Georgia 2026 Plan Highlights

We encourage all agents to review the full plan documents—such as the Summary of Benefits, Evidence of Coverage, and the Annual Notice of Coverage (ANOC)—to gain a complete and detailed understanding of our health care plans. These official documents contain the full list of covered services, cost-sharing, limitations, and rules, and they should always be your primary reference for confirming specific benefits or answering detailed questions. You can find them HERE.

At the same time, we understand that you often need to quickly compare options, highlight key differences, and explain our plans in clear, simple terms. For that reason, we created this overview of our plan highlights to give you a concise, easy-to-use snapshot of the most important features and extra benefits. This summary is designed to help you distinguish our plans from those of other carriers, support side-by-side comparisons, and guide members more confidently toward the coverage that best fits their health and budget needs.

📝2026 Georgia HMO C-SNP Plan Benefits:

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) H6672-003

• $0 Monthly Premium (must continue to pay Medicare Part B premium)
• Maximum Out-of-Pocket: $6,751
• Copays:
  • $0 for PCP
  • $0 for Endocrinologist
  • $35 for other Specialists
  • $200 for Ambulatory Surgery Center
• Dental: up to $2,000 max per non-Medicare-covered comprehensive dental services
• Vision: up to $250 max per year for non-Medicare-covered eyewear
• Groceries: up to $70 per month (does not carry over)
• OTC: up to $50 per month (does not carry over)
• Wellness Program: up to $575 in Better Health 4 You Program
• Transportation: 12 one-way trips every year to plan-approved locations

📝2026 Georgia HMO Plan Benefits:

Clear Spring Health BrightPath Advantage (HMO) H6672-005

• $0 Monthly Premium (must continue to pay Medicare Part B premium)
• Maximum Out-of-Pocket: $4,200
• Copays:
  • $0 for PCP
  • $0 for Endocrinologist
  • $35 for other Specialists
  • $295 Inpatient Hospital Days 1-7
  • $200 Ambulatory Surgery Center
• Dental: up to $3,000 max per non-Medicare-covered comprehensive dental services
• Vision: up to $200 max per year for non-Medicare-covered eyewear
• Groceries: up to $60 every 3 months (does not carry over)
• OTC: up to $50 every 3 months (does not carry over)
• Wellness Program: up to $150 in Better Health 4 You Program
• Transportation: 12 one-way trips every year to plan-approved locations

📝2026 Georgia PPO Plan Benefits:

Clear Spring Health BrightPath Advantage (PPO) H9589-003

• $0 Monthly Premium (must continue to pay Medicare Part B premium)
• Maximum Out-of-Pocket $9,250 (combined In and Out-of-Network)
• Copays (In-Network)
  • $0 PCP
  • $0 Endocrinologist
  • $25 for other Specialists
  • $295 Inpatient Hospital for Days 1-7, OON $395 for days -1-7
  • $175 Ambulatory Surgery Center
• Dental: up to $2,000 max per non-Medicare-covered comprehensive dental services
• Vision: up to $200 max per year for non-Medicare-covered eyewear
• OTC: up to $50 every 3 months (does not carry over)
• Wellness Program: up to $150 in Better Health 4 You Program

🚨Remember, to enroll in a Chronic Condition Special Needs Plan (C-SNP), your client must have at least one qualifying chronic condition, such as diabetes, chronic heart failure, or certain cardiovascular disorders. This condition must be documented and verified by their healthcare provider after the application is submitted. The plan enrollment is considered “pending” until that verification is received. Learn more HERE.

To qualify for HSBCI for HMO plans, a health risk assessment (HRA) must be submitted and verified with other data sources. Must have one of the qualifying chronic illnesses, which are diabetes, COPD, chronic heart failure, or chronic kidney disease. Not available on PPO plans. Refer to Evidence of Coverage for full details.

For transportation benefits, any trip over 25 miles requires prior authorization.