Original Medicare vs a plan · Fulton County, GA · 2027 plan year
Original Medicare vs Kaiser Permanente Senior Advantage Standard (HMO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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Kaiser Permanente Senior Advantage Standard (HMO)
- Plan premium
- $34 a month
- Yearly limit, in network
- $7,150
- 2027 star rating
- 4.5 of 5
- Prior authorization needed for
- 17 services
In most states, including Georgia, you cannot count on getting Medigap later
You can buy any Medigap plan with no health questions in the 6 months that start when you are 65 or older and have Part B. After that, a Medigap company in Georgia can ask about your health. It can say no, or it can charge you more. So if you join a Medicare Advantage plan now, you may not be able to get Medigap later.
One exception is the trial right. If you joined Medicare Advantage when you first got Medicare at 65, or you left a Medigap plan to try Medicare Advantage for the first time, you can switch back within 12 months. Then you can buy a Medigap plan with no health questions.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Medicare.gov lists $145 to $469 a month for a 65-year-old woman who does not use tobacco. We start at the lowest price. Health questions can raise the price after your first 6 months with Part B.
Original Medicare
With Medigap Plan G at $145 a month and Wellcare Value Script (PDP)
$6,785 a year
- Premiums
- $4,318
- Medical costs
- $292
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $4,610.
Kaiser Permanente Senior Advantage Standard (HMO)
HMO from Kaiser Permanente
$4,571 a year
- Premiums
- $2,922
- Medical costs
- $1,085
- Drugs
- $564
Most you can pay in a bad year, before drugs: $10,072.
With these settings, Kaiser Permanente Senior Advantage Standard (HMO) costs about $2,214 less a year than Original Medicare.
Tipping point for Kaiser Permanente Senior Advantage Standard (HMO): with this drug use, if your medical copays and coinsurance in this plan pass $3,299 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $7,150.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: Plan G.
Primary doctor visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$0
Specialist visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$0-$30
Lab tests
Original Medicare + Medigap Plan G
$0
most Medicare-covered tests
Kaiser Permanente Senior Advantage Standard (HMO)
$0-$35
Prior authorization
MRI or CT scan
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$0-$290
Prior authorization
Emergency room
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$130
Urgent care
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$30
Outpatient surgery
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$300
Prior authorization
Ground ambulance
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$280
Prior authorization
Hospital stay, 5 days
Original Medicare + Medigap Plan G
$0
Plan G pays the $1,788 Part A deductible
Kaiser Permanente Senior Advantage Standard (HMO)
$1,900
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare + Medigap Plan G | Kaiser Permanente Senior Advantage Standard (HMO) |
|---|---|---|
| Monthly premium | Part B $209.50 + Medigap Plan G $145 + drug plan $5.30 | $34 + Part B $209.50 |
| Yearly limit on what you pay | You pay the $292 Part B deductible. Plan G pays the rest. | $7,150 in network |
| Medical deductible | $292 Part B. Plan G pays the $1,788 Part A deductible. | $0 |
| Primary doctor visit | $0, after the $292 yearly Part B deductible | $0 copay |
| Specialist visit | $0, after the $292 yearly Part B deductible | $0-$30 copay |
| Lab tests | $0, most Medicare-covered tests | $0-$35 copayPrior authorization |
| MRI or CT scan | $0, after the $292 yearly Part B deductible | $0-$290 copayPrior authorization |
| X-rays | $0, after the $292 yearly Part B deductible | $0-$50 copayPrior authorization |
| Emergency room | $0, after the $292 yearly Part B deductible | $130 copay |
| Urgent care | $0, after the $292 yearly Part B deductible | $30 copay |
| Outpatient hospital | $0, after the $292 yearly Part B deductible | $0-$300 copayPrior authorization |
| Surgery center | $0, after the $292 yearly Part B deductible | $300 copayPrior authorization |
| Ground ambulance | $0, after the $292 yearly Part B deductible | $280 copayPrior authorization |
| Hospital stay | $0, Plan G pays the $1,788 Part A deductible | $380 per day for days 1-6; $0 per day for days 7-90Prior authorization |
| Skilled nursing facility | $0, Plan G pays days 21-100 | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | $0, after the $292 yearly Part B deductible | $30 copay |
| Physical therapy | $0, after the $292 yearly Part B deductible | $30 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization |
| Medical equipment | $0, after the $292 yearly Part B deductible | 0%-20% coinsurancePrior authorization |
| Part B drugs | $0 after the $292 Part B deductible | $0-$47 copay, 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Wellcare Value Script (PDP) | $0 |
| Drug tiers (one month, retail) | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 47% coinsuranceInjectable Drugs: 15% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $11 copay | Preferred Generic: $0 copayGeneric: $0 copayPreferred Brand: $47 copayNon-Preferred Drug: $100 copaySpecialty Tier: 32% coinsuranceVaccines: $0 copay |
Not sure which of these costs apply to you?
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A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Georgia, 9 drug plans are for sale for 2027, from $5.30 to $216.80 a month. Half of them cost $145.70 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules, and you may not be able to get Medigap later.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Kaiser Permanente Senior Advantage Standard (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 17 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Psychiatrist visits, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Kaiser Permanente Senior Advantage Standard (HMO) |
|---|---|---|
| Dental | No | Comprehensive |
| Eye exam | No | Yes |
| Glasses or contacts | No | Yes, $500 allowance |
| Hearing aids | No | No |
| Over-the-counter allowance | No | $340 a year |
| Fitness benefit | No | Yes |
| Rides to care | No | Yes |
| Meals after a hospital stay | No | No |
| Emergency care abroad | Plan G and Plan N pay 80% after a $250 deductible | Yes |
| Part B premium giveback | No | No |
What changed for 2027
Kaiser Permanente Senior Advantage Standard (HMO)
Renewal Plan · 2026 plan H1170-016-0
- In-network out-of-pocket maximum up from $6,500 to $7,150
- Specialist visit: $0-$25 copay to $0-$30 copay
- Urgent care: $25 copay to $30 copay
- Inpatient hospital: $335 per day for days 1-6; $0 per day for days 7-90 to $380 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
More 2027 plans in Fulton County
- Humana Gold Plus H4141-017 (HMO)
- HumanaChoice Giveback H7617-094 (PPO)
- HumanaChoice Giveback H5216-345 (PPO)
- Humana USAA Honor Giveback (PPO), H5216-286
- Humana Gold Plus Giveback H4141-022 (HMO)
- Kaiser Permanente Senior Advantage Basic 1 (HMO), H1170-009
- AARP Medicare Advantage from UHC GA-10 (HMO-POS), H5322-053
- Aetna Medicare Elite (PPO), H5521-091
County guide: 2027 plans in Fulton CountyState guide: Georgia
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Medigap prices are the range Medicare.gov showed for ZIP 30303 on 2026-10-09. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Kaiser Permanente Senior Advantage Standard (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 30303 on Medicare.gov
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.