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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 2025, 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 4.5 out of 5 stars in 2025.
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 $40.00. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium will be $40.
Additional Benefits
The Georgia Health Advantage (HMO I-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including primary care, ambulance services, emergency services, home health services, and skilled nursing facility stays for the first 100 days. Other services, such as outpatient services, partial hospitalization, and vision services, typically involve a 20% coinsurance. This plan also covers preventive, hearing, and dental services, often with no copay or a 20% coinsurance. Home infusion, dialysis, and diagnostic services are covered, with differing coinsurance amounts. However, it's important to note that not all services are covered, such as certain dental procedures, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but the cost sharing details are not provided. Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services and observation services with a 20% coinsurance, and ambulatory surgical center (ASC) services and outpatient substance abuse services, both with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the Georgia Health Advantage (HMO I-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services. For ground and air ambulance services, you will pay 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Georgia Health Advantage (HMO I-SNP) plan, with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Georgia Health Advantage (HMO I-SNP) plan covers Primary Care Physician Services with no copay, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 0-20% coinsurance, Physician Specialist Services with 0-20% coinsurance, and Mental Health Specialty Services with 0-20% coinsurance. This plan also covers Podiatry Services with 0-20% coinsurance and no copay for Medicare-covered services, Other Health Care Professional services with 0-20% coinsurance, Psychiatric Services with 0-20% coinsurance, Physical Therapy and Speech-Language Pathology Services with 0-20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar services. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, counseling services, are not covered. In-Home Support Services are covered with no copay. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with a coinsurance of at most 20% for routine hearing exams and no copay for fitting/evaluation. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Georgia Health Advantage (HMO I-SNP) plan covers vision services, including eye exams with a 20% coinsurance for routine eye exams and no copay, and eyewear with a 20% coinsurance. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. The plan offers a combined maximum of $325 per year for eyewear.
Dental Services See details
Dental Services are partially covered by the Georgia Health Advantage (HMO I-SNP) plan. Medicare Dental Services are covered with a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Georgia Health Advantage (HMO I-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Georgia Health Advantage (HMO I-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered, with a coinsurance of up to 20% for diagnostic procedures and radiological services. Lab services have no copay.
Home Health Services See details
Home Health Services are covered under the Georgia Health Advantage (HMO I-SNP) plan with no copay and no coinsurance, though Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Georgia Health Advantage (HMO I-SNP) plan. There is no copay for days 1-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Georgia Health Advantage (HMO I-SNP) plan, including acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and more. No authorization or referral is required for these services.
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