Georgia Health Advantage Choice (I-SNP) Plan Details for Worth County, GA
This Georgia Health Advantage plan (H8093-002-0) is rated 4.0 (Good) stars by CMS.
Georgia Health Advantage Choice (I-SNP HMO) is a Medicare Special Needs Plan (SNP). Enrollment for 2025 starts Oct 15. Get notified.
Delivery of healthcare services and costs by Georgia Health Advantage differs from Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all qualification requirements can join this Georgia Health Advantage I-SNP plan.
2025 Georgia Health Advantage Choice Cost and Coverage Notification
The 2025 cost and coverage information for Georgia Health Advantage Choice will not be available until early October. We'll notify you when it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 enrollment period begins October 15.
Plan Basics | |
---|---|
Plan ID: | H8093-002-0 |
Plan Type: | HMO |
Plan Year: | 2024 |
Premium: | $44.20/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Worth County, GA |
Insured By: | Georgia Health Advantage |
Summary of Benefits |
---|
Health Plan Cost Sharing & Benefits
Georgia Health Advantage Choice is a Health Maintenance Organization (HMO) plan. HMO I-SNP plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Georgia Health Advantage Choice does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Georgia Health Advantage plan:
Healthcare Service | Member Cost |
---|---|
Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | 20% Coinsurance |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 20% Coinsurance |
Routine foot care: | $0 Copay |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | 20% Coinsurance |
Routine chiropractic care: | $0 |
Emergency Care / Urgent Care | |
Emergency room care: | 20% Coinsurance |
Urgent care: | 20% Coinsurance |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $0.00 per day for days 21 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | 20% Coinsurance |
Outpatient individual therapy visit: | 20% Coinsurance |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | 20% Coinsurance Prior Authorization Required |
Occupational therapy visit: | 20% Coinsurance Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Prior Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required |
Lab services: | $0 Copay Prior Authorization Required |
Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Georgia Health Advantage Choice Summary of Benefits information.
Supplemental Health Plan Benefits (H8093-002-0)
The following is a summary of the supplemental benefits Georgia Health Advantage includes with this plan:
Supplemental Healthcare Service | Member Cost |
---|---|
Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | $0 Copay Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $225.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Georgia Health Advantage Choice includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the details of this plan's prescription drug plan premium.
Basic Part D Premium: | $44.20 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $44.20 |
Part D Premium with Full LIS Assistance: | $0.00 |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay at the pharmacy before Georgia Health Advantage begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Georgia Health Advantage Choice has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
---|---|---|
$0 copay on all covered generic and brand-name prescriptions. |
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage I-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Georgia Health Advantage plan.
CMS Measure | Star Rating |
---|---|
2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | Not enough data available |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | Not enough data available |
Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Georgia Health Advantage Choice
To be eligible to enroll in Georgia Health Advantage Choice, you must meet three requirements:
- You are eligible for Medicare;
- You live in Worth County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining Georgia Health Advantage Choice, consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- None.
Contact Georgia Health Advantage
Plan Website: | http://GeorgiaHealthAdvantage.com |
---|---|
Formulay Information: | http://GeorgiaHealthAdvantage.com |
Pharmacy Information: | Georgia Health Advantage Pharmacy Page |
Prospective Members: | (844)917-0645 |
TTY Users: | (833)312-0046 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold Medicare Supplement Insurance at the same time.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Georgia Health Advantage, http://GeorgiaHealthAdvantage.com, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Georgia", Last Accessed January 4, 2024
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.