Georgia Medicare Annual Enrollment Period (AEP) Guide 2026

The Medicare Annual Enrollment Period (AEP) runs every year from October 15 through December 7, the federal window during which Medicare beneficiaries who are already enrolled in Medicare can change their plan choices. AEP is the single largest decision point in the Medicare calendar. More plan changes happen during AEP than during all other enrollment windows combined.

During AEP, a Georgia Medicare beneficiary can:

• Switch from Original Medicare (Part A + Part B) to a Medicare Advantage plan
• Switch from a Medicare Advantage plan back to Original Medicare
• Switch from one Medicare Advantage plan to another
• Switch from one standalone Part D Prescription Drug Plan (PDP) to another
• Add a Part D PDP to Original Medicare for the first time
• Drop Part D coverage entirely

Plan changes elected during AEP take effect January 1 of the following year.

For Georgia, AEP is operationally significant because the state has hundreds of thousands of Medicare Advantage enrollees and many more enrolled in standalone Part D plans. Every one of these beneficiaries has the right to evaluate their plan during AEP, because plan formularies, networks, premiums, deductibles, out-of-pocket maximums, and quality star ratings change every plan year.

GeorgiaCares, Georgia's State Health Insurance Assistance Program (SHIP), provides free, unbiased AEP plan comparison counseling at 1-866-552-4464. The Georgia Senior Medicare Patrol (SMP) monitors AEP marketing fraud and abuse, a particularly important function because AEP is the peak season for high-pressure marketing tactics targeting seniors.

This guide explains the federal AEP framework, the coordination with related enrollment windows, the plan change options available, the documentation and timing requirements, the AEP-related Medigap and Late Enrollment Penalty considerations, and the Georgia-specific marketplace context and free counseling resources.

The Federal AEP Framework

Statutory and regulatory authority

The Medicare Annual Enrollment Period rests on two grants of authority: Section 1851(e)(2) of the Social Security Act for Medicare Advantage AEP enrollment, and Section 1860D-1(b)(1)(B)(iv) of the Social Security Act for Part D AEP enrollment. Together these establish the October 15 through December 7 window, with plan changes taking effect January 1 of the following year.

Section 1851(e)(2) of the Social Security Act establishes the AEP for Medicare Advantage. The statute specifies that the AEP runs from October 15 through December 7 each year and that elections made during AEP take effect on January 1 of the following year. The Centers for Medicare & Medicaid Services (CMS) implements this authority through federal regulation.

Section 1860D-1(b)(1)(B)(iv) of the Social Security Act establishes the parallel AEP for the Medicare Part D prescription drug benefit. The statutory window mirrors the MA AEP: October 15 to December 7, with January 1 effective dates. CMS implements this authority through federal regulation.

The two AEPs were intentionally aligned to permit a single enrollment window for all post-IEP plan choice decisions. Before the Part D program launched in 2006, the MA AEP existed in a different form; the alignment of the MA and Part D AEPs into the current October 15 to December 7 window dates from changes made under the Affordable Care Act of 2010 and refined by subsequent CMS rulemaking.

Annual Notice of Change (ANOC)

The Annual Notice of Change is the most important document a current Medicare Advantage or Part D enrollee receives each year. Federal regulation requires every MA plan and every Part D plan to send each current enrollee an ANOC by September 30 of each year. The ANOC must summarize, in plain language, every material change to the plan for the upcoming year, including:

• Monthly premium changes
• Annual deductible changes
• Tier-by-tier cost-sharing changes
• Out-of-pocket maximum changes
• Formulary changes (drugs added, removed, moved tiers, subjected to prior authorization, step therapy, or quantity limits)
• Network changes (providers added or removed)
• Service area changes
• Quality Star Rating changes
• New supplemental benefits (dental, vision, hearing, OTC, transportation, meals, etc.)
• Discontinuation of any current supplemental benefits

The ANOC is not junk mail. A beneficiary who throws away the ANOC unread can find themselves on January 1 paying a higher premium for a plan that no longer covers their primary care physician, no longer covers their specialty medication, and has dropped the dental benefit they actually used. Read the ANOC every September. If anything material has changed, evaluate alternatives during AEP.

