Georgia Medigap: Medicare Supplement Plans and Enrollment

In Georgia, the single decision that shapes your access to Medicare Supplement Insurance is timing. Medigap, as it is known, is the private coverage that pays the cost-sharing Original Medicare leaves behind, and Georgia follows the federal minimum: insurers must sell you any plan they offer, at the standard rate and regardless of health, only during your one-time six-month Medigap Open Enrollment Period.1 The gaps a plan fills are real money. A Part A inpatient hospital stay carries a $1,736 deductible per benefit period in 2026, an outpatient specialist visit leaves a 20 percent coinsurance after the $283 annual Part B deductible, and a hospitalization followed by a full skilled nursing facility stay adds $217 a day for days 21 through 100.2 Miss the open enrollment window in Georgia, and an insurer can later require medical underwriting and decline you or charge more, unless one of the separate federal guaranteed-issue protections applies.1

What Georgia Medigap Is and Who Regulates It

Medicare Supplement Insurance, known as Medigap, is private insurance that fills the deductibles, coinsurance, and copayments Original Medicare Parts A and B do not pay. In Georgia, Medigap policies are regulated by the Georgia Office of Commissioner of Insurance and Safety Fire, which licenses the carriers and agents that sell them.1

Federal law under Section 1882 of the Social Security Act (42 U.S.C. 1395ss) and 42 CFR 403.205 through 403.272 standardizes Medigap into ten lettered plan types and guarantees a six-month enrollment window when health cannot be used against you. Georgia adopts those federal protections and adds a small number of its own, but it does not add an annual guaranteed-issue window.1 Georgia offers all ten federally standardized plans (A, B, C, D, F, G, K, L, M, N); Plans C and F are closed to people first eligible for Medicare on or after January 1, 2020.1

Two Georgia-specific points sit on top of that federal floor. Georgia is one of the states that require insurers to offer at least one kind of Medigap policy to people who have Medicare under age 65, though the plan letters and terms of that offer vary and are worth confirming for your own situation. And Georgia prohibits attained-age rate structures: state regulation bars a carrier from filing an attained-age rating structure for any Medicare supplement policy issued after the rule's September 2009 amendment, which reaches essentially every policy sold today.1 The state insurance office publishes no consumer Medicare supplement guide, so for help with either point, call GeorgiaCares SHIP, Georgia's free State Health Insurance Assistance Program, at 1-866-552-4464.4

The Federal Framework: Section 1882 of the Social Security Act

The statutory foundation of Medigap is Section 1882 of the Social Security Act, codified at 42 U.S.C. 1395ss. It was enacted in 1980 under the Baucus Amendment to curb fraud in the unstandardized Medigap market of the 1970s, then amended through the Omnibus Budget Reconciliation Act of 1990 (OBRA 1990, PL 101-508), which standardized the lettered plans, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA 2015, PL 114-10), which closed Plans C and F to newly eligible beneficiaries.

Five federal principles carry the framework:

• Standardization. Carriers may sell only plans matching the ten federally defined types; benefits of a given letter are identical across carriers (Massachusetts, Minnesota, and Wisconsin use their own systems).
• Open enrollment. A six-month guaranteed-issue window begins the first month a beneficiary is both age 65 or older and enrolled in Part B.1
• Medicare Advantage (MA) trial right. Beneficiaries who joined an MA plan for the first time get a 12-month window to switch to Original Medicare and buy Medigap with guaranteed issue.5
• Guaranteed renewability. Any policy issued since 1992 is guaranteed renewable; the carrier cannot cancel it while the enrollee stays enrolled and pays the premium.6
• Prohibition on duplicate sales. It is illegal to sell Medigap to a Medicare Advantage enrollee, unless that person is switching back to Original Medicare and the MA coverage will end before the Medigap policy takes effect.7

The National Association of Insurance Commissioners (NAIC) Medicare Supplement Insurance Model Regulation provides the template states adopt. Georgia's Medigap law sits in O.C.G.A. Title 33 and follows the NAIC model with the federal minimum protections.1

