At a glance: Medicare health insurance in Georgia
- Nearly 1.7 million Georgia residents are enrolled in Medicare.
- About 38 percent of Georgia Medicare beneficiaries are enrolled in Medicare Advantage plans
- All counties in Georgia have Med
icare Advantage plans available.
- Georgia prohibits Medigap insurers from increasing premiums as an enrollee gets older.
- Georgia requires Medigap insurers to offer plans to disabled Medicare beneficiaries under age 65, but the premiums are significantly higher.
- There are 26 stand-alone Part D prescription plans available in Georgia in 2019.
- Per-enrollee Original Medicare spending in Georgia is a little higher than the national average.
Medicare enrollment in Georgia
As of December 2018, 1,689,801 Georgia residents had Medicare coverage. That’s a little less than 16 percent of the state’s population, versus a little more than 18 percent of the total US population enrolled in Medicare.
For most Americans, Medicare eligibility begins when they turn 65. But nearly 10 million people under the age of 65 also have Medicare coverage. This is because Medicare eligibility is also triggered once a person has been receiving disability benefits for 24 months, or has kidney failure or ALS. Nationwide, 16 percent of Medicare beneficiaries are under age 65; in Georgia, it’s 18 percent.
Disabled beneficiaries make up the largest share of Medicare enrollees in Alabama, Kentucky, and Mississippi, where 23 percent of Medicare beneficiaries are disabled and under age 65. But just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.
Medicare Advantage in Georgia
Medicare beneficiaries can choose to get their coverage through private Medicare Advantage plans, or directly from the federal government via Original Medicare. There are pros and cons to either option, and the right solution is different for each person.
Medicare Advantage plans are offered by private insurers, so plan availability varies from one area to another: In Whitfield County, Georgia, there are just six Medicare Advantage plans available in 2019, whereas residents in Fulton County can select from among 48 plans.
As of 2017, 34 percent of Medicare beneficiaries in Georgia were enrolled in Medicare Advantage plans (very similar to the nationwide 33 percent average). But Medicare Advantage enrollment had increased to nearly 38 percent of the state’s Medicare population by the end of 2018, when 641,317 Georgia Medicare beneficiaries had private Medicare coverage (not counting people with private supplemental coverage like Part D and Medigap). Just over a million Georgia Medicare beneficiaries had coverage under Original Medicare instead at that point.
The popularity of Medicare Advantage varies from one state to another. In Minnesota, 56 percent of the state’s Medicare population is enrolled in Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (and those are via employer-sponsored coverage, as there are no Medicare Advantage plans available for individuals to purchase in Alaska).
Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). Starting in 2019, people who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.
Medigap in Georgia
Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had Original Medicare on its own.
According to an AHIP analysis, 346,192 Georgia Medicare beneficiaries — about 34 percent of the state’s Original Medicare beneficiaries — had Medigap coverage as of 2016 (Medigap coverage cannot be used with Medicare Advantage plans).
Medigap plans are sold by private insurers, but they’re standardized under federal rules and regulated by state laws and insurance commissioners. Details about the insurers that offer Medigap plans in Georgia are available here.
All of the available plans are priced on an issue-age basis; Georgia is one of four states that prohibits insurers from using attained-age rating, and requires either issue-age rating or community rating. Issue-age rating means that premiums are based on the age the person was when they enrolled in the plan, so a person who enrolls at age 65 will always pay a lower premium than a person who enrolls at age 80 (rates can still increase overall, but not based on a particular enrollee’s increasing age). Attained-age rating is the approach that most insurers use nationwide (except where prohibited), and it allows the insurer to increase premiums based on the enrollee’s current age, so rates go up as a person ages. Community rating means that premiums don’t vary with age, but there are only eight states that require this approach, and insurers rarely use it if not required to do so.