CMS Medicare Plan Finder

The CMS Medicare Plan Finder at medicare.gov/plan-compare is the federal government's free, unbiased plan comparison tool. CMS refreshes Plan Finder each year before AEP opens with the following year's plan data. By October 15, every plan available for January 1 enrollment is in the tool.

Plan Finder allows comparison by:

• Monthly premium
• Annual deductible
• Cost-sharing structure (copays vs coinsurance)
• Out-of-pocket maximum
• Total estimated annual cost based on your personal medication list and pharmacy
• Formulary coverage of your specific medications
• Network coverage of your specific providers
• Quality Star Rating
• Supplemental benefits (for MA plans)

Plan Finder is the single most powerful tool for AEP plan comparison. A beneficiary who enters their actual medications, their actual pharmacy, and their actual providers can see total estimated annual cost across every plan available in their county, often revealing significant differences between the lowest-cost and highest-cost plans for the same person.

GeorgiaCares SHIP counselors use Plan Finder as their primary AEP comparison tool. A beneficiary who calls GeorgiaCares at 1-866-552-4464 in October or November will typically receive a one-on-one Plan Finder walkthrough comparing 3-5 plans tailored to their actual prescriptions and providers, with no sales pressure.

"Medicare & You" Handbook

Each year in September, CMS mails the "Medicare & You" handbook to every Medicare beneficiary household. The handbook contains the annual updates to Medicare premiums, deductibles, cost-sharing, and program rules. The 2026 handbook (mailed September 2025) covered the AEP that just closed; the 2027 handbook (mailed September 2026) will cover the AEP running October 15 to December 7, 2026 for January 1, 2027 effective dates.

The handbook is also available online at medicare.gov in PDF and HTML formats, with translations available in Spanish, Chinese, Korean, Vietnamese, and several other languages. Atlanta's diverse senior population, including substantial Vietnamese, Korean, and Spanish-speaking communities, has full access to translated handbook editions.

CMS Quality Star Ratings

CMS releases its annual Quality Star Ratings for Medicare Advantage and Part D plans in October each year, timed to coincide with AEP. Star Ratings measure plan performance on dozens of quality measures including:

• Member experience
• Customer service responsiveness
• Drug pricing and patient safety
• Preventive care delivery
• Chronic condition management
• Complaint and disenrollment rates

Plans are rated on a star scale. 5-star plans are the highest rated and qualify for a special CMS-authorized year-round enrollment window (the "5-star SEP") that allows a beneficiary to enroll in a 5-star MA or Part D plan once during the entire plan year.

Star Ratings change every year. A plan that was highly rated last year may receive a lower rating this year, or vice versa. AEP is the time to check whether your current plan's rating has slipped and whether a higher-rated plan is available in your county.

Medicare Communications and Marketing Guidelines (MCMG)

The CMS Medicare Communications and Marketing Guidelines (MCMG) govern what MA and Part D plans and their agents can say and do during AEP. Key MCMG provisions include:

• Plans and agents may not make unsolicited contact (no cold calls, no door-to-door sales, no unsolicited emails or texts) to prospective enrollees.
• Plans must provide accurate, non-misleading information about benefits, networks, formularies, and cost-sharing.
• Plans must clearly disclose that they are a Medicare Advantage plan, not Original Medicare, and that benefits and providers are subject to plan-specific rules.
• Plans may not use the words "free Medicare" or imply that plan benefits are paid by Medicare rather than by the plan.
• Plans must permit beneficiaries to disenroll without retaliation.
• Agents who make material misrepresentations may be terminated and face CMS sanctions.

The Georgia Senior Medicare Patrol monitors MCMG compliance and reports violations to CMS. A beneficiary who receives misleading marketing, especially during AEP, should call the Georgia SMP at 1-866-552-4464 (same line as GeorgiaCares SHIP).

AEP Plan Change Options

A Georgia Medicare beneficiary can make any of the following six changes during AEP:

Option 1: Original Medicare to Medicare Advantage

A beneficiary currently in Original Medicare (Part A + Part B, possibly with a standalone Part D PDP and possibly with Medigap) can enroll in a Medicare Advantage plan during AEP. Effective January 1, the MA plan becomes the beneficiary's primary coverage and Original Medicare claims processing stops. If the MA plan includes drug coverage (an MA-PD), any prior standalone Part D PDP is automatically terminated.

