Georgia Health Insurance: Find Affordable Plans

Are you looking for an affordable health insurance plan in Georgia? You have various options available. You may receive health insurance through your employer or buy a plan from the Health Insurance Marketplace. Medicaid is available if you have low income, and Medicare is available if you’re age 65 and older or have a qualifying disability.

Read on to look at these options in detail and make the best health care selection for yourself and your family.

• Marketplace plans: You can purchase a plan through the Health Insurance Marketplace if you don’t have employer health coverage or your employer’s plan is inadequate for your needs. All Affordable Care Act (ACA)-compliant plans are guaranteed issue, which means the plans provide coverage for preexisting conditions and mental health care.
• Alternative enrollment: You also have the option to buy a health care policy off the exchange through a broker, an insurance agent, or a private company. Alternatively, you can purchase a short-term health care policy that provides insurance for a limited period.
• Open enrollment: Open enrollment for insurance coverage beginning in 2023 in Georgia starts October 15 and ends December 7, 2022. If you want to enroll outside of this time frame, you will need to qualify for a special enrollment with a life event. Qualifying events include getting married, having a baby, losing your job, or moving.
• Coverage types: About half of Georgia residents get health insurance through an employer (48.9%), followed by Medicare (17.3%), then Medicaid (12.6%). Non-group insurance, such as marketplace plans or short-term insurance accounts for 5.6%, while the military provides health coverage for 2.2%. About 13.4% are uninsured.

You can enroll in Georgia’s health insurance marketplace via the HealthCare.gov website. When you register, you’ll provide personal information, such as your date of birth, Social Security number, family income, and the number of people in your household. Your plan premiums are mainly determined by estimated annual household income and household size. Using this information, HealthCare.gov presents you with available plans and how much of a subsidy you can expect. You’ll be able to compare three plans at a time to help you find the best health care for the best cost. Six health insurance companies offer marketplace plans in Georgia:

• Aetna CVS Health
• Ambetter From Peach State Health Group (Centene)
• Blue Cross Blue Shield Healthcare Plan of Georgia
• CareSource
• Cigna Healthcare of Georgia, Inc.
• Friday Health Plans
• United Healthcare

Answer important questions as you select health care for yourself or your family: What are your current coverage needs from a health insurance plan? Do you just visit the doctor once a year for your annual physical, or do you need regular care or expect a major surgery?

• If you have minimal health care needs, consider a plan that balances an affordable premium with a reasonable deductible that you can meet in a worst-case scenario.
• Suppose you have a chronic condition that requires regular and frequent visits to the doctor. In that case, your best bet may be to select a health care plan with a lower deductible, so the plan covers significant medical expenses sooner as you meet that deductible earlier in the year.

Insurance for individuals in Georgia

Consider the types of insurance available to you:

• A Health Maintenance Organization (HMO) plan offers fewer up-front costs. If you’re healthy and make limited doctor visits, this may be a good choice. The drawback: there are more restrictions with an HMO plan. You can only use the plan’s in-network medical providers, you will be assigned a local primary care physician, and you’ll need to get a referral if you want to see a specialist.
• A Preferred Provider Organization (PPO) plan allows you to use both in-network and out-of-network medical providers. It gives you greater flexibility in health care choices, although it can be more costly. Additionally, you don’t need to name a primary care physician nor obtain referrals to see a specialist.
• A Point-of-Service Plan (POS) provides a mix of benefits. You’ll need a referral to see a specialist, but you aren’t limited to in-network medical providers.

If you don’t want to purchase a plan through the HealthCare.gov Marketplace, you can buy plans off-exchange. These are health care plans sold through a broker or directly from the insurance company. It is possible for a plan to be off-exchange and still be ACA-compliant.

The main difference between on-exchange and off-exchange plans is that the off-exchange plans do not offer the tax credits or subsidies available through marketplace plans. You can earn premium tax credits that lower premiums if your projected annual household income is between 100% to 400% of the Federal Poverty Level (FPL). You may also be eligible for cost-sharing reductions (CSRs) if you select a silver plan on HealthCare.gov.

If your annual household income exceeds 400% of the FPL, an off-exchange health insurance plan may offer savings. You may have to do more research to find the right plan as these options aren’t as plainly presented as your options on the marketplace.

Insurance for families in Georgia

Questions about health care that involve an entire family become a little more complex. If you’re healthy, but your spouse or one of your children has a chronic health concern, it will affect the kind of plan you select. It’s possible to select different health plans for different family members, but you’ll need to shop separately.

An HMO is a good choice if your family is healthy overall. This plan makes sense if you don’t make many doctor visits and if your health care needs are minimal. On the other hand, if you or another family member has a chronic health condition and needs regular specialist visits, it might be a better idea to investigate a PPO plan or a POS plan.

Balance how much you can pay for a monthly premium and how much you can afford in out-of-pocket costs charted against the value the plan provides in coverage.

