More than 250,000 residents of Georgia have Medicare Advantage plans.
Medicare Parts A and B are what is often called traditional Medicare. Part A handles home health, hospital and hospice benefits, but is not meant for preventive services. Part B offers additional services like doctor's visits, but requires a monthly premium payment. Medicare Part C is more often referred to as Medicare Advantage. Medicare Advantage plans are offered by private insurance companies working with Medicare. They combine Parts A and B with even more medical services. Medicare Advantage plans differ by state, so Part C plans in Georgia will differ from those in other areas.
Health Maintenance Organization Plans
Many Medicare Advantage plans in Georgia are HMOs. These policies generally have less expensive premiums, but require customers to choose a primary care physician, who will then make all referrals to specialists and medical services. Customers must also get all their medical care from providers who are part of the network, under contract with that particular insurance company. Most Georgia HMO plans are offered by county, since HMOs are required to keep their network providers within a certain distance. In 2010, Medicare Advantage HMO plans offered in Georgia include the Aetna Medicare Value Plan and Medicare Premier Plan, the Southeast Community Care Plus, the Blue Value Basic from BlueCross and the Advantra Elite.
Preferred Provider Organization Plans
PPO health insurance gives more choice to the customer, but also costs more per month. PPO plans also have a network, but customers can choose to go outside the network if they want, though this will result in paying higher co-pays and out-of-pocket costs. You may also go to specialists who are part of the network without a referral. PPO Medicare Advantage plans are offered all over Georgia, including a statewide PPO from Humana, the HumanaChoice. Georgia offers a state contribution toward the cost of monthly premiums for Medicare, but in order to receive this, residents must be enrolled in a Medicare Advantage PPO through either United Healthcare or Humana.
Private Fee-For-Service Plans
Private fee-for-service plans are not as well known as HMOs and PPOs, but there are many Medicare Advantage plans in Georgia which use this model. PFFS coverage allows you to choose any health care provider which agrees to the payment terms offered by the plan and accepts Medicare. PFFS has no network and no need for referrals. Having a PFFS policy may mean higher out-of-pocket costs, however. Private fee-for-service plans can be found statewide, including BlueCross BlueShield's Anthem PFFS, the Presidential Plus, the Any, Any, Any Gold plan and the CIGNA Medicare Access Plus RX Plan Four.
Special Needs Plans
Georgia residents in institutions or with certain health conditions may also qualify for Medicare Advantage special needs plans. Special needs health insurance can offer customized insurance for people with disabling or chronic conditions. SNPs are also available for people who are dually eligible for Medicare and Medicaid, as well as those already in health care institutions. In 2010, Georgia has five special needs plans for people with chronic illnesses or disabilities, seven for people with dual eligibility, and one institutional SNP (see references 5).
