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Medicare Advantage (also known as Medicare Part C) plans cover all the same services that Original Medicare (Part A and Part B) plans do, but they also often include prescription drug coverage and other extra benefits. For this reason, Medicare Advantage plans are a popular selection for Medicare coverage.
In Georgia, residents have many options when it comes to Medicare Advantage plans. With numerous insurance giants in the mix, cutting through the clutter and pinpointing the providers and plans that align best with individual needs is essential.
Georgia hosts a diverse selection of Medicare Advantage plans from well-known insurance companies. To assist you in this decision-making journey, we’ll focus on streamlining comparisons in key areas such as drug coverage, member experience, and the availability of cost-effective plans. We will also present key plan data for select providers, including monthly premium and out-of-pocket cost information.
Compare Medicare Advantage Providers in Georgia
Before viewing the important statistics of key Medicare Advantage plan providers in Georgia, let’s learn more about some key metrics to consider when selecting a Medicare plan:
CMS Star Rating: Published every year by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of health and drug services received by customers. The overall star rating, between 1 (low) and 5 (high) stars, considers up to 40 quality and performance measures and is a strong point of comparison for plan selection.
Monthly Premium: The amount you would pay to a provider for health insurance plan coverage each month.
In-Network Max Out-of-Pocket Amount: The maximum amount of money you would pay to a provider for in-network services you received during a coverage period (usually one year).
Note: All statistics in the charts below were calculated using plan data specific to Georgia.
National Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| UnitedHealthcare | 4.2★ | $0.00 | $6,300 |
| Humana | 4.3★ | $0.00 | $8,600 |
| Aetna | 3.6★ | $0.00 | $6,350 |
| Cigna Healthcare | 3.3★ | $0.00 | $6,750 |
| Blue Cross Blue Shield | 3.2★ | $0.00 | $6,700 |
| Kaiser Permanente | 3.5★ | $0.00 | $5,900 |
| Wellcare | 2.9★ | $0.00 | $6,350 |
Regional Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| Clover Health | 3.0★ | $0.00 | $7,499 |
| Clear Spring Health | Not Ranked | $0.00 | $5,075 |
Top-Rated Medicare Advantage Providers in Georgia
United Healthcare
UnitedHealthcare is a national provider of health insurance and related products. Additionally, they are the market share leader (28.5%) in the competitive Medicare Advantage segment, providing service to over 9 million enrollees across the country. Similarly, they are also the Medicare Advantage market share leader in Georgia (35%) as well.
Additionally, they are also the fastest growing MA plan provider, having grown 12.7% YoY in 2023 from 2022 (second fastest growing MA provider was Humana at 10.1%).
Humana
Humana is a massive health insurance company in the United States which offers a diverse range of healthcare insurance and related products, one of which is Medicare.
By market share, they are the second largest provider of Medicare Advantage plans in the United States (17%).
Aetna
Aetna is a national provider of health insurance and related products. They operate as a subsidiary of CVS Health Corporation.
As of March 2023, they were the third-largest provider of Medicare plans (10.6% market share) and the largest provider of Medicare prescription drug plans (27.2% market share).
Cigna Healthcare
Cigna Healthcare is a global health services organization that provides a wide range of health insurance products and related services. For 2024, Cigna will be offering Medicare Advantage plans to eligible members across 29 states. Additionally, they will also be offering three standalone PDPs to eligible members in all 50 states (plus Washington D.C. and Puerto Rico).
For 2024, Cigna will be providing a total of 27 Medicare Advantage plan options to the Medicare-eligible population in Georgia.
Blue Cross Blue Shield
Blue Cross Blue Shield, a Division of Health Care Service Corporation, provides health related services to over 3.5 million Georgians. They have over 150 hospitals as well as close to 26,000 primary care physicians and specialists in-network statewide.
Kaiser Permanente
Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving 12.6 million members across the country. They are headquartered in Oakland, CA and employ almost 24k physicians and 68k nurses.
