Medicare Advantage (Medicare Part C) plans are required to offer the same coverage as Original Medicare (Part A and Part B). However, this is just the minimum coverage required. Many Medicare Advantage plans in Georgia offer additional benefits. These plans are offered by private insurance companies that have been approved by Medicare. Private companies set the cost and the benefits for the plans.
Medicare Advantage plans in Georgia usually provide additional benefits when compared to Original Medicare. Many of these plans offer vision and dental coverage, along with wellness programs and prescription drug coverage. These plans typically allow people to keep premiums and copays low while getting coverage.
However, it’s important to understand that along with the Medicare Advantage premium (if the plan has one), the Medicare Part B premium must also be met with these plans. Some plans pay part or all of the Medicare Part B premium, further reducing the out-of-pocket expenses people have to pay. An insurance agent can help you find plans that pay some or all of the premium.
When you shop for Medicare Advantage plans in Georgia, you’ll notice that these plans look very similar to other types of private insurance plans. Instead of choosing from a single type of policy, you can select from HMOs, PPOs, and other types of plans. Availability can vary from one location to the next, but these are the most common Medicare Advantage plans in the state.
HMO plans are extremely popular in this state. If you get an HMO, you will have access to a network of doctors, healthcare providers, and hospitals. You’ll need to stay within that network to get coverage, with the exception of emergency care. Also, many HMO plans require that the insured gets a referral from a primary care provider before seeing a specialist.
PPO plans provide additional flexibility for the insured. Instead of having to choose from a network of providers, you can select providers inside and outside of the network. This gives you access to more providers, but you will save money by staying within the network. You normally do not need to get a referral to see a specialist if you have a PPO Medicare Advantage plan.
If you want a plan that is as close to Original Medicare as possible, consider a PFFS plan. Just as with Original Medicare, the insurance company has a set of terms. The terms indicate how much the company will cover and how much you will pay. If a provider accepts the terms, you can use your insurance.
Special Needs Plans are available for people with Medicare and Medicaid, have specific chronic health conditions, or live in a nursing home. These plans address the health needs of people with special needs.
People often get confused when trying to buy a Medicare Advantage plan that offers prescription drug coverage. Medicare Advantage plans do not automatically come with drug coverage unless you opt for it. Plans with prescription drug coverage are called Medicare Advantage Drug Plans. These plans include a formulary that lists all the drugs it covers. It’s wise to consult at the formulary before committing to a plan. Formularies differ from one plan to the next, so do your research and choose the right policy.
Several factors go into selecting one of the Medicare Advantage plans. First, of course, is the cost of the plan. Original Medicare bases premiums on income, meaning the more you make, the more you will pay. Medicare Advantage does not have set rates for premiums. Instead, private insurance companies set the premiums.
Out-of-pocket expenses are also important to consider. Many of these plans cover more than Original Medicare, but that’s not always the case. For example, some of the zero-premium Medicare Advantage plans have prohibitively high out-of-pocket expenses.
Finally, consider the benefits. You can get a wealth of benefits with these plans, but benefits aren’t set from one plan to the next. Compare plans to find the best one for you.
This can be difficult to do on your own. Instead of trying to pick a plan by yourself, speak to a licensed insurance agent by calling 844-903-4406. Your agent can go over the different Medicare Advantage plans in Georgia and help you make a selection.