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Medicare can feel confusing at first. Most people hear about Part A, Part B, Part C, Part D, Medicare Advantage, Medicare Supplement plans, drug plans, networks, penalties, and enrollment windows before they ever feel like anyone has explained the basics in plain English.
That is where we help. Georgia Health Insurance works with Georgia residents who are turning 65, retiring, losing employer coverage, reviewing Medicare plan options, or trying to decide between Medicare Supplement and Medicare Advantage coverage.
For deeper Medicare resources, plan information, and Medicare-specific help, visit our dedicated Medicare website: Georgia Medicare Insurance.
Have questions about starting Medicare or reviewing your coverage? Schedule a Medicare appointment with Daniel or call Georgia Health Insurance at 770-452-9335.
Choosing Medicare coverage is not just about finding a low premium. The right decision depends on your doctors, prescriptions, travel habits, budget, health needs, risk tolerance, and whether you prefer a provider network or broader access to Medicare-accepting providers.
Our role is to explain your options clearly, compare the choices available to you, and help you avoid costly enrollment mistakes. You do not pay extra for our help. If you enroll in a plan through our agency, the plan premium is the same as enrolling directly with the insurance company.
Most people first become eligible for Medicare at age 65. Some qualify earlier because of a disability, end-stage renal disease, or ALS. Work history, citizenship or qualifying residence, and the applicable enrollment rules affect eligibility and premiums. Social Security determines eligibility for Parts A and B. Confirm your own eligibility and start date before ending other coverage.
| Part A | Hospital insurance. Helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. |
| Part B | Medical insurance. Helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and other medical services. |
| Part C | Medicare Advantage. Private Medicare plans that provide Part A and Part B benefits, and often include Part D drug coverage and extra benefits. |
| Part D | Prescription drug coverage. Helps pay for covered prescriptions through a standalone drug plan or a Medicare Advantage plan that includes drug coverage. |
| Medigap | Medicare Supplement Insurance. Private coverage that works with Original Medicare to help pay some of the costs Medicare does not pay. |
| Dental/Vision/Hearing | These are often handled through separate plans, extra benefits in some Medicare Advantage plans, or standalone coverage options. |
Original Medicare includes Part A and Part B. It is accepted nationwide by providers who take Medicare, but it does not have a built-in annual out-of-pocket maximum. That is why many people add either a Medicare Supplement plan and Part D drug plan, or choose a Medicare Advantage plan instead.
Medicare costs can change each year. For 2026, the standard Part B premium is $202.90 per month and the Part B deductible is $283. Most people do not pay a Part A premium if they or a spouse worked and paid Medicare taxes long enough. The 2026 Part A hospital deductible is $1,736 per benefit period. Part A also has daily coinsurance amounts for longer hospital or skilled nursing facility stays.
Source: https://www.medicare.gov/basics/costs/medicare-costs
| Question | Original Medicare with Medigap and separate Part D | Medicare Advantage |
|---|---|---|
| How do I receive medical coverage | Original Medicare provides Part A and Part B benefits. Medigap helps pay specified costs left by Original Medicare. | A private plan provides your Part A and Part B benefits. Plan rules and costs apply. |
| What premiums might I pay | Part B, any applicable Part A premium, Medigap, and a separate Part D premium. | Part B, any applicable Part A premium, and any Medicare Advantage plan premium. A $0 plan premium does not mean all care is free. |
| Which providers can I use | Providers who accept Medicare, subject to availability. Medicare SELECT Medigap policies can have network requirements. | Provider access depends on the plan's network and out-of-network rules. |
| How do prescription drugs work | New Medigap policies do not include drug coverage. Many people buy a separate Part D plan. | Many plans include Part D. Check the specific plan's covered drugs and pharmacy rules. |
| Is there a medical spending limit | Original Medicare has no annual out-of-pocket maximum. A Medigap policy pays the benefits specified by that policy. | Plans have a limit for covered Part A and Part B cost sharing. Premiums, Part D drugs, and noncovered services are separate. |
| Can I switch later | Medigap applications outside a protected period may require medical underwriting. | Medicare Advantage enrollment changes require an applicable enrollment period. A change does not automatically create a Medigap guaranteed-issue right. |
Some Medicare Advantage plans have a $0 plan premium. You generally still pay your Medicare Part B premium, and you may have deductibles, copays, coinsurance, and other costs. Compare the full year’s potential expenses, your doctors and prescriptions, and the plan’s medical out-of-pocket limit before choosing coverage.
The medical out-of-pocket maximum does not include every expense. Premiums, services the plan does not cover, and Part D drug costs follow separate rules. Check the plan’s Summary of Benefits and Evidence of Coverage for the details.
Medigap supplements Original Medicare. Most Medigap policies let you use providers who accept Medicare across the country; Medicare SELECT policies can have network requirements. New Medigap policies do not include prescription drug coverage, so many people add a separate Part D plan.
Medicare Advantage is another way to receive your Part A and Part B benefits. Many plans include Part D coverage and additional benefits. Provider networks, referrals, prior authorization, and cost sharing depend on the plan.
The federal Medigap Open Enrollment Period lasts six months, starting with the first month you are 65 or older and enrolled in Part B. Later applications may involve medical underwriting unless you have a guaranteed-issue right or another applicable protection. Medicare’s fall enrollment period does not create a general right to buy any Medigap policy without underwriting. Learn about Medigap.
For 2026, covered Part D out-of-pocket drug costs are capped at $2,100. Premiums and drugs outside Part D coverage do not become covered expenses simply because you reach that limit.
The Medicare Prescription Payment Plan lets you spread covered Part D out-of-pocket costs across the calendar year. It changes when you pay; it does not lower the total amount you owe. Ask your health or drug plan about participation. You can also check whether you qualify for Extra Help or a Medicare Savings Program. Medicare explains the payment option and financial help.
Initial Enrollment Period: A seven-month window around the month you turn 65. It includes the three months before your 65th birthday month, your birthday month, and the three months after.
Annual Enrollment Period:October 15 through December 7. This is when many people can change Medicare Advantage or Part D coverage for the next year.
Medicare Advantage Open Enrollment Period: January 1 through March 31. People already in a Medicare Advantage plan can switch Medicare Advantage plans or return to Original Medicare and join a Part D plan.
Special Enrollment Periods: Certain life events may allow a change outside normal windows, such as moving, losing employer or union coverage, or other qualifying events.
If you are covered through current employment, review the employer’s plan and Medicare coordination rules before delaying Part B. COBRA and retiree coverage are different from coverage based on current employment. HSA contributions also need attention when Medicare begins, including possible retroactive coverage. We can help you identify the questions to confirm with your employer and Social Security before your coverage changes.
Our team helps clients understand Medicare in plain English. We can review your situation, explain your options, compare plan types, and help you enroll when you are ready. We also remain available after enrollment if you have questions about your plan, renewal, or coverage changes.
You do not have to make Medicare decisions alone, and you do not have to pay extra for our help.
Bring your medication list, preferred pharmacies, doctors, current insurance information, and the dates of any upcoming retirement or coverage change. We will help you understand the options we offer and the next steps for your situation.
Schedule a Medicare appointment with Daniel or call 770-452-9335.
