Jane Dotson
Medicare is a federal health insurance program for individuals aged 65 and above or those with specific medical conditions. Eligibility criteria include being 65 or older, under 65 with certain disabilities, under 65 with End-Stage Renal Disease (ESRD), or under 65 with Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease). Enrollment in Georgia can be done through official state websites ending in '.gov' or by calling 1-800-GEORGIA to verify eligibility and complete the application process.
| Characteristics | Values |
|---|---|
| Eligibility criteria | Age 65 or older, under 65 with certain disabilities, under 65 with End-Stage Renal Disease (ESRD), or under 65 with Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease) |
| Enrollment options | Online, phone, or through Social Security |
| Medicare parts | Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (prescription medications) |
| Enrollment timing | Initial Enrollment Period begins 3 months before turning 65 and ends 3 months after; a total of 7 months. |
| Enrollment penalty | A monthly late enrollment penalty may apply if Part B is not selected when turning 65 |
| Medicare card | Mailed 3 months before coverage starts or 2 weeks after signing up |
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What You'll Learn
Eligibility requirements for Medicare in Georgia
To be eligible for Medicare in Georgia, you must meet specific requirements set by the state and federal governments. Here are the key eligibility requirements for Medicare in Georgia:
Age and Medical Conditions:
Medicare is typically available for individuals aged 65 and older. However, if you have certain medical conditions or disabilities, you may qualify for Medicare earlier. This includes individuals with End-Stage Renal Disease (requiring dialysis or a transplant), ALS (Lou Gehrig's disease), or other disabilities.
Income and Financial Criteria:
Your income and financial situation play a role in determining your eligibility for Medicare in Georgia. The state considers your household income and resources when assessing eligibility. For example, individuals must have resources worth less than $4,000, while couples should have resources worth less than $6,000, excluding their primary residence, one car, and certain insurance policies. Additionally, there are specific income limits for Medicare Savings Plans, such as the Qualified Medicare Beneficiary (QMB) program, which assists low-income individuals.
Residency and Citizenship:
To be eligible for Medicare in Georgia, you must be a resident of the state. Additionally, you must be a citizen of the United States or a permanent legal resident for at least five years. This requirement ensures that individuals meeting specific residency and citizenship criteria can access the benefits provided by the state and federal governments.
Enrollment in Medicare Part A or B:
Eligibility for Medicare in Georgia also depends on your enrollment status in Medicare Part A or Part B. You must be enrolled or eligible to enroll in either part to qualify for the state's Medicare Savings Plans programs. These programs can help with out-of-pocket expenses, premiums, deductibles, and coinsurance associated with Medicare coverage.
Application and Verification Process:
To apply for Medicare in Georgia, you can complete a short application form, which may require additional information as determined by an eligibility worker. You can apply online or contact your local Division of Family and Children Services (DFCS) office for assistance. They will verify your eligibility based on the criteria mentioned above and determine your enrollment in Medicare.
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Medicare Part A and Part B
Medicare is the federal health insurance program for people aged 65 and over in the US. If you are under 65, you may still be eligible if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's Disease).
Medicare Part A is insurance for hospitalisation, home or skilled nursing, and hospice. You will get Part A automatically once you start receiving Social Security retirement benefits. If you are under 65, you will get Part A automatically if you have received Social Security disability benefits for two years. If you have ALS, you will get Part A immediately upon enrolling in Social Security disability benefits.
Medicare Part B is medical insurance. You will need to sign up for Part B separately. You can sign up for Part B online at Social Security or by contacting your local Social Security office. You can only sign up for Part B at certain times. If you don't sign up for Part B when you turn 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
To get full Medicare benefits, you need both Part A and Part B.
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Medicare Advantage Plans
The State Health Benefit Plan (SHBP) in Georgia offers Medicare Advantage Plan Options (Standard and Premium) from two vendors: Anthem Blue Cross and Blue Shield. Aetna, BlueCross Blue Shield of Tennessee, Cigna, and Kaiser also sell highly-rated plans in the state. The average monthly premium for a Medicare Advantage Plan in Georgia in 2025 is $14.29, a slight decrease from 2024. There are 162 plans available in total, and all Medicare-eligible individuals in Georgia can access a $0-premium Medicare Advantage Plan.