Medigap warning: Enrolling in MA does NOT terminate a Medigap policy automatically. The beneficiary must call their Medigap insurer to cancel. Medigap pays nothing while a beneficiary is enrolled in MA, but premiums continue to be charged until cancelled.

Option 2: Medicare Advantage to Original Medicare

A beneficiary currently in MA can return to Original Medicare during AEP. Effective January 1, MA enrollment terminates and Original Medicare resumes. The beneficiary may want to:

• Add a standalone Part D PDP (highly recommended if they lose MA-PD drug coverage)
• Purchase a Medigap policy (but see Medigap warning below)

Medigap warning: Switching from MA to Original Medicare during AEP does NOT trigger a guaranteed-issue right for Medigap in Georgia (Georgia is not one of the states with stronger Medigap protections). The beneficiary will face medical underwriting and may be denied or rated up for pre-existing conditions, unless they qualify for a federal trial right (typically only available to those in their first 12 months of MA enrollment after first becoming Medicare-eligible) or another guaranteed-issue scenario.

Option 3: Medicare Advantage Plan to Medicare Advantage Plan

A beneficiary currently in one MA plan can switch to a different MA plan during AEP. Effective January 1, enrollment in the new plan begins and the old plan automatically terminates. This is the most common AEP plan change, with beneficiaries switching MA plans within the same insurer family or across insurers in response to ANOC changes, network changes, formulary changes, or rating changes.

Option 4: Part D PDP to Part D PDP

A beneficiary currently in a standalone Part D PDP (typically paired with Original Medicare) can switch to a different Part D PDP during AEP. Effective January 1, enrollment in the new PDP begins and the old PDP automatically terminates. PDP changes are typically driven by formulary changes (a current PDP dropped a critical medication or moved it to a higher tier) or premium changes.

Option 5: Add Part D PDP to Original Medicare

A beneficiary currently in Original Medicare without Part D coverage can enroll in a standalone Part D PDP during AEP. Effective January 1, Part D coverage begins.

LEP warning: If the beneficiary was previously eligible for Part D and went without creditable drug coverage for more than 63 consecutive days, a Part D Late Enrollment Penalty will apply for life.

Option 6: Drop Part D Coverage

A beneficiary currently in Part D (either standalone PDP or MA-PD) can drop Part D coverage during AEP. Dropping Part D without other creditable drug coverage is generally inadvisable because:

• Future re-enrollment will be subject to the Part D LEP
• The beneficiary will pay full retail price for prescriptions
• Many seniors discover later that they need a drug they can no longer afford

Drug coverage from VA, TRICARE, FEHB, Indian Health Service, or some retiree plans may be creditable (equivalent to or better than Part D) and may permit dropping Part D without LEP exposure. The beneficiary should obtain a written creditable coverage notice from the alternative payer before dropping Part D.

Coordination with Other Enrollment Windows

Medicare Advantage Open Enrollment Period (MA OEP)

The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 each year. The MA OEP is a one-time, three-month window during which a beneficiary currently in MA can make exactly one change:

• Switch to a different MA plan (with or without drug coverage), or
• Return to Original Medicare (with the option to add a standalone Part D PDP)

The MA OEP exists as a corrective window for beneficiaries who realize after January 1 that the plan they chose during AEP doesn't work for them. The MA OEP is NOT available to beneficiaries in Original Medicare (they must wait for AEP) and is limited to one change per OEP.

Initial Enrollment Period (IEP) and General Enrollment Period (GEP)

The IEP and GEP are for initial Medicare enrollment, not for plan changes by current Medicare beneficiaries. A 64-year-old approaching 65 enrolls during their IEP. A 67-year-old who never enrolled in Medicare may enroll during the GEP (January 1 through March 31 each year, with coverage effective the first day of the month following enrollment per BENES Act 2020 reforms). Neither IEP nor GEP is an AEP substitute.

Special Enrollment Periods (SEPs)

Special Enrollment Periods are triggered by specific qualifying events: loss of employer coverage, geographic move, plan termination, loss of Medicaid, dual-eligible status (quarterly), 5-star plan availability, FEMA-declared disasters, and several others. SEPs operate alongside AEP and may permit plan changes outside the AEP window. A beneficiary should evaluate whether an SEP applies before defaulting to AEP; an SEP may permit a change effective sooner than January 1.

Medigap Considerations During AEP

The single most important Medigap fact for AEP is: AEP does NOT trigger a Medigap guaranteed-issue right.