Any plan sold on Georgia’s insurance marketplace or off-exchange is required to have the same cost by law. Plans sold on HealthCare.gov use the metal tier system: Bronze, Silver, Gold, and Platinum. The different metal tiers do not signal a difference in the kind of health care you will receive, but tiers indicate a difference in monthly premium and out-of-pocket costs:

• Bronze plans are suitable for healthy people with few medical needs. The plans feature low monthly premiums but high deductibles. There is also a high coinsurance payment of 40%. The most affordable Bronze plan in Georgia has a monthly premium of $328.
• Silver plans are suitable for people with more complicated health situations. The plans offer lower deductibles, which is good if you need to make frequent doctor visits, but you’ll pay more in a monthly premium. The coinsurance fee also costs less at 30%. Silver plans offer CSRs for individuals who qualify financially, which results in lower deductibles. Sometimes, the bottom line cost on a Silver plan is lower than a Bronze plan. The lowest-priced Silver plan in Georgia is $411 per month.
• A Gold or Platinum A Gold or Platinum plan is appropriate if you have significant health issues and need regular doctor visits or have numerous prescriptions. Be prepared as you will pay more for monthly premiums with these plans. You will save money on coinsurance payments (20% for gold and 10% for platinum). The lowest-priced Gold plan in Georgia costs $433 a month.

There are 2,092,114 residents of Georgia enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) — known in Georgia as PeachCare for Kids — which provides health coverage for children up to the age of 18.

Medicaid in Georgia

You are eligible for Medicaid in Georgia if you have low income and fit in one of the following categories:

• You are 65 or older
• You think you are pregnant
• You are 18 or younger
• You are legally blind
• You have a qualifying disability
• You require nursing home care

Qualifying financial limits vary depending on your category. Resource limits, including most kinds of funding such as Social Security and pensions, are $2,000 a year for individuals, $3,000 for a couple, and $4,000 for a medically needy couple.

PeachCare for Kids

PeachCare for Kids is a comprehensive program that provides health coverage for uninsured children in Georgia. Even if you don’t qualify for Medicaid, your children may still be eligible for PeachCare.

The program includes doctor’s visits to primary care physicians and specialists, dental and vision care, emergency room services, hospitalizations, prescription medicines, and mental health care — call (877) 427-3224 for more information.

If you’re 65 or older or if you have a qualifying disability, you’re eligible for Medicare, the federal government program that provides health coverage for these groups.

• When you first enroll in Medicare, you’ll get Original Medicare, which includes Part A (hospitalization, home care, hospice, and skilled nursing care) and Part B (ambulance services, mental health care, doctor’s visits, and durable medical equipment). Original Medicare does not provide any limits on out-of-pocket costs, and a Medicare Part D prescription drug plan requires an additional cost. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• You can select a Medicare Advantage Plan, an alternative to Original Medicare known as Medicare Part C. There are four different types of Medicare Advantage Plans: HMOs, PPOs, Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs). These plans offer benefits beyond Original Medicare, such as vision, dental, and hearing. Many Medicare Advantage Plans offer prescription drug coverage. As of 2023, there are 627 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

You can manage the out-of-pocket costs of Original Medicare with a Medicare Supplement Insurance plan, also known as Medigap, which can help pay for deductibles, copays, and coinsurance and provide international coverage. While Medigap can help with out-of-pocket costs, it won’t provide dental, hearing, vision coverage, or long-term care insurance and doesn’t work with a Medicare Advantage Plan.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

Many resources in Georgia help seniors and the disabled select the most appropriate plan for them. Need help getting information on Medicare? The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers free, unbiased, and confidential information on Medicare and other health care options in Georgia. None of the trained volunteers work for an insurance company, nor will they ever try to sell you a plan. You can call to get help at 1-877-423-4746 or arrange an in-person consultation.

Yes, there are short-term health insurance options available in Georgia. Short-term health insurance offers limited coverage for a short period. It’s appropriate if you’re between jobs or miss the enrollment period for the marketplace. Short-term health plans are convenient and relatively inexpensive but aren’t ACA-compliant. The plans don’t cover pre-existing conditions, pregnancy, or mental health care. Short-term health insurance can last up to 364 days and can be renewed for up to 36 months, although insurers can sell plans as short as one month’s duration of coverage.

• CMS.gov: Medicare Open Enrollment | Last accessed December 22, 2022
• GeorgiaCares: State Health Assistance Insurance Plan | Last accessed December 22, 2022
• KFF: Health Insurance Coverage of the Total Population | Last accessed December 22, 2022
• Healthcare.gov: Cost-Sharing Reduction | Last accessed December 22, 2022
• HealthCare.gov: Dates and deadlines for 2021 health insurance | Last accessed December 22, 2022
• HealthCare.gov: Deductible | Last accessed December 22, 2022
• HealthCare.gov: Health Maintenance Organization (HMO) | Last accessed December 22, 2022
• HealthCare.gov: Point of Service (POS) Plans | Last accessed December 22, 2022
• HealthCare.gov: Preferred Provider Organization (PPO) | Last accessed December 22, 2022
• HealthCare.gov: The ‘metal’ categories: Bronze, Silver, Gold & Platinum | Last accessed December 22, 2022
• Healthcare.gov: Premium Tax Credit | Last accessed December 22, 2022
• Medicaid.gov: Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels | Last accessed December 22, 2022
• Medicare.gov: Part A & Part B sign up periods | Last accessed December 22, 2022
• National Academy for State Health Policy: Georgia CHIP Fact Sheet | Last accessed December 22, 2022