Introduction to Medicare Part C in Georgia (Medicare Advantage)

Have you heard of a Medicare “replacement” policy? It’s another name for a Medicare Part C, a.k.a. Medicare Advantage policy. This is a special type of private health insurance which is regulated by the federal government and helps you get your Medicare benefits, in addition to protecting you from potentially expensive gaps in Traditional Medicare coverage. The reason it’s sometimes called a replacement policy is because it will, in fact, replace your federal Medicare coverage with that of a private health insurance policy. But don’t worry – there are still laws in place which ensure that you will get the coverage you would expect from Traditional Medicare.

Federal Regulations for Medicare Advantage

Based on the laws mentioned above, your Medicare Advantage policy will offer at least the same type of medical coverage and benefits which Traditional Medicare does, and nothing less. Most Advantage policies will, in fact, offer much more than Medicare Parts A and B. For the most part, this additional coverage helps protect you from coverage gaps which exist in Traditional Medicare. The extra incentives also serve to attract business for the insurance company. Incentives like prescription drugs are specifically common with MAPD plans.

Medicare Advantage Enrollment In Georgia

There are a significant number of seniors in Georgia who prefer the convenience of a Medicare Advantage plan. 28% of Medicare-qualified seniors within the state are currently getting their benefits through one of these private plans. Within the Medicare Advantage family of policies, there are several different types of plans to choose from. You can see how these break down, and which ones are the most popular, in the diagram below.

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

There are many different ways in which your monthly premium for a Medicare Advantage policy might be calculated. Things like smoking habits, overall health, age, and location are significant factors which will change your rate from one senior to another. Below, you can find some estimated quotes for senior citizens living near you.

Most Popular Medicare Advantage Plans in Georgia

Your Medicare Advantage plan, should you choose to sign up for one, will be tailored to your individual needs. Plans vary by location, by type, and by insurance company, and the benefits your policy offers will be crafted to you, specifically. One major difference between Advantage plans and other Medicare supplement policies is that Advantage plans come with a provider network. You might be willing to pay more per month for a PPO plan, which has a large and varied network of doctors and hospitals. You can also choose an HMO plan, which has fewer authorized doctors and facilities, but costs less. It’s essentially a trade-off.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

As mentioned above, the type of provider network associated with your plan will determine what doctors you can see, and where you can get care. PPOs and PFFS plans are more expensive because they give you more variety. HMO plans, on the other hand, offer lower prices because they tightly restrict which doctors and facilities you can visit. Keep in mind that if you travel regularly, or if you have a specific doctor that you prefer to see, subscribing to a less costly plan may inhibit your ability to receive your preferred level of medical care once your plan is active.

Doctor/Providers List

Drug, Vision and Dental Coverage

There are other types of coverage which may be added to your Medicare Advantage policy which are not offered by other Medicare supplements. Prescription drugs (Medicare Part D) is one benefit, along with dental and/or vision. Adding additional benefits will make your plan more expensive, but you’ll be getting your money’s worth in exchange for the convenience of having all of your benefits under one streamlined plan.

Enrollment Options & Best Time To Enroll

Unlike other types of Medicare supplements, such as a Medigap policy, your Medicare Advantage provider has more freedom to evaluate your current health status before approving you for coverage. If you are newly enrolled in Medicare and relatively healthy, it shouldn’t pose too much of a problem; however, major conditions such as End State Renal Disease (ESRD) will make it more difficult to get covered. Check with your local insurance agent, as well as your state department of insurance for special laws and regulations which can help you get covered, should you be denied.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

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