A beneficiary who leaves Medicare Advantage during AEP and returns to Original Medicare typically wants to purchase a Medigap policy to fill the gaps in Original Medicare cost-sharing. But in Georgia, that Medigap purchase is subject to medical underwriting unless one of these guaranteed-issue scenarios applies:

• The beneficiary is in their Medigap Open Enrollment Period (the six-month period starting when they first enroll in Part B at age 65 or later), rarely the case at AEP.
• The beneficiary is exercising a federal trial right, typically only available to those who enrolled in MA when they first became Medicare-eligible and are within their first 12 months of MA enrollment.
• The beneficiary's MA plan is terminating or leaving their service area.
• The beneficiary is moving outside their MA plan's service area.

Outside these scenarios, a Georgia Medigap applicant during AEP can be:

• Denied coverage entirely
• Approved at standard rates
• Approved at "rate-up" prices reflecting pre-existing conditions
• Subjected to a six-month pre-existing condition waiting period

This Medigap reality means a beneficiary considering switching from MA to Original Medicare during AEP must apply for Medigap first (before disenrolling from MA) to confirm acceptance, or accept the risk of returning to Original Medicare without Medigap protection.

Late Enrollment Penalty Implications

AEP plan changes do NOT trigger new Late Enrollment Penalties. A beneficiary who switches from one MA plan to another, or from one Part D PDP to another, faces no new LEP exposure.

However:

• Existing LEPs continue. A beneficiary already paying a Part B or Part D LEP continues to pay that LEP after the AEP change.
• New Part D enrollment may trigger an LEP. A beneficiary who has been without creditable drug coverage for more than 63 consecutive days and uses AEP to enroll in Part D for the first time will face a Part D LEP based on the months of uncovered eligibility.
• Dropping Part D creates future LEP exposure. A beneficiary who drops Part D during AEP and goes 63+ days without creditable coverage will face an LEP when they re-enroll.

Late Enrollment Penalties are calculated based on how long a beneficiary went without creditable coverage and are permanent additions to the monthly premium.

Low-Income Subsidy (LIS) Coordination

The Low-Income Subsidy (LIS) / Extra Help program subsidizes Part D premiums and cost-sharing for beneficiaries with income and assets below specified thresholds. LIS-eligible beneficiaries get:

• $0 or reduced Part D premium (depending on plan and LIS level)
• $0 or reduced annual deductible
• Significantly reduced copays
• Protection from the coverage gap

LIS-eligible beneficiaries also receive a quarterly Special Enrollment Period to change Part D plans, so they are not strictly dependent on AEP for plan changes. But AEP is still a useful time for LIS beneficiaries to review their plan, especially if:

• The plan dropped a critical medication from the formulary
• A new plan offers a higher quality star rating
• A new plan has a better pharmacy network in their area

GeorgiaCares SHIP can help LIS-eligible Georgians compare plans during AEP, and can also help them apply for LIS if they have not yet been screened.

Special Needs Plans (SNPs)

Three types of Medicare Advantage Special Needs Plans (SNPs) are available during AEP:

• D-SNPs (Dual-Eligible SNPs): For dual Medicare-Medicaid beneficiaries
• C-SNPs (Chronic Condition SNPs): For beneficiaries with specific chronic conditions (diabetes, heart failure, COPD, ESRD, etc.)
• I-SNPs (Institutional SNPs): For beneficiaries living in long-term care facilities

SNPs provide tailored benefits, care coordination, and provider networks designed for the target population. A diabetic Georgia Medicare beneficiary may benefit substantially from a C-SNP that includes diabetes self-management training, free glucose monitors, and specialty diabetic care coordination. Dual-eligible beneficiaries should always evaluate D-SNP options during AEP. D-SNPs typically provide better care coordination than non-SNP MA plans.

Dual-Eligible Considerations

Dual-eligible beneficiaries (Medicare + Medicaid) have additional considerations during AEP:

• D-SNP evaluation: D-SNPs are designed for dual eligibles and typically provide better care coordination.
• Quarterly SEP: Dual eligibles have a quarterly Special Enrollment Period (one per quarter), so they are not limited to AEP for plan changes.
• Medicaid coverage continuity: Changing MA plans during AEP does not affect Medicaid eligibility. Georgia Medicaid continues regardless of which Medicare plan the beneficiary chooses.
• D-SNP look-alike restrictions: CMS has restricted non-SNP "D-SNP look-alike" MA plans that previously targeted dual eligibles without providing the integrated benefits of true D-SNPs. Dual eligibles should be skeptical of plans that aggressively market to them without being formally designated as D-SNPs.

