness. As a member, you need to seek care from in-network providers, except in emergencies. Because they provide targeted services and coverage, SNPs often have higher premiums and out-of-pocket costs than other types of Medicare Advantage plans.

Eligibility for Medicare Advantage Plans in Georgia


The year you turn 65 years old, you become eligible to enroll in Medicare. While enrollment is not mandatory, waiting to enroll may come with financial penalties if you join after the initial enrollment period. If you’re already receiving Social Security benefits when you turn 65, enrollment in Medicare Parts A and B is automatic. If you’re eligible for Original Medicare, you also have the option to enroll in a Medicare Advantage plan. To do so, you must:

  • Live in an area where a plan is available
  • Not have Medigap insurance
  • Be a U.S. citizen or legal permanent resident

SNPs are the only plans that accept those with end-stage renal failure, and dialysis treatments are covered out-of-network when not available in-network.

Also, some individuals are eligible for Medicare under the age of 65 if they’ve been receiving disability benefits for at least 24 months.

Prescription Drug Coverage

Prescription drug coverage is handled separately through Original Medicare. Original Medicare offers no drug coverage, but seniors with Parts A and B may also enroll in a stand-alone Part D plan. Many Medicare Advantage plans include drug coverage, though some plans may charge a separate premium for prescription benefits. When enrolling in a Medicare Advantage plan, remember that you may not be eligible for Part D with your plan. If you don’t have prescription coverage and need it, you will need to select an alternative Advantage plan that offers it or revert to Original Medicare. All SNPs include prescription coverage.


GeorgiaCares is the State Health Insurance Assistance Program (SHIP), and it is administered by the Georgia Department of Human Services Division of Aging Services. It offers free, factual information about Original Medicare, Medigap, Medicare Advantage, and prescription drug coverage options. The goal of the services offered through this program is to help seniors and their caregivers make informed decisions about insurance and to better understand Medicare benefits. After you select a plan, counselors can help with enrollment and understanding your benefits in action.