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Healthcare Advisor

Dr. Noor Ali is a licensed medical doctor and surgeon with an established national health insurance consulting practice serving clients in 34+ states.

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.

What to know about health insurance in Georgia

  • 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 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 in Georgia starts no earlier than October 1 and ends no later than November 15. If you want to enroll outside of this timeframe, 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.
  • Open Enrollment extension:This year, Georgia extended Open Enrollment to August 15, 2021, due to the COVID-19 pandemic. You don’t need a qualifying life event to enroll in a marketplace plan during the extended Open Enrollment.
  • Coverage types: About half of Georgia residents get healthcare through an employer (48.9%), followed by Medicare (17.3%), then Medicaid (12.6%). Nongroup 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.

How do I enroll in Georgia’s health insurance marketplace?

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:

  • Alliant
  • Ambetter From Peach State Health Group (Centene)
  • Blue Cross Blue Shield Healthcare Plan of Georgia
  • CareSource
  • Kaiser Permanente
  • Oscar

How do I enroll in Georgia individual and family insurance?

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 plan (HMO) 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. 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.

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.

How much does health insurance cost in Georgia?

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

  • 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 $348.
  • 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 $443 per month.
  • A gold or platinum plan is appropriate if you have significant health issues and need regular doctor visits or have numerous prescriptions. Be prepared; 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 $463 a month.

What kind of low-income health insurance is available in Georgia?

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 1-877-427-3224 for more information.

What are Georgia’s Medicare options for seniors and people with disabilities?

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.
  • 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 Plans, and Special Needs Plans. These plans offer benefits beyond Original Medicare, such as vision, dental, and hearing. Many Medicare Advantage Plans offer prescription drug coverage.

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
Eligibility
  • A U.S. citizen or a permanent resident who has legally resided in the U.S. for the past five years
  • At least 65 or have a qualifying disability such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS — also known as Lou Gehrig’s disease)
Enrollment
  • Initial Enrollment begins three months before you turn 65, the month of your 65th birthday, and the three months following your birthday month.
  • Open Enrollment takes place between October 15 and December 7. You can move from Original Medicare to a Medicare Advantage Plan, return to Original Medicare from a Medicare Advantage Plan or switch between Medicare Advantage Plans.
  • If you change counties in Georgia, you’re eligible for the Special Enrollment Period.

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.

Are there short-term health insurance plan options in Georgia?

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:

  • National General
  • United Healthcare

Georgia insurance FAQs

Does Georgia require health insurance?

Georgia state law requires citizens to have health care, but there is no penalty if you go without.

Do I have to use the Health Insurance Marketplace in Georgia?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Georgia?

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.

Do I need health insurance if I have HSA/FSA?

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.

Do I need short-term disability coverage in Georgia if I have health insurance?

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.

Do I need long-term disability coverage in Georgia if I have health insurance?

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.

What does PeachCare for Kids cover?

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.

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