Federal rules require Medigap insurers to offer plans on a guaranteed-issue basis during an enrollee’s open enrollment period, which begins when the person is at least 65 years old and enrolled in Medicare Part B (and Part A; you have to be enrolled in both to obtain Medigap, but some people delay enrollment in Part B if they continue to receive employer-sponsored coverage to supplement Medicare Part A). But despite the fact that nearly 10 million Medicare beneficiaries are not yet 65 (and are enrolled in Medicare due to a disability) there is no federal requirement that Medigap insurers offer plans to people who are under age 65.
But the majority of the states have addressed this with legislation that ensures at least some access to Medigap plans for people under age 65, and Georgia is among them. In Georgia, Medigap insurers must offer their plans on a guaranteed-issue basis to anyone who enrolls in Medicare Part B, regardless of age (see O.C.G.A. § 33-43-3). This rule took effect in 2011, and Georgia granted a one-time six-month open enrollment period to people who already had Part B; since then, people who enroll in Medicare in Georgia all have the same six-month open enrollment period for Medigap, regardless of their age.
Georgia’s statute clarifies that people under age 65 can be charged higher premiums, but that the premium variation “shall not be excessive, inadequate, or unfairly discriminatory and shall be based on sound actuarial principles and reasonable in relation to the benefits provided.” Even with that parameter, Medigap rates are substantially higher for Georgia residents under the age of 65. Rate filings are available in SERFF, and most Georgia Medigap insurers are charging under-65 enrollees between three and ten times as much as they charge enrollees who are 65.
But disabled Medicare beneficiaries have costs that are much higher than the average costs for Medicare beneficiaries who are eligible due to age. Blue Cross Blue Shield of Georgia filed an average 2019 Medigap rate of about $608/month for disabled (under-65) Medicare beneficiaries, and an average rate of about $198/month for non-disabled enrollees (65+). But even with premiums that are more than three times as high, BCBSGA notes in their filing that their loss ratio for the under-65 population was projected to be 136.8 percent (versus 71.2 percent for the pool of non-disabled beneficiaries). Loss ratio reflects the percentage of premiums that the insurer is spending on medical claims; for disabled beneficiaries in Georgia, BCBSGA projected that they would spend 137 percent of their premium revenue on claims costs.
Disabled Medicare beneficiaries have access to another Medigap open enrollment period when they turn 65. At that point, they can obtain a plan with the standard age-65 rates.
Disabled Medicare beneficiaries have the option to enroll in a Medicare Advantage plan instead of Original Medicare, as long as they don’t have kidney failure. Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the premiums are not higher for those under 65. But Advantage plans have more limited provider networks than Original Medicare, and total out-of-pocket costs can be as high as $6,700 per year for in-network care, plus the out-of-pocket cost of prescription drugs.
Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months if you didn’t have at least six months of continuous coverage prior to your enrollment (although many of them choose not to do so). And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the Medigap insurer can consider your medical history in determining whether to accept your application, and at what premium.
Medicare Part D in Georgia
Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries nationwide have supplemental coverage either through an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.
But Medicare Part D, created under the Medicare Modernization Act of 2003, provides drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs. Part D can be purchased as a stand-alone plan or obtained as part of a Medicare Advantage plan with built-in Part D benefits. Both options are available for purchase (or plan changes) during the annual election period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.
There are 26 stand-alone Part D plans for sale in Georgia in 2019, with premiums that range from about $15 to $109/month.
626,073 Georgia residents had stand-alone Part D plans as of December 2018, and another 609,807 had Medicare Advantage plans that included integrated Part D coverage. That’s more than 1.2 million people out of the state’s nearly 1.7 million Medicare beneficiaries; most of the rest have prescription coverage through an employer-sponsored plan or Medicaid.
Medicare spending in Georgia
Original Medicare’s average per-beneficiary spending in Georgia was a little higher than the national average in 2016, at $9,639(nationwide, the average was $9,533). The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage.
You can read more about Medicare in Georgia in our state Medicare guide. You can also contact GeorgiaCares, the State Health Insurance Assistance Program, with questions related to Medicare coverage in Georgia.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.