The Georgia AEP Marketplace

Georgia has a large Medicare beneficiary population, with hundreds of thousands enrolled in Medicare Advantage, representing a lower MA penetration rate than the national average. The Georgia MA market includes:

• Humana: Major presence statewide, particularly strong in metro Atlanta and middle Georgia
• UnitedHealthcare: Largest national MA insurer, comprehensive Georgia footprint
• Aetna (CVS Health): Strong statewide presence
• Anthem (Elevance Health): Significant Georgia membership
• Wellcare (Centene): Strong in Medicaid-Medicare dual-eligible space
• Cigna: Targeted metro Atlanta presence
• Kaiser Permanente Georgia: Closed-network HMO model, metro Atlanta only
• Alignment Health Plan: Newer entrant, technology-forward

For Part D, Georgia beneficiaries typically have many standalone PDP options available in each county, with major plans including:

• Wellcare Value Script
• Wellcare Classic
• Humana Walmart Value
• AARP MedicareRx Preferred
• AARP MedicareRx Saver Plus
• Cigna Saver Rx
• SilverScript Choice
• SilverScript Plus

The number of plan options is both a strength (real competition, meaningful price differences) and a challenge (decision paralysis, marketing fraud opportunity, and confusion). This is where GeorgiaCares SHIP is invaluable.

GeorgiaCares SHIP

GeorgiaCares is Georgia's federally-funded State Health Insurance Assistance Program (SHIP). GeorgiaCares provides free, unbiased, personalized Medicare plan comparison counseling to all Georgia Medicare beneficiaries.

GeorgiaCares counselors are certified by CMS, trained in plan comparison methodology, and prohibited from selling or recommending any specific plan. Their service is funded by federal SHIP grants and provided at no cost to the beneficiary.

During AEP, GeorgiaCares typically:

• Conducts one-on-one phone or in-person consultations
• Walks beneficiaries through the CMS Medicare Plan Finder
• Compares 3-5 plans tailored to the beneficiary's actual medications, pharmacy, and providers
• Explains ANOC changes affecting the beneficiary's current plan
• Identifies LIS / Extra Help eligibility
• Identifies Medicare Savings Program (MSP) eligibility
• Refers beneficiaries to additional resources (Medicaid, SNAP, LIHEAP, etc.)
• Documents the consultation for follow-up

GeorgiaCares operates through Georgia's 12 Area Agencies on Aging and several community partner organizations. The statewide intake line is 1-866-552-4464. AEP is the busiest season. Beneficiaries should call early (October) rather than waiting until late November or early December when wait times spike.

Georgia Senior Medicare Patrol (SMP)

The Georgia Senior Medicare Patrol monitors and investigates Medicare-related marketing fraud, billing fraud, and abuse. AEP is the peak season for marketing fraud because plans and unscrupulous agents intensify outreach to capture enrollment.

Common AEP marketing fraud scenarios include:

• Unsolicited phone calls offering "free Medicare benefits"
• Door-to-door sales at senior apartment complexes
• Misleading TV advertising showing celebrities promising benefits not actually available in the caller's plan
• Bait-and-switch tactics promising one plan's benefits but enrolling the beneficiary in a different plan
• Identity theft during purported AEP enrollment, with the fraudster collecting Medicare numbers and bank information
• Cross-selling of unrelated insurance products (life insurance, annuities) during a Medicare consultation

The Georgia SMP at 1-866-552-4464 investigates reports, refers cases to CMS and law enforcement, and educates seniors and family caregivers about prevention. A Georgia beneficiary who experiences pressure tactics or suspicious offers during AEP should call SMP immediately and should never share their Medicare number, Social Security number, or banking information with an unsolicited caller.