The Ten Standardized Medigap Plans

Every Medigap plan must cover the same core benefits: Part A hospital coinsurance plus 365 extra hospital days, Part B coinsurance, the first three pints of blood, and Part A hospice coinsurance. Plans differ in the additional cost-sharing they cover, and two of them pay only a share of some of those core benefits. Plan K covers 50% and Plan L 75% of the Part B coinsurance, the first three pints of blood, the skilled nursing facility coinsurance, the Part A deductible, and the Part A hospice coinsurance, leaving you the rest; both still cover the Part A hospital coinsurance and the 365 extra hospital days in full.8,3 Once a Plan K or Plan L enrollee has met both that plan's annual out-of-pocket limit ($8,000 for Plan K and $4,000 for Plan L in 2026) and the annual Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.8 Because benefits of a given letter are identical across carriers, the only thing that varies between two Plan G policies is price, rating method, and service.

In practice, most Georgians newly eligible for Medicare weigh three options. Plan G is the most comprehensive plan available to anyone newly eligible after January 1, 2020, covering every Original Medicare cost-sharing item except the Part B deductible, with foreign travel emergency care covered at 80% up to plan limits; High-Deductible Plan G trades a much lower premium for an annual deductible of $2,950 in 2026 that you pay before the policy pays anything; and Plan N cuts the premium further in exchange for copayments of up to $20 for some office visits and up to $50 for emergency-room visits that do not lead to an inpatient admission, plus no coverage of Part B excess charges.3 Plans C and F (which covered the Part B deductible) closed to anyone newly eligible on or after January 1, 2020, and the remaining letters (A, B, D, K, L, M) are niche or rarely sold in Georgia.

For the letter-by-letter breakdown and a benefit-by-benefit table of all ten plans, see the ten standardized Medigap plans compared.

What Plan G Pays: The 2026 Reference Numbers

Plan G is the de facto reference plan for Georgians newly eligible for Medicare. Here is exactly what it covers against the 2026 Original Medicare cost-sharing figures.

Part A (Plan G covers these in full):

• Inpatient hospital deductible: $1,736 per benefit period.2
• Hospital coinsurance, days 61 through 90: $434 a day.2
• Lifetime reserve days, days 91 through 150: $868 a day.2
• 365 additional hospital days beyond Medicare's coverage.2
• Skilled nursing facility coinsurance, days 21 through 100: $217 a day.2

Part B:

• Annual deductible: $283 (the beneficiary pays this; Plan G does not cover it).2
• Coinsurance: 20 percent of the Medicare-approved amount, covered by Plan G.2
• Part B excess charges: up to 15 percent above the approved amount when a provider does not accept assignment, covered by Plan G.

Foreign travel emergency: a share of emergency care costs incurred outside the United States during the first 60 days of a trip, subject to a deductible and a lifetime maximum set in the standardized plan definition.

What Plan G does not cover: the Part B deductible ($283 in 2026), Part D prescription drugs (a separate plan is required), and services Medicare does not cover at all, such as routine dental, vision, hearing aids, and long-term custodial care.2

The Georgia Medigap Open Enrollment Period

The most important consumer protection in the framework is the Medigap Open Enrollment Period. In Georgia it is a six-month window that begins the first month a beneficiary is both age 65 or older and enrolled in Medicare Part B. During this window a carrier must issue any plan it sells regardless of health, charge the same premium it would charge a healthy applicant of the same age, and waive pre-existing condition waiting periods for anyone with at least six months of continuous prior creditable coverage. Without that prior coverage, an insurer may still refuse to cover out-of-pocket costs for a pre-existing condition for up to six months.1

For most people the window opens the month they turn 65. A beneficiary who delays Part B past 65 because of active employer coverage gets the window when Part B coverage actually starts, not at age 65.

The window matters more in Georgia than in birthday-rule states. Georgia has no annual guaranteed-issue window and no birthday rule, so a beneficiary who misses these six months faces medical underwriting on any later application, and a carrier may decline coverage or charge more based on health, except where a separate federal guaranteed-issue right applies.1 For Georgia families this is effectively a once-in-a-lifetime decision.