Wellcare
Wellcare is a large Healthcare enterprise which provides health insurance and related products to Americans nationwide. Medicare Advantage is a key product offering of Wellcare’s – they have a market share of 4.3%.
Additionally, as of 2023, they are the second-largest provider of prescription drug plans (PDPs) (19.9% market share). As with the other large health insurance providers, they have a strong presence in Georgia with deep connections to hospitals, services, and physicians statewide.
Clover Health
Clover Health is a physician enablement company committed to bringing access to great healthcare to everyone on Medicare. Through their insurance line of business, they provide PPO and HMO Medicare Advantage plans across several states, one of which being Georgia.
In 2022, Clover nearly tripled its membership in Georgia by increasing the breadth of its provider network throughout the state with the addition of dozens of hospitals, health systems and provider partners across the region, aligning about 5,000 new primary care physicians and specialists with its MA network.
Clover MA plans are available to over 650,000 eligible persons in 151 of the 159 counties in Georgia.
Clear Spring Health
Founded in 2007, Clear Spring offers three comprehensive Medicare Advantage products in the states of Colorado, Georgia, Illinois, South Carolina and Virginia. The company is headquartered in Miramar, Florida.
How to Choose the Best Medicare Advantage Plan
Choosing the right Medicare Advantage plan, tailored to fit your unique needs, is a critical component in maintaining a healthy lifestyle. Let’s review the key steps to simplify the decision-making process of choosing a plan.
From understanding your healthcare needs to exploring plan specifics, our goal is to empower you with the knowledge necessary to navigate the array of options.
- Assess Your Healthcare Needs: Determine your specific medical needs, including prescription medications, anticipated doctor visits, and any specialized care requirements.
- Review Plan Options: Explore available Medicare Advantage plans in your area, considering coverage, costs, and additional benefits. Check for plans offered by reputable insurance companies.
- Check Network Providers: Confirm that your preferred doctors, hospitals, and healthcare providers are included in the plan’s network to ensure convenient and cost-effective access to care.
- Evaluate Drug Coverage: If you take prescription medications, assess each plan’s formulary to ensure your drugs are covered. Consider copayments, coinsurance, deductibles, and any restrictions.
- Consider Additional Benefits: Medicare Advantage plans often include extra benefits like dental, vision, or wellness programs. Evaluate these perks based on your individual needs.
- Examine Cost Structures: Compare premiums, deductibles, copayments, and coinsurance for each plan. Consider your budget and how these costs align with your expected healthcare usage.
- Check Star Ratings: Refer to Medicare’s Star Ratings for plans. Higher-star-rated plans typically offer better overall quality, customer satisfaction, and healthcare outcomes.
- Understand Plan Rules and Restrictions: Familiarize yourself with the plan’s rules, including any prior authorization requirements or referrals for specialists. Ensure you understand how the plan operates.
- Review Out-of-Pocket Maximums: Identify the plan’s annual out-of-pocket maximum, which limits your spending on covered services. This can provide financial predictability in case of unexpected healthcare expenses.
- Get Personalized Assistance: Reach out to CoverRight for personalized assistance. We can help clarify any doubts and guide you through the enrollment process.
Remember that individual preferences and healthcare needs vary, so the best Medicare Advantage plan for you depends on your own unique circumstances. If you have questions unique to your situation that you would like answered, we recommend scheduling a call to speak with a licensed insurance agent.
Additionally, if you are in the process of evaluating your drug coverage, we recommend looking into switching to the generic version of your drugs. If available, the generic version will be much cheaper than the brand-name version.
What Medicare Advantage Plans Cover
Medicare Advantage plans (a.k.a. Medicare Part C plans) are offered by Medicare-approved private insurance companies.
These plans provide all the coverage of Original Medicare (Part A and Part B) and often include additional benefits. Here’s an overview of what Medicare Advantage plans typically cover:
- Hospital Coverage (Part A): This includes inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Medical Coverage (Part B): This covers outpatient care, doctor visits, preventive services, and some home health care.