14 AEP Best Practices

1. Read your ANOC every September. It tells you exactly what's changing in your current plan for January 1.
2. Use the CMS Plan Finder at medicare.gov/plan-compare with your actual medications, pharmacy, and providers entered.
3. Compare total annual cost, not just monthly premium. A $0 premium plan can cost more total than a $40 premium plan if its cost-sharing is poor.
4. Check formulary coverage for every medication you take, including tier, prior authorization, step therapy, and quantity limits.
5. Check network coverage for every doctor, hospital, and specialist you currently use.
6. Check the Quality Star Rating, released each October.
7. Call GeorgiaCares SHIP at 1-866-552-4464 for free, unbiased counseling.
8. Apply for Medigap BEFORE disenrolling from MA if you're switching to Original Medicare and want Medigap. AEP does not trigger guaranteed issue.
9. Verify creditable coverage if you're dropping Part D for an alternative source (VA, TRICARE, FEHB, retiree plan).
10. Document your AEP enrollment with a confirmation number, written confirmation from the plan, and a calendar reminder for January 1.
11. Don't share your Medicare number with unsolicited callers, door-to-door agents, or anyone you didn't initiate contact with.
12. Take advantage of the MA OEP (January 1 through March 31) if you realize after January 1 that your AEP plan choice doesn't work.
13. Don't wait until December 7. The closer to the deadline, the longer the wait times at GeorgiaCares and Medicare.gov, and the more rushed the decision.
14. Re-evaluate every year. Plans change every year. The plan that was best last year may not be best this year.

14 Common AEP Issues

1. Throwing away the ANOC unread. The single most common mistake. Forces the beneficiary into the new plan year without knowing what changed.
2. Choosing the lowest premium without checking total cost. A $0 premium plan with $100 specialist copays can cost more than a $40 premium plan with $40 specialist copays.
3. Not checking the formulary. Discovering on January 1 that a critical medication is no longer covered.
4. Not checking the network. Discovering on January 1 that the primary care physician is out-of-network.
5. Assuming Medigap is automatic. Disenrolling from MA and discovering that Medigap requires underwriting.
6. Falling for marketing fraud. Sharing the Medicare number with an unsolicited caller and ending up enrolled in a plan that doesn't fit.
7. Confusing AEP with other windows. Trying to use AEP for initial Medicare enrollment (use IEP), trying to use AEP for MA-to-MA changes after January 1 (use MA OEP), or trying to use AEP for Medigap changes (Medigap has its own rules).
8. Missing the December 7 deadline. Plan changes elected after December 7 require waiting for the next AEP, MA OEP, or an SEP.
9. Dropping Part D for non-creditable coverage. Discovering later that the alternative coverage was not creditable and accruing an LEP.
10. Not applying for LIS. Many LIS-eligible Georgians never apply because they don't know they qualify.
11. Not evaluating D-SNPs. Dual-eligible beneficiaries who stay in non-SNP plans rather than evaluating D-SNP options.
12. Believing TV ads literally. The celebrity-endorsed benefits shown on TV are not always available in every county or every plan.
13. Calling the plan's number rather than 1-800-MEDICARE. Plan agents are sales agents. GeorgiaCares and 1-800-MEDICARE are unbiased.
14. Not documenting the enrollment. No confirmation number, no written confirmation, no proof that the enrollment actually went through.

Worked Examples

Example 1: Fulton County, Age 67 (Atlanta Routine AEP Plan Refresh)

Margaret, age 67, lives in Atlanta (Fulton County). She has been enrolled in a Humana MA-PD plan since her IEP at age 65. In September 2026, she receives the Humana ANOC for her plan year 2027. The ANOC discloses:

• Monthly premium rising from $35 to $52
• Annual deductible rising from $200 to $350
• Specialist copay rising from $40 to $50
• Tier 2 drug copay rising from $10 to $15
• Quality Star Rating dropped from 4.5 stars to 4.0 stars

Margaret calls GeorgiaCares SHIP at 1-866-552-4464 on October 18. A counselor walks her through the CMS Plan Finder with her seven medications, her Walgreens pharmacy, her primary care physician (Northside Medical Group), and her cardiologist. Plan Finder identifies three alternatives:

• A UnitedHealthcare MA-PD at $0 premium, 4.5 stars, covering all her medications and providers
• An Aetna MA-PD at $25 premium, 4.0 stars, with a richer dental benefit
• A Kaiser Permanente HMO at $15 premium, 5.0 stars, but Margaret's current providers are not in network

Margaret selects the UnitedHealthcare plan and enrolls via medicare.gov on October 22. She receives a confirmation number and written confirmation by mail within two weeks. Her old Humana plan auto-terminates December 31; her new UHC plan begins January 1, 2027. Estimated savings: $600/year in premium plus reduced cost-sharing.