For the full mechanics, including the pre-existing condition limitation and how to count creditable coverage, see the Medigap open enrollment period in Georgia and the Medigap pre-existing condition waiting period.

The Medicare Advantage Trial Right

Georgians who chose Medicare Advantage at their first Medicare eligibility get a second chance. The 12-month Medicare Advantage trial right lets someone who joined an MA plan for the first time switch back to Original Medicare and buy any Medigap plan with guaranteed issue and no medical underwriting, provided they do so within those first 12 months. Beyond the trial right, other federal guaranteed-issue situations apply, such as moving outside an MA plan's service area, the plan leaving Medicare, or losing employer or union coverage that paid after Medicare; in most of them you must apply for the Medigap policy no later than 63 days after the prior coverage ends.5

Without it, switching to Original Medicare plus Medigap after the open enrollment window would require underwriting in Georgia.1 For who qualifies and how to time the switch, see the Medicare Advantage trial right and guaranteed issue in Georgia.

Guaranteed Renewability and the Ban on Duplicate Coverage

Any Medigap policy issued since 1992 is guaranteed renewable, so the carrier cannot cancel it as long as you stay enrolled and keep paying the premium.6 Guaranteed renewability is what makes Medigap durable: once you are in, your coverage holds however your health changes.

Federal law also makes it illegal to knowingly sell Medigap to a Medicare Advantage enrollee, because Medigap pays nothing toward services an MA plan covers. The narrow exception is the beneficiary who is switching back to Original Medicare, whose MA coverage will end before the Medigap policy takes effect. The same prohibition covers selling a second Medigap policy to someone who already holds one, absent a written statement that they will cancel the existing policy. The teeth are in Section 1882(d)(3)(A) of the Social Security Act: a violator can be fined under title 18 or imprisoned up to five years, or both, and faces a civil money penalty of up to $25,000 per prohibited act, or $15,000 where the seller is not the policy's issuer.7 Report any agent who attempts such a sale to the Georgia Office of Commissioner of Insurance and Safety Fire, whose number is in the help section below.

Georgia Carriers, Premiums, and Rating Methods

Because the benefits of a given plan letter are identical across carriers, shopping in Georgia comes down to price, rating method, premium history, and carrier service rather than coverage. Major Medigap carriers active in Georgia include AARP UnitedHealthcare, Anthem Blue Cross Blue Shield of Georgia, Cigna, Humana, Mutual of Omaha, and Aetna, among others.

Carrier-set Medigap premiums are not fixed by CMS; they vary by plan letter, age, geographic area, tobacco use, and the carrier's rating method, and they are not published as a single authoritative Georgia figure.2 To compare real quotes for your county and age, use the Medicare.gov Medigap policy search tool or call GeorgiaCares SHIP at 1-866-552-4464 for free, unbiased counseling.4

The federal framework recognizes three rating methods, but Georgia does not allow all three:

• Attained-age starts lower and rises as the beneficiary ages. Georgia bars it. R. 120-2-8-.15(7) provides that "an issuer shall not present for filing or approval a rate structure for its Medicare supplement policies or certificates issued after the effective date of the amendment of this regulation based upon attained age rating as a structure or methodology," and that amendment took effect September 23, 2009.1
• Issue-age sets the premium by age at enrollment and does not rise with age, only with approved general rate increases. Permitted in Georgia.1
• Community-rated charges every enrollee the same premium regardless of age. Also permitted in Georgia.1

So a Georgia policy issued today should be community-rated or issue-age rated. Note the shape of the rule: Georgia prohibits one structure rather than requiring another, so community rating stays on the table alongside issue-age. If a quote is described as rising each year because you are older, ask the carrier in writing which structure applies before you sign.1

Many carriers offer household discounts when two members of a household enroll, and most charge a surcharge for tobacco use; the size of each is set by the carrier, not by CMS. For how the three methods compare over a lifetime, see Georgia Medigap rating methods.

