Medicare Advantage in Georgia

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Georgia Medicare Advantage enrollment by the numbers

There were more than 554,000 people in the state of Georgia with a Medicare Advantage plan in 2017, which is the ninth-highest Medicare Advantage enrollment of any state.¹

There are several major types of Medicare Advantage plans. In the state of Georgia, there are 48 different plans available as of 2018.² Not every plan is available in each county, so it's important to find out which ones are offered where you live.

Local PPO plans led the way in Georgia in 2017, with 45 percent of the state’s beneficiaries enrolled in this type of plan. HMO plans (30 percent) and regional PPO plans (24 percent) are also well-represented in Georgia. The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans that are less popular in most states. There were no Georgia residents enrolled in such plans in 2017.

Total number of Medicare Advantage enrollees in Georgia: 554,075 as of 2017¹

Georgia's Medicare Advantage enrollees by plan type:

Plan type Percentage of Georgia enrollees (2017)
HMO 30%
Local PPO 45%
Regional PPO 24%
PPFS 1%
Cost Plans 0%
Other Plans 0%

Data reflects Medicare Advantage enrollment in the state of Georgia as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

GeorgiaCares

GeorgiaCares is a program made up of volunteers who provide free assistance and information to Georgia’s Medicare beneficiaries and their caregivers. The program is part of the national State Health Insurance Assistance Program (SHIP) and can be reached at 1-800-552-4464 (Option 4).    

You can also explore more information about the insurance industry in Georgia by visiting the state’s Department of Insurance website.

 

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

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Last Updated: 4/24/2018