Medicare in Georgia
- Prepare to enroll in Medicare by learning about your options and when you can enroll in a new plan. This guide to Medicare in Georgia gives you a great starting point.
What Georgia Medicare Plans Are Available?
Medicare is a federal insurance plan for citizens age 65 and older as well as some younger individuals with qualifying disabilities. The program is broken up in different parts, each of which applies to a different type of coverage.
Part A is the original program of Medicare and is meant to provide coverage for inpatient services. It is funded by the federal government and premiums are determined based on participation in the payroll tax system. Part A coverage includes inpatient services in a hospital, skilled nursing or surgical center facility and home health.
Part B is the portion of Medicare that covers preventative services, including annual visits, some diagnostics and even some prescription medications. Premiums are designated based on income, which means it varies for beneficiaries. Parts A and B may be purchased as stand-alone policies for those that may not automatically be covered.
Medicare Advantage programs are supplemental policies that cover many of the elements of Parts A and B. Beneficiaries may choose this policy to replace A and B, though enrollment in both parts is necessary to qualify for an Advantage program. Advantage plans are administered through private insurance companies. Coverage may vary depending on the insurer, but generally is provided through one of four constructs:
- Private fee-for-service
- Special needs plan
- Health maintenance organization (HMO)
- Preferred provider organization (PPO)
The benefit of a Medicare Advantage plan is that this option includes provisions for dental and vision services, where Parts A and B do not.
Part D/Prescription Drug Plan
Part D of Medicare is the prescription drug plan, which is geared specifically towards medications. It is supplemental to the other components and may cover some things that the other parts do not. This is an optional feature and can be purchased as a stand-alone program.
Beneficiaries can sign up for coverage through Part D when enrolling in the other Medicare components. However, doing so outside of the enrollment periods may incur a penalty.
Medigap coverage does exactly as it suggests: it fills in the financial gaps for medical and healthcare services administered through Medicare. Medigap is also administered through private insurers and may be used for copays, coinsurance and deductibles.
As of 2020, there are almost two million Georgians enrolled in Medicare. Of this number, almost half have an Advantage plan. Every Georgia county has at least one Advantage plan option. Georgia's Medigap insurers maintain steady premiums that do not increase with the age of the beneficiary.
However, Medigap premiums for disabled residents under the age of 65 are higher than those for traditional enrollees.
Who Is Eligible for Georgia Medicare?
Georgia citizens are available for automatic enrollment in Medicare if they are already receiving Social Security benefits. They receive a mailed package four months prior to their 65th birthday apprising them of benefits information.
Those who are not automatically enrolled can do so in the period three months prior to turning 65, their birth month and in the three months after that date.
Medicare also offers special enrollment periods. The first is from January 1 through March 31, with benefits beginning as of July 1. The second is a special fall enrollment that starts October 15 and extends through December 7, with benefits kicking in January 1.
The fall enrollment period is also the point at which enrollees can change Advantage and Part D plans.
Those who qualify for Medicare and have either lost employer-sponsored coverage, recently moved back into the country or became ineligible for Medicaid can enroll at any time without incurring a penalty. All others may have to pay a fee for enrolling outside of the predetermined enrollment periods.
How Do I Enroll in Medicare in Georgia?
There are three ways to enroll in Medicare in Georgia:
- Apply online via the Social Security Administration
- Call the Social Security Administration at (800) 772-1213 to speak with a live agent.
- Make an appointment at the local Social Security Administration office to get in-person assistance.
Contact Information for Georgia Medicare, Medicaid and Insurance Help
For help signing up for Medicare or choosing a plan, as well as getting assistance with other insurance options including Medicaid, there are various resources available.
HelpAdvisor: The HelpAdvisor website offers information on enrolling in Medicare as well as eligibility criteria, resources for assistance and more.
Georgia State Health Insurance Program (SHIP): The Georgia SHIP program provides assistance with choosing the best Medicare plan as well as help with enrollment and any other questions.
GeorgiaCares: This public-private partnership provides assistance with Medicare enrollment as well as differentiating between the various plans. Those in need of assistance can visit the GeorgiaCares website or call (866) 552-4464.