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage Plans on a scale of 1 to 5 stars, with 5 being the best. In 2025, there are no 5-star plans in Georgia, but several companies offer plans rated 4.5 stars, including BlueCross BlueShield of Tennessee and Kaiser Permanente. Anthem Blue Cross and Blue Shield, Clover Health, and UnitedHealthcare offer plans rated 4 stars.
When considering a Medicare Advantage Plan, it is important to research the plan's costs, your required level of coverage, and whether the plan suits your specific needs. You can also seek free counselling and assistance with Medicare through the State Health Insurance Assistance Program (SHIP), previously known as GeorgiaCares.
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Medicare prescription drug plans
Medicare Part D plans offer prescription drug coverage. Each plan has a formulary, or a list of covered drugs, with drug tiers that indicate the drug's cost. While Part D offers broad coverage, it generally excludes medications administered in your doctor's office or as an inpatient—those are covered by Medicare Part B. You can enrol in a Medicare Part D prescription drug plan if you're enrolled in Medicare Part A and/or Part B or a Medicare Advantage Private Fee-for-Service (PFFS) Plan that doesn't offer prescription drug coverage.
In Georgia, there are 24 Part D prescription drug plans available in 2023, with an average premium of $73.42 per month. Eight of these plans participate in the Part D Senior Savings Model, which offers lower out-of-pocket insulin costs than other plans. The lowest 2023 Part D prescription drug plan monthly premium in Georgia is $7.30. You will pay a monthly premium and be subject to an annual deductible and copays for each prescription with a Medicare Part D plan. The average deductible in Georgia is $462, though there are plans that do not require a deductible payment. After reaching your deductible, you will pay either a copayment or coinsurance for each prescription. A copayment is a set amount, while coinsurance is a percentage of the drug cost.
It is important to review each plan's formulary to ensure your prescriptions are covered at an affordable rate. You can enrol in a Medicare Part D prescription drug plan on the Medicare Plan Finder or on the plan's website, or by completing a paper enrolment form.
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How to apply for Medicare in Georgia
Medicare is a federal health insurance program for people aged 65 and over or those with certain medical conditions. If you meet any of the following criteria, you may be eligible for Medicare in Georgia:
- Age 65 or older
- Under 65 with certain disabilities
- Under 65 with End-Stage Renal Disease (ESRD)
- Under 65 with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease)
There are several ways to enrol in Medicare in Georgia:
- Automatic enrolment: If you begin receiving Social Security retirement benefits between the age of 62 and up to 4 months before turning 65, you will be automatically enrolled in Medicare Part A and Part B when you turn 65.
- Apply during the Initial Enrollment Period: If you apply for Social Security 3 months before you turn 65 or later, you can sign up for Medicare during this time. The Initial Enrollment Period begins 3 months before you turn 65 and ends 3 months after the month you turn 65, a total of 7 months.
- Apply for Part A and/or Part B: If you are already 65 or older, you can enrol online for Medicare Part A and/or Part B. You can also call TTY +1 800-325-0778 if you're deaf or hard of hearing.
- Apply if you have End-Stage Renal Disease (ESRD): If you have ESRD, you can call 800-772-1213 and inform the representative that you want to apply for Medicare due to having ESRD.
- Apply for Part B if receiving disability benefits: If you have been receiving disability benefits for 24 months, you will automatically receive Part A. If you want Part B, you will need to sign up for it separately.
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Frequently asked questions
To be eligible for Medicare in Georgia, you must meet one of the following criteria:
- Age 65 or older
- Under 65 with certain disabilities
- Under 65 with End-Stage Renal Disease (ESRD)
- Under 65 with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease)
You can apply for Medicare in Georgia by calling 1-800-MEDICARE or visiting the official website of the State of Georgia. Make sure you are on an official state website before sharing any personal information.
Yes, if you are 65 or older, you can enroll online for Parts A and B, or Part A only. You can also apply online for Social Security benefits, which will automatically enroll you in Medicare Parts A and B when you turn 65.
The Initial Enrollment Period for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65, for a total of 7 months. If you miss this Initial Enrollment Period, you may have to pay a penalty.
Medicare Part A is insurance for hospitalization, home or skilled nursing, and hospice. You will get Part A automatically once you start receiving benefits from Social Security or the Railroad Retirement Board.
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