About the Health Plan

Georgia Health Advantage is a Health Maintenance Organization (HMO) contracted with Medicare. Georgia Health Advantage offers an Institutional Special Needs Plan specially designed for eligible Medicare beneficiaries living in one of our participating long-term care nursing homes. As a Member of Georgia Health Advantage, you receive not only the standard benefits offered by original Medicare, but the added attention and care that are so important to your health and well-being.

Georgia Health Advantage focuses on Members who meet institutional level of care criteria and live in a Georgia Health Advantage participating nursing homes located in the following Georgia counties:

Georgia Health Advantage covers all medically-necessary and preventive services covered under Medicare Part A and Part B, and prescription drug coverage under Part D.

Plus, Georgia Health Advantage includes extra benefits including vision, routine foot care, preventive care, in-home/out-of-home support services. You pay nothing for these extra benefits! This is a brief list of benefits we cover and what you pay. It does not list every medical service or item covered or every limitation or exclusion. For a complete list of covered medical services or items, you may call Georgia Health Advantage Member Services at 1-844-917-0645, TTY 711 and request us to mail the Georgia Health Advantage [H8093-001] Evidence of Coverage or Georgia Health Advantage Choice [H8093-002] Evidence of Coverage to you.

• • Part D prescription drug coverage.
  • Vision, hearing, routine foot care, and preventive services and screenings.
  • Coordinated care and more personal attention.
  • Dedicated nurse practitioner as your trusted partner to manage your care and collaborate with your doctors, your family, and the nursing home staff.
  • Regular visits from your nurse practitioner to your residing nursing home to help avoid unnecessary and often unwanted trips to the hospital.
  • Your nurse practitioner can complete tests and treatments in the nursing home that are normally done in the hospital.
  • One point of contact for communication with you, your family, your doctors and nursing home staff.

How much is the monthly premium?

• • $37.30 Georgia Health Advantage [H8093-001] monthly plan premium.
  • $37.30 Georgia Health Advantage Choice [H8093-002] monthly plan premium.
  • Note: You must continue to pay your Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party).

How much is the Parts A and B deductible?

• • $226 Georgia Health Advantage [H8093-001] per year for covered Parts A and B medical services and items you receive from in-network providers services.
  • $226 Georgia Health Advantage Choice [H8093-002] per year for covered Parts A and B medical services and items you receive from in-network providers services.

How much is the Part D deductible?

• • $505 Georgia Health Advantage [H8093-001] deductible per year for Part D prescription drugs.
  • $505 Georgia Health Advantage Choice [H8093-002] deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?

• • Yes. Georgia Health Advantage (HMO I-SNP) protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly out-of-pocket limit(s):

• • $8,300 Georgia Health Advantage [H8093-001] annual out-of-pocket limit for covered Parts A & B medical services and items you receive from in-network providers.
  • $8,300 Georgia Health Advantage Choice [H8093-002] annual out-of-pocket limit for covered Parts A & B medical services and items you receive from in-network providers.
  • If you reach the limit on out-of-pocket costs, you keep getting covered Parts A & B medical services and items and we will pay the full cost for the rest of the year.
  • Please note that you will still need to pay your monthly Medicare Part B premium (unless your Medicare Part B premium is paid for you by State Medicaid or another third party), your monthly Georgia Health Advantage (HMO I-SNP) premium, Part D prescription drug deductibles and Part D prescription drug cost-sharing.

Is there a limit on how much the plan will pay?

• • Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.