TABLE OF CONTENTS
Looking for a health care plan in Georgia? You have various options available. You may receive healthcare 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 over 65 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.
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:
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?
Consider the types of insurance available to you:
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. 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 federal poverty level, 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.
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.
|Average premium in Georgia||2018||2019||2020||2021|
|Most affordable bronze plan||$410||$354||$347||$348|
|Most affordable silver plan||$470||$460||$430||$443|
|Most affordable gold plan||$587||$538||$491||$463|
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.
You are eligible for Medicaid in Georgia if you have low income and fit in one of the following categories:
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 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 1-877-427-3224 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.
As of 2019, there were 63 Medicare Advantage Plans available in Georgia. You can only select a plan open to you 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 and Enrollment|
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. Two companies offer short-term healthcare insurance in Georgia:
Georgia state law requires citizens to have health care, but there is no penalty if you go without.
If you want to qualify for subsidized individual insurance, you need to go through the marketplace. But you can also purchase health care in Georgia through a broker, online, or directly from an insurance company.
You may find cost-sharing health plans available in Georgia. These plans are typically faith-based, but you don’t necessarily have to be a member of a particular denomination to sign up. Cost-sharing plans share health costs among members but come with many limitations. For one, the plans aren’t health insurance plans and aren’t legally obligated to pay out any claims. The plans may not cover pre-existing conditions and sometimes don’t provide for other health situations like pregnancy or mental health care, so read the fine print before signing up.
Unless you can pay for your health care needs entirely out of pocket, you should have health insurance, even if you have an HSA or FSA. You’ll need a qualifying high-deductible health plan to contribute to a Health Savings Account. And while an HSA or FSA can help pay for deductibles, copays, and coinsurance, it’s best to minimize your financial exposure with insurance that puts a limit on your out-of-pocket costs.
It depends upon the nature of your job. Disability coverage pays for everyday household expenses such as the mortgage or groceries. It is not designed to pay for health insurance, nor is health insurance designed to pay for household maintenance expenses in the event of a disability. Short-term disability coverage is a good idea if you work on a job where there is a high possibility of an injury.
If you work in a job where a long-term injury is a real possibility, purchasing a long-term disability plan is a good idea. It will help you pay for the costs that accumulate while you’re recovering from an injury and unable to work.
PeachCare for Kids covers visits to primary care physicians and specialists, dental and vision care, emergency room services, hospitalizations, prescription medicines, and mental health care.