Example 2: DeKalb County, Age 70 (AEP Switch from MA to Original Medicare)

James, age 70, lives in Decatur (DeKalb County). He has been enrolled in an Anthem MA plan for three years but has grown frustrated with prior authorization delays for specialist referrals and out-of-network restrictions when he travels to visit grandchildren in Texas. He wants to return to Original Medicare and purchase a Medigap policy.

James calls GeorgiaCares SHIP in mid-October. The counselor explains:

• AEP does NOT trigger a Medigap guaranteed-issue right in Georgia
• James is past his federal trial right window (he enrolled in MA at age 67, more than 12 months ago)
• James will face medical underwriting for Medigap
• James should apply for Medigap FIRST (before disenrolling from MA) to confirm acceptance

James applies for a Plan G Medigap policy with Mutual of Omaha in late October. He is approved at standard rates (he has controlled hypertension but no other significant conditions). On November 15, with his Medigap approval in hand, he enrolls in a standalone Wellcare Value Script Part D PDP and disenrolls from his Anthem MA plan via medicare.gov.

Effective January 1, 2027:

• Original Medicare resumes (Part A + Part B)
• Wellcare Part D PDP active
• Mutual of Omaha Plan G Medigap active
• Anthem MA plan terminated

James now has true freedom of choice: any provider that accepts Medicare nationwide, with Medigap filling the cost-sharing gaps. Annual cost: approximately $2,200 in Medigap premiums + $400 in Part D premiums + minimal cost-sharing. Worth it for the predictability and freedom.

Example 3: Cobb County, Age 68 (AEP Part D PDP Switch Due to Formulary Change)

Robert, age 68, lives in Marietta (Cobb County). He has been enrolled in Original Medicare with a SilverScript Choice standalone Part D PDP for two years. In September 2026, the SilverScript ANOC discloses that Eliquis (apixaban), Robert's critical anticoagulant, is being moved from Tier 3 to Tier 4 (Specialty Tier) in 2027, raising his copay from $47/month to $145/month after deductible.

Robert calls GeorgiaCares on October 16. The counselor enters Robert's medications (Eliquis, atorvastatin, lisinopril, metformin) and his CVS pharmacy into Plan Finder. The tool identifies two PDPs that keep Eliquis on Tier 3 for 2027:

• Humana Premier Rx PDP at $58/month premium, Eliquis at $47/month copay
• AARP MedicareRx Preferred at $72/month premium, Eliquis at $40/month copay

Robert chooses the AARP MedicareRx Preferred plan. Effective January 1, 2027, his SilverScript auto-terminates and AARP MedicareRx Preferred begins. Estimated savings: $1,260/year versus staying in SilverScript with the new Eliquis tier.

Example 4: Worth County, Age 72 (Rural AEP Plan Comparison with Limited Options)

Linda, age 72, lives in rural Worth County in south Georgia. She has Original Medicare with a Wellcare Value Script PDP. In September 2026, the Wellcare ANOC discloses minor premium increases but no major formulary changes. However, Linda wants to evaluate whether a Medicare Advantage plan might offer better value, particularly given the dental and vision benefits MA plans often include.

Linda calls GeorgiaCares in late October. The counselor enters Linda's information into Plan Finder. The results show:

• Only three MA plans available in Worth County (compared to 25+ in Fulton County)
• All three MA plans have narrow provider networks that exclude Linda's primary care physician in Albany
• The nearest in-network specialists are 60+ miles away in Macon or Tifton
• Linda's current Wellcare PDP combined with Original Medicare gives her access to ANY Medicare-accepting provider statewide

The counselor explains that for rural Georgians, Original Medicare + standalone PDP often provides better access than narrow-network MA plans. Linda stays in Original Medicare and her current PDP. She declines to switch.

Lesson: Rural Georgia AEP comparison is structurally different from metro Atlanta. Provider network access often outweighs the supplemental benefit attractions of MA plans.

