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Georgia Health Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Georgia Health Advantage (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Georgia Health Advantage (HMO I-SNP) in 2026, please refer to our full plan details page.
Georgia Health Advantage (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Georgia. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Georgia Health Advantage (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Georgia Health Advantage (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Georgia Health Advantage (HMO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Georgia Health Advantage (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Georgia Health Advantage (HMO I-SNP) Medicare plan has an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan starts covering its share of the costs. Specific drug coverage tier details, such as individual copayments and coinsurance rates for different medication levels, are not available for this plan. To determine your exact prescription costs, you should consult the plan's formulary or contact the plan provider directly.
Additional Benefits
The Georgia Health Advantage (HMO I-SNP) plan offers comprehensive medical coverage with many essential services requiring no copay. Beneficiaries enjoy no copay and no coinsurance for inpatient hospital stays, primary care visits, home health services, and skilled nursing facility care for up to 100 days. Emergency services, outpatient care, and ambulance rides are also available with no copay, though they generally require a 20% coinsurance. For specialized care, the plan provides routine hearing exams and hearing aids up to $500 per ear with no copay, alongside eyewear coverage up to $325 annually with no copay and no coinsurance. While diabetic supplies and home health care have no copay and no coinsurance, durable medical equipment and dialysis require a 20% coinsurance. It is important to note that routine dental care, fitness programs, and transportation services are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Georgia Health Advantage (HMO I-SNP) with no copay and no coinsurance, though Medicare-defined cost sharing and prior authorization are required. This benefit does not cover additional hospital days, non-Medicare-covered stays, or room upgrades.
Outpatient Services See details
Georgia Health Advantage (HMO I-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services, and there is no deductible for blood services.
Partial Hospitalization See details
Georgia Health Advantage (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Georgia Health Advantage (HMO I-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to health-related locations are not covered.
Emergency Services See details
Georgia Health Advantage (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, both of which count toward the plan-level deductible and are waived if you are admitted to the hospital within one day. Some worldwide emergency services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Georgia Health Advantage (HMO I-SNP) covers primary care and telehealth services with no copay and no coinsurance, while chiropractic services are not covered. Other professional services, including specialist visits, mental health, psychiatric, podiatry, and therapy services, are covered with no copay and 0% to 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Georgia Health Advantage (HMO I-SNP) with no copay and no coinsurance for covered benefits like Medicare-covered zero-dollar services, kidney disease education, and in-home support. However, several benefits are not covered, including an annual physical exam, fitness benefits, health education, and home safety assessments.
Hearing Services See details
Georgia Health Advantage (HMO I-SNP) partially covers hearing services with no deductible, offering routine exams with no copay and 20% coinsurance, alongside fittings and prescription hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Georgia Health Advantage (HMO I-SNP) vision services are partially covered, featuring one annual routine eye exam with no copay and a 20% coinsurance, while other eye exams are not covered. Eyewear is covered up to a $325 annual limit with no deductible, offering contact lenses with no copay and a 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Georgia Health Advantage (HMO I-SNP) partially covers dental services, offering coverage only for Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services—including oral exams, cleanings, x-rays, fluoride, restorative services, and orthodontics—are not covered.
Home Infusion bundled Services See details
Georgia Health Advantage (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Georgia Health Advantage (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Georgia Health Advantage (HMO I-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Georgia Health Advantage (HMO I-SNP) with prior authorization required. Outpatient diagnostic procedures and tests require a copay and 20% coinsurance, lab services require no copay and have coinsurance, and radiological services and X-rays require no copay and 20% coinsurance.
Home Health Services See details
Georgia Health Advantage (HMO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Georgia Health Advantage (HMO I-SNP) covers some services under Cardiac Rehabilitation Services with no copay and a 20% coinsurance, and prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Georgia Health Advantage (HMO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copayment and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for this benefit, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Georgia Health Advantage (HMO I-SNP) plan.
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