- Prescription Drug Coverage (Part D): Many Medicare Advantage plans include prescription drug coverage. If not, beneficiaries can usually purchase a standalone Medicare Part D prescription drug plan.
- Additional Benefits: Depending on the exact plan, Medicare Advantage plans can often offer extra benefits not covered by Original Medicare, such as dental care, vision care, hearing aids, fitness programs, and wellness services.
- Out-of-Pocket Maximums: These plans have yearly limits on out-of-pocket costs for medical services, providing financial protection for beneficiaries.
It’s important to note that coverage can vary between different Medicare Advantage plans, so individuals should carefully review plan documents, including the Summary of Benefits, and consider their specific healthcare needs when choosing a plan.
Additionally, beneficiaries must continue to pay their Medicare Part B premium in addition to any premium charged by the Medicare Advantage plan.
When to Enroll for Medicare Advantage Plans in Georgia
Enrollment for Medicare Advantage Plans in Georgia takes place during specific timeframes.
Initial Enrollment occurs when you’re first eligible for Medicare, usually around age 65. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, allowing you to switch, drop, or add Medicare Advantage plans.
The Medicare Advantage Open Enrollment Period from January 1 to March 31 permits plan changes or a return to Original Medicare.
Special Enrollment Periods may apply in certain circumstances, such as moving, losing employer coverage, or qualifying for Medicaid. It’s crucial to be aware of these periods to make informed decisions about your Medicare Advantage coverage in Georgia.
Medicare Advantage vs. Medigap
Choosing between Medicare Advantage (Part C) and Medigap (Medicare Supplement) involves being aware of key distinctions between the two categories of plans. Medicare Advantage combines Part A and B benefits, often incorporating extras like prescription drug coverage.
These bundled plans are typically more affordable and administratively convenient, despite potentially having some network restrictions.
Overall, Medicare Advantage plans are very popular in Georgia. As of May 2023, nearly 53% of Georgia residents with Medicare were enrolled in private Medicare Advantage plans. This figure is higher than the 2023 national average of 51%.
On the other hand, Medigap plans work in tandem with Original Medicare, covering out-of-pocket costs. While offering greater flexibility in healthcare provider choice, Medigap plans generally come with higher premiums.
Here’s a breakdown of the two types of plans:
| Medigap (Medicare Supplement) | Medicare Advantage (Part C) | |
| Coverage | – Comprehensive coverage of out-of-pocket costs. – Greater flexibility in choosing healthcare providers. | – Bundled coverage, often includes prescription drugs and extras. – Limited to network providers; may require referrals. |
| Costs | – Higher premiums but lower out-of-pocket costs. | – Lower premiums, but potential for higher out-of-pocket costs. |
| Prescription Drugs | – Doesn’t typically include prescription drug coverage. | – Often includes prescription drug coverage. |
| Network Restrictions | – No network restrictions; can see any doctor accepting Medicare. | – Limited to network providers; may require referrals. |
| Administration | – Simplifies administrative processes with a single plan. | – Requires managing multiple aspects (Part A, B, and sometimes D). |
| Flexibility | – Freedom to use healthcare services nationwide. | – May be limited to specific geographic regions or networks. |
| Additional Benefits | – Focuses solely on medical costs; no additional benefits. | – May include extra benefits like dental, vision, and wellness programs. |
| Decision Criteria | – Suited for those who prioritize flexibility and are willing to pay higher premiums. | – Attractive for those seeking bundled coverage with potentially lower costs. |
The decision here hinges on your own personal priorities: Medicare Advantage for cost-effective bundled benefits with some network constraints, or Medigap for more flexibility in provider selection, albeit at a potentially higher cost.
All Medicare Advantage Providers in Georgia for 2024
- Aetna Medicare
- Anthem Blue Cross and Blue Shield
- BlueCross BlueShield of Tennessee
- Cigna
- Clear Spring Health
- Clover Health
- Humana
- Kaiser Permanente
- Sonder Health Plan
- UnitedHealthcare
- Wellcare
