Georgia Health Advantage (HMO I-SNP) By Georgia Health Advantage

Georgia Health Advantage (HMO I-SNP) H8093 001 0 is a 2023 Medicare Advantage Special Needs Plan plan by Georgia Health Advantage. This plan from Georgia Health Advantage works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Georgia Health Advantage and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Georgia Health Advantage (HMO I-SNP) H8093-001 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.

2023 Medicare Special Needs Plan Details

Plan Name:Georgia Health Advantage (HMO I-SNP)
Plan ID:H8093 001 0
Special Needs Type:Institutional
Provider:Georgia Health Advantage
Plan Year:2023
Plan Type:Local HMO
Monthly Premium C+D:$37.30
Part C Premium:$0
Part D (Drug) Premium:$37.30
Part D Supplemental Premium$0
Total Part D Premium:$37.30
Drug Deductible:$505.00
Tiers with No Deductible:0
Benchmark:below the regional benchmark
Type of Medicare Health Plan:Defined Standard Benefit
Drug Benefit Type:Basic
Gap Coverage:No
Similar Plan: H8093-002

The Georgia Health Advantage (HMO I-SNP) H8093-001 is available to residents to Medicare eligible seniors in Georgia. All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Georgia Health Advantage (HMO I-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

How much does Georgia Health Advantage (HMO I-SNP) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Georgia Health Advantage charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Georgia Health Advantage (HMO I-SNP) has a monthly drug premium of $37.30 and a $505.00 drug deductible. This Georgia Health Advantage plan offers a $37.30 Part-D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Georgia Health Advantage above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $37.30. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Georgia Health Advantage Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Georgia Health Advantage plan does not offer additional coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Georgia Health Advantage (HMO I-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $9.30 for 75% low-income subsidy $18.60 for 50% and $28.00 for 25%.

Full Assistance Premium:$0
75% Assistance Premium:$9.30
50% Assistance Premium:$18.60
25% Assistance Premium:$28.00

H8093-001 Formulary and Drug Coverage

Georgia Health Advantage (HMO I-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Tier 1 NA 25%
The complete Georgia Health Advantage (HMO I-SNP) H8093-001 Formulary
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what Georgia Health Advantage (HMO I-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Georgia Health Advantage helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Not covered

Contact lenses

Vision$0 copay

Eyeglass frames

Vision$0 copay

Eyeglass lenses

Vision$0 copay

Eyeglasses (frames and lenses)

Vision$0 copay


VisionNot covered

Routine eye exam

Vision$0 copay


Vision$0 copay

TransportationNot covered
Skilled Nursing Facility$0 per day for days 1 through 20
$0 per day for days 21 through 100

Occupational therapy visit

Rehabilitation services0-20% coinsurance

Physical therapy and speech and language therapy visit

Rehabilitation services0-20% coinsurance


Preventive dentalNot covered

Dental x-ray(s)

Preventive dentalNot covered

Fluoride treatment

Preventive dentalNot covered

Oral exam

Preventive dentalNot covered

Preventive care$0 copay
Outpatient hospital coverage20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo

Inpatient hospital - psychiatric

Mental health servicesIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90

Outpatient group therapy visit

Mental health services20% coinsurance

Outpatient group therapy visit with a psychiatrist

Mental health services20% coinsurance

Outpatient individual therapy visit

Mental health services20% coinsurance

Outpatient individual therapy visit with a psychiatrist

Mental health services20% coinsurance


Medicare Part B drugs20% coinsurance

Other Part B drugs

Medicare Part B drugs20% coinsurance

Diabetes supplies

Medical equipment/supplies$0 copay

Durable medical equipment (e.g., wheelchairs, oxygen)

Medical equipment/supplies20% coinsurance per item

Prosthetics (e.g., braces, artificial limbs)

Medical equipment/supplies20% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,300 In-network
Inpatient hospital coverageIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90


Hearing$0 copay

Hearing aids

Hearing$0 copay

Hearing exam

Hearing20% coinsurance

Health plan deductible$226 per year for in-network services.
Ground ambulance20% coinsurance

Foot exams and treatment

Foot care (podiatry services)20% coinsurance

Routine foot care

Foot care (podiatry services)$0 copay


Emergency care/Urgent care20% coinsurance per visit (always covered)

Urgent care

Emergency care/Urgent care20% coinsurance per visit (always covered)


Doctor visits$0 copay


Doctor visits20% coinsurance per visit

Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging20% coinsurance

Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging20% coinsurance

Lab services

Diagnostic procedures/lab services/imaging$0 copay

Outpatient x-rays

Diagnostic procedures/lab services/imaging20% coinsurance

Diagnostic services

Comprehensive dentalNot covered


Comprehensive dentalNot covered


Comprehensive dentalNot covered

Non-routine services

Comprehensive dentalNot covered


Comprehensive dentalNot covered

Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dentalNot covered

Restorative services

Comprehensive dentalNot covered

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No

CMS Star Ratings

Is Georgia Health Advantage (HMO I-SNP) a good plan? Georgia Health Advantage (HMO I-SNP) received 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Special Needs Plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Georgia Health Advantage (HMO I-SNP) performance among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with H8093-001 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for Georgia Health Advantage

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Special Need Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Georgia Health Advantage (HMO I-SNP) requires you to live in that plan’s service area. The service area is listed below:

Source: CMS.

Plans as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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