Georgia Medigap or Medicare Advantage

Each year Georgians choose between Original Medicare with Medigap and a Part D drug plan, or an all-in-one Medicare Advantage plan. The trade-off in brief:

• Original Medicare plus Medigap plus Part D accepts any Medicare provider nationwide, involves little prior authorization, and makes costs predictable, at the price of a higher monthly premium and no built-in dental, vision, or hearing benefits. It suits travelers, snowbirds, and anyone with high or specialized health needs.
• Medicare Advantage often carries a low or zero plan premium beyond Part B and bundles extras like dental and vision, but restricts you to a network, uses prior authorization, and exposes you to an annual out-of-pocket maximum that Medicare caps at $9,250 for in-network Part A and Part B cost-sharing in 2026, with plans free to set a lower limit. That cap does not apply to Part D drug spending, and a plan that covers out-of-network care sets a second, higher limit for combined in-network and out-of-network costs.2 Either way, the beneficiary still pays the standard Part B premium of $202.90 a month in 2026.2

For a full side-by-side and how to decide for your situation, see Medigap versus Medicare Advantage in Georgia.

How Medigap Interacts With Medicaid and Medicare Savings Programs

This is the most misunderstood point for lower-income Georgia families, and it can save or waste real money. The answer depends on which Medicare-Medicaid coordination program the beneficiary qualifies for, and the Medicare Savings Programs (MSPs) administered through Georgia Medicaid are central to it.

• Full Georgia Medicaid plus Qualified Medicare Beneficiary (QMB). These beneficiaries do not need Medigap. Under Section 1902(n)(3) of the Social Security Act, Medicare providers and suppliers may not bill a QMB enrollee for Medicare Part A or Part B cost-sharing, including deductibles, coinsurance, and copayments, so the cost-sharing Medigap exists to pay is already off the table.9 Buying Medigap here is wasted premium, and selling a Medigap policy to someone with Medicaid is prohibited except in limited circumstances.7 Georgia Medicaid also pays Part A and Part B premiums for these beneficiaries through the Medicare Buy-In.
• QMB only, without full Medicaid. The federal billing ban holds even where the state pays nothing toward that cost-sharing, so Medigap is generally unnecessary.9
• Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI). These programs pay only the Part B premium and do not cover deductibles or coinsurance, so Medigap can be useful, but premium affordability is the real constraint on a fixed income.

A family shopping for Medigap should disclose any Medicaid eligibility upfront, verify the agent is licensed by the Georgia Office of Commissioner of Insurance and Safety Fire, and use GeorgiaCares SHIP for unbiased guidance first. For the income and asset thresholds, see Georgia Medicare Savings Programs and Qualified Medicare Beneficiary (QMB) in Georgia.

Common Georgia Medigap Mistakes to Avoid

The decisions that cost Georgia families the most are nearly all about timing and eligibility, not plan choice.

• Missing the six-month open enrollment window. Georgia has only the federal minimum protections, so after the window an insurer can underwrite, decline, or surcharge based on health.1
• Treating all plans of one letter as different products. Benefits of a given letter are identical across carriers; only price and service differ, so always compare several quotes for the same letter.
• Being offered Plan F or Plan C when newly eligible after 1/1/2020. Both are closed to that group; an agent offering them is mistaken or worse.1
• Buying Medigap while enrolled in Medicare Advantage, which is prohibited, or while holding full Medicaid plus QMB, which is both wasteful and prohibited.
• Overlooking the Medicare Advantage trial right, the 12-month guaranteed-issue second chance for those who started in MA.
• Confusing Medigap with Part D. Medigap has not covered prescription drugs since the drug-bearing plans (H, I, J) were retired in 2006; a separate Part D plan is required.
• Skipping a Medicare Savings Program check. QMB enrollment can eliminate most of the reason to buy Medigap; low-income beneficiaries should check eligibility first.

Where to Get Help in Georgia

Start with free, unbiased counseling before you buy.

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.