- Nearly 1.8 million residents are enrolled in Medicare in Georgia.
- About 43 percent of Georgia Medicare beneficiaries are enrolled in Medicare Advantage plans
- All counties in Georgia have Medicare Advantage plans available, but plan options vary considerably from one county to another.
- Most Medigap plans in Georgia use issue-age rating, which means premiums do not increase based on an enrollee’s increasing age.
- Georgia requires Medigap insurers to offer plans to disabled Medicare beneficiaries under age 65, but the premiums are significantly higher.
- There are 28 stand-alone Part D prescription plans available in Georgia in 2020.
- Per-enrollee spending for Medicare in Georgia is a little higher than the national average.
Medicare enrollment in Georgia
As of July 2020, there were 1,765,292 people enrolled in Medicare in Georgia. That’s a little less than 16 percent of the state’s population, versus almost 19 percent of the total US population enrolled in Medicare.
For most Americans, enrolling in Medicare benefits goes along with being a senior. But nearly 10 million Americans 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, 15 percent of Medicare beneficiaries are under age 65; for beneficiaries of Medicare in Georgia, it’s 17 percent.
Disabled beneficiaries make up the largest share of Medicare enrollees in Alabama, Arkansas, Kentucky, and Mississippi, where 22 percent of Medicare beneficiaries are under age 65. In contrast, just 9 percent of Hawaii’s Medicare beneficiaries are eligible due to disability.
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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. Original Medicare includes Part A (which helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center) and Part B (which helps pay for outpatient care like a doctor appointment or a preventive healthcare service, such as a vaccination). Medicare Advantage plans bundle Parts A and B under a single premium and often include other services like prescription drug and vision coverage. There are pros and cons to either option, and the “right” solution is different for each individual.
Medicare Advantage plans are offered by private insurers, and their availability and service offerings and vary from one area to another. For example, in Whitfield County, Georgia, there are just eight Medicare Advantage plans available in 2020, whereas residents in DeKalb County can select from among 61 plans.
As of 2018, 35 percent of beneficiaries with Medicare in Georgia were enrolled in Medicare Advantage plans (very similar to the nationwide average of 34 percent). Medicare Advantage enrollment had increased to 43 percent of the state’s Medicare population by the middle of 2020, when 762,697 Georgia Medicare beneficiaries had Medicare Advantage coverage (not counting people with private coverage like Part D and Medigap, used to supplement Original Medicare). Just over a million Georgia Medicare beneficiaries had coverage under Original Medicare instead at that point. Overall Medicare enrollment has been steadily increasing in Georgia (as has been the case nationwide), with the percentage of beneficiaries enrolled in Original Medicare declining and Medicare Advantage enrollment increasing.
Annual open enrollment for the various Medicare programs (which runs from 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 drug plan). People who are already enrolled in Medicare Advantage plans also have the option to switch to a different Medicare 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 (like monthly premiums and coinsurance or copayments), so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through Medicaid or employer-sponsored programs. 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, 369,924 Georgia Medicare beneficiaries — about 35 percent of the state’s Original Medicare beneficiaries — had Medigap coverage as of 2018 (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 through the Plan Finder tool on Medicare.gov website.
There are three ways Medigap insurers can set their premiums: 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 (in Georgia, USAA Life and Companion Life use community rating for their Medigap plans as of 2020). In Georgia, issue-age rating is by far the most common approach, although some insurers use attained-age rating. This is the opposite of what we see in most states, where attained-age rating is generally the most common approach unless the state dictates otherwise.
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. Most Georgia Medigap insurers are charging under-65 enrollees between three and ten times as much as they charge enrollees who are 65. For example, Medigap Plan A premiums for a 65-year-old non-smoking male in Atlanta range from $109-$248/month. But if that person is under 65, the premiums for the same plans range from $239-$2,468/month.
This is because disabled Medicare beneficiaries have costs that are much higher than the average costs for Medicare beneficiaries who are eligible due to age. For example, Blue Cross Blue Shield of Georgia (BCBSGA) 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 noted 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 (note that as of 2021, kidney failure will no longer prevent people from enrolling in Medicare Advantage plans, thanks to the 21st Century Cures Act). Medicare Advantage plans are otherwise available to anyone who is eligible for Medicare, and the premiums are not higher for those under 65. But Medicare 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 (increasing to $7,550 in 2021), 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 an individual 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.
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 drugs expenses. Medicare Part D coverage can be purchased as a stand-alone plan (called a prescription drug plan, or PDP) or obtained as part of a Medicare Advantage plan. (Medicare Advantage plans with built-in prescription drug coverage are called Medicare Advantage-Prescription Drug [MAPD] plans).
You can sign up for a PDP or MAPD (or change to a different one) during the annual enrollment period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.
There are 28 stand-alone Medicare Part D plans for sale in Georgia in 2020, with premiums that range from about $13 to $84/month.
Overall Medicare Part D enrollment — including stand-alone plans and Medicare Advantage plans with integrated Part D coverage — has been steadily increasing in Georgia (and in the US) as overall Medicare coverage enrollment has grown. But enrollment in stand-alone Medicare Part D plans has been decreasing in Georgia, because Medicare Advantage enrollment growth has outpaced Original Medicare enrollment growth. As of mid-2020, there were 597,106 Georgia residents with stand-alone Medicare Part D plans. That was down from more than 626,000 in late 2018. But during the same period, enrollment in Medicare Advantage plans with integrated Part D coverage had grown from about 610,000 people to more than 726,000 people.
Medicare spending in Georgia
Average per-beneficiary spending for Medicare in Georgia was a little higher than the national average in 2018, at $10,328 (nationwide, the average was $10,096). 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.
How does Medicaid provide financial assistance to Medicare beneficiaries in Georgia?
Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Georgia includes overviews of these programs, including Extra Help, long-term care coverage, and eligibility guidelines for assistance.
Additional information and resources
Need help with your Medicare coverage enrollment, or understanding your Medicare eligibility in Georgia? You can contact GeorgiaCares, the State Health Insurance Assistance Program, with questions related to Medicare enrollment in Georgia.
Regardless of whether you’re about to submit your Medicare application in Georgia or have been a Medicare beneficiary for many years, you’re likely to have questions from time to time. The Medicare Rights Center website is a nationwide resource for information, with helpful content geared to Medicare beneficiaries, caregivers, and professionals.
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.