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Georgia Health Advantage Choice (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Georgia Health Advantage Choice (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 Choice (HMO I-SNP) in 2025, please refer to our full plan details page.
Georgia Health Advantage Choice (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 Choice (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 Choice (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 Choice (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 Choice (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.60. 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 Choice (HMO I-SNP) plan has a $590 deductible for prescription drugs. Once the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. After 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 (LIS), you may have a reduced premium.
Additional Benefits
The Georgia Health Advantage Choice (HMO I-SNP) plan offers a range of services with varying cost-sharing. Many services have no copay, including primary care visits, ambulance and transportation services, preventive services, home health services, and over-the-counter items. However, some services like outpatient services, emergency services, hearing exams, vision exams, and dental services, have a 20% coinsurance. The plan also covers inpatient hospital stays, outpatient services, partial hospitalization, and home infusion services, but these may require prior authorization. The plan provides coverage for a variety of services, including hearing and vision, with specific cost-sharing for each. The plan does not cover certain services such as cardiac rehabilitation, and has limitations on other services like hearing aids and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Georgia Health Advantage Choice (HMO I-SNP) plan, but require prior authorization. The copay for these services is determined by the Medicare-defined cost share for tier 1. Additional days, non-Medicare covered stays, and upgrades for both acute and psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services and observation services, each with a 20% coinsurance, as well as ambulatory surgical center services and outpatient substance abuse services, each with a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Georgia Health Advantage Choice (HMO I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay, but a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including urgently needed services, with a 20% coinsurance. Worldwide emergency services, including worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation, are not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a 20% coinsurance, with routine care not covered. Occupational Therapy Services are covered with a coinsurance between 0% and 20%. Physician Specialist Services and Physical Therapy and Speech-Language Pathology Services have a coinsurance between 0% and 20%. Mental Health and Psychiatric Services are covered with a coinsurance between 0% and 20% for individual and group sessions. Podiatry Services are covered with a coinsurance between 0% and 20% and no copay for Medicare-covered services. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services are covered by the Georgia Health Advantage Choice (HMO I-SNP) plan. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a 20% coinsurance for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids have a maximum benefit of $500 per year, with no copay for prescription hearing aids of all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, has a 20% coinsurance, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are partially covered by the Georgia Health Advantage Choice (HMO I-SNP) plan, with a 20% coinsurance for Medicare Dental Services. 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 are covered by the Georgia Health Advantage Choice (HMO I-SNP) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetics/Medical Supplies have a 20% coinsurance and Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the Georgia Health Advantage Choice (HMO I-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Georgia Health Advantage Choice (HMO I-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Georgia Health Advantage Choice (HMO I-SNP) plan, with prior authorization required. There is no copay for days 1-100. However, additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items with a maximum plan benefit of $110.00 per month and no copay. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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