Example 5: Bibb County, Age 69 (AEP Marketing Fraud Incident)

David, age 69, lives in Macon (Bibb County). On October 22, he receives an unsolicited phone call from a person identifying themselves as a "Medicare benefits coordinator" offering "free additional benefits" and "$200 grocery cards" if he switches to a "new Medicare plan." The caller asks for David's Medicare number, date of birth, and bank account information to "complete the enrollment."

David becomes suspicious when the caller refuses to identify the specific plan name or provide a written follow-up. He hangs up and calls GeorgiaCares / Georgia SMP at 1-866-552-4464. The SMP intake specialist:

• Confirms the call was almost certainly fraudulent (no plan can make unsolicited calls per MCMG)
• Notes that "grocery cards" and "extra benefits" language is a classic AEP fraud pattern
• Files an SMP fraud report for investigation
• Refers David to a SHIP counselor for legitimate AEP plan review
• Advises David to monitor his Medicare claims for any unauthorized enrollments

Two weeks later, David's Medicare account shows no unauthorized changes. The call was apparently a phishing attempt that failed because David didn't share his information. The SMP investigation contributes to a CMS case file documenting fraudulent outreach in the metro Macon area.

Lesson: Hang up on unsolicited callers, call GeorgiaCares / SMP to report, and never share Medicare number or banking information with an unsolicited caller.

Example 6: Hall County, Age 65 (First AEP After IEP)

Sarah, age 65, lives in Gainesville (Hall County). She enrolled in Medicare during her IEP in March 2026, choosing an Anthem MA-PD plan. October 2026 is her first AEP. She receives the Anthem ANOC in September and is surprised to see the plan's quality star rating dropped from 4.0 to 3.5 and her primary care provider was dropped from the network for 2027.

Sarah calls GeorgiaCares in late October. The counselor explains that AEP is exactly the right window to make a change in response to network or quality changes. The counselor runs Plan Finder with Sarah's medications, pharmacy, and providers, and identifies:

• A 4.5-star Humana MA-PD plan keeping Sarah's primary care provider in network at $0 premium
• A 4.0-star Wellcare MA-PD plan with broader dental benefits at $25 premium
• An option to return to Original Medicare + standalone PDP + Medigap (but Sarah is past her Medigap Open Enrollment Period at six months past Part B start, so Medigap would require underwriting)

Sarah selects the 4.5-star Humana plan, enrolls November 5, and receives confirmation. Her old Anthem plan terminates December 31; her new Humana plan begins January 1, 2027. She keeps her primary care provider, gains a higher-rated plan, and pays nothing extra.

Lesson: First AEP after IEP is the optimal time to course-correct if the IEP plan choice isn't working. Don't accept network or quality degradation passively.

CTA: Free Georgia AEP Resources

• Medicare: 1-800-MEDICARE (1-800-633-4227): federal Medicare information line
• SSA Medicare Enrollment: 1-800-772-1213: initial Medicare enrollment and IRMAA
• GeorgiaCares SHIP: 1-866-552-4464: free AEP plan comparison counseling
• Georgia Senior Medicare Patrol: 1-866-552-4464: AEP marketing fraud detection
• Medicare Rights Center: 1-800-333-4114: national Medicare advocacy
• Georgia DCH Member Services: 1-866-211-0950: Medicaid coverage questions
• Atlanta Legal Aid: 404-377-0701: legal assistance with Medicare disputes
• Georgia Legal Services: 1-800-498-9469: legal assistance outside metro Atlanta
• Eldercare Locator: 1-800-677-1116: federal eldercare referral service
• 211 Georgia: 211: local social services referral
• Patient Advocate Foundation: 1-800-532-5274: chronic disease patient advocacy
• Humana Medicare: 1-800-457-4708
• UnitedHealthcare Medicare: 1-800-721-0627
• Aetna Medicare: 1-800-282-5366
• Anthem Medicare: 1-833-919-1577
• Wellcare Medicare: 1-833-444-9088
• Cigna Medicare: 1-800-668-3813
• Kaiser Permanente Georgia: 1-888-865-5813
• Alignment Health Plan: 1-833-242-2223

Find personalized help comparing Georgia Medicare plans at brevy.com.

Last verified: 2026-05-14. AEP rules, dates, and Georgia plan offerings change annually. Always verify current plan details at medicare.gov/plan-compare or by calling GeorgiaCares SHIP at 1-866-552-4464 before enrolling. This guide is informational and does not constitute legal, financial, or medical advice.