Georgia currently doesn’t have a state-run health exchange from where one can directly get quotes, so the federal health exchange direct people seeking information and quotes on health insurance plans to different approved insurance brokers and exchanges. As per early 2019, enrollments in health insurance in Georgia’s exchange were more than 417,000 people. Georgia healthcare exchange is an online insurance marketplace operating for individuals and families residing in this state. For 2020 health plan enrollments in Georgia, the open enrollment period starts November 1, 2019 and ends on December 15, 2019.
Top Health Insurance plan in Georgia
- Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Anthem Catastrophic Pathway X Guided Access HMO 8550
Deductible $8550/yrCoinsurance6%Insurance Type HMOHSA Eligible No
- Kaiser Permanente
KP GA Signature Catastrophic 8550/0
Deductible $8550/yrCoinsurance3%Insurance Type HMOHSA Eligible No
- Kaiser Permanente
KP GA Signature Bronze 5000/50
Deductible $6500/yrCoinsurance3.7%Insurance Type HMOHSA Eligible No
- Kaiser Permanente
KP GA Signature Bronze 6500/40%/HSA
Deductible $6500/yrCoinsurance5%Insurance Type HMOHSA Eligible Yes
- Ambetter from Peach State Health Plan
Ambetter Essential Care 1 (2021)
Deductible $8300/yrCoinsurance3%Insurance Type HMOHSA Eligible No
Latest news and updates from Georgia Insurance Marketplace
- Open enrollment period for 2020 insurance plan coverage will start from November 1 and end on December 15, 2019.
- In 2019 the average rate increase was less than 4% and the insurance companies have proposed an average rate increase of just 2.4% in 2020.
- The four participating insurers of 2019 will be joined by two more insurers, Oscar Health and CareSource.
- Short-term health plans are available in the state with initial plan terms of up to 364 days.
Individuals and Family Health Insurance in Georgia
After several years of substantial rate increases, Georgia’s individual health insurance market now seems to be stabilizing. In 2019 the average rate increase was less than 4 percent, and insurers have proposed an average rate increase of just 2.4 percent for 2020. In individuals and families plans in 2019 there was addition of short-term plans and Christian Medi-Share coverage. Purchasing health insurance might often seem a challenge for most individuals and families in Georgia. Individual and family health insurance plans in Georgia that comply with the Affordable Care Act are usually expensive, though the price of the plans mostly depend on the county you live in. ACA compliant individual and family plans are expensive because these plans have comprehensive coverage and include benefits like maternity, prescription drugs and mental health services and also include expenses for pre-existing conditions and it ensures that no one is denied insurance based on their pre-existing health conditions. Since, everyone cannot afford to pay the hefty premium amount so government has introduced programs such as subsidies to help residents offset the costs. Individuals who do not qualify for a subsidy can look for a plan with a high deductible. People of some counties in Georgia can obtain a Catastrophic level health plan that has the lowest premiums and also cover less.
Georgia has following types of Individual and Family health insurance plans available through the marketplace:
Health Maintenance Organization
In this plan beneficiaries have access to a network of doctors who are in contract with the HMO. It does not cover out-of-network care except in an emergency. These plans provide integrated coverage and focus on prevention and wellness of the individuals.
Point of Service
This is the most affordable plans available to individuals especially if they visit doctors, hospitals and other health care providers that are associated with the plan’s network. In this plan members will require to get a referral from their primary care doctor if they have to see a specialist.
Preferred Provider Organization
Members enrolled in this plan pay less amount from their pocket if they avail healthcare services from the plan’s network doctors. Though, members can avail services from outside network doctors, hospitals and providers without a referral but by paying an additional cost.
Exclusive Provider Organization
Members enrolled in this plan are covered only if they avail services from the network doctors, specialists or hospitals except in an emergency.
Short-term Health Insurance in Georgia
Georgia defaults to the federal regulations, as it does not have state-specific regulations for short-term health insurance plans. Individuals who missed the open enrollment period and even don’t qualify for a special enrollment, then there is a temporary option available in Georgia known as short term health plans. Short-term plans are temporary alternative to the insurance plans which individuals can buy. This plan is ideal for all those individuals who missed the window to sign for ACA compliant plan, or were dropped from an employer or parent’s plan, or who are retired and waiting for Medicare benefits to start because it covers the basics like unforeseen accidents, illness and hospital visits. The short-term health insurance plan in Georgia can be purchased at any time from the private insurance carrier. Individuals can purchase this plan in Georgia for up to 364 days and can also obtain back-to-back policies for up to 36 months. Every policy constitutes a new term and individuals need to reapply for it and they can even be denied. These plans offers just a basic coverage and are more limited form of health insurance and only offer a layer of financial protection for unforeseen accidents and illness and are not comprehensive health insurance.
Dental Plans in Georgia
Leading insurance carriers provide different types of dental insurance plans in Georgia that mainly differs in terms of price, and coverage. Dental insurance in Georgia works in similar manner as health insurance. Individuals with dental insurance pay a monthly premium for which they are entitled of certain dental benefits like regular checkups, cleanings, x-rays and services to promote general dental health. In Georgia both Indemnity and managed care dental plans are available.
Managed-care plans maintain networks of dental care providers and the participating dentist in the network agree to render dental are services at pre-negotiated rates and bill is submitted to the insurance carrier by the dentists. Individuals usually have lower out-of-pocket costs with a managed care dental plan.
Indemnity plans offer a broader selection of dental care and carrier pays for the covered dental services only after receiving a bill. Indemnity plan provides broader choice of dentists to people of Georgia.
Georgia Vision Plans
Vision insurance in Georgia can be availed through private insurance carrier that offers coverage for the eye-care services rendered by ophthalmologists and optometrists. The vision insurance plans in Georgia generally provide coverage for eye examination along with partial or full coverage of eyeglasses, sunglasses, and contact lenses with or without co-pays depending upon the plan chosen by the individual.
FAQ on Georgia Health Insurance
Georgia’s residents need to know that they won’t face a tax penalty for going without health insurance in 2020, however, there are big downsides of being uninsured. The ACA tax penalty that was earlier imposed on the residents has been repealed in 2019, which means that individuals who don’t have health insurance coverage in 2019 will not have to pay a penalty while filing their taxes in the year. Though there is no more tax penalty, but still residents should carefully decide whether it will be wise to forego health insurance. Sudden medical emergencies can create havoc on the financial conditions of the residents and could do more damage than the penalty, so it is always wise to have proper health insurance in place.
The open enrollment period in Georgia for 2021 health plans will start from November 1, 2020, and will end on December 15, 2020. Only residents with qualifying even can still enroll or make changes in their plans offering coverage for 2020. Georgia has the federally run health insurance exchange, so people can enroll in the health plans through HealthCare.gov.
There are four ways through which you can apply for coverage in the health insurance marketplace. You can apply online by visiting the site HealthCare.gov, apply by phone, apply in person by getting touch with a trained counselor of your community to avail information and enroll in person, and you can even apply for a health plan by mail where you will need to complete a paper application and mail it.
After comparing all health plans on the Georgia marketplace, the cheapest health plan in each metal-tier for a 40-year old individual in 2020 are:
In the Catastrophic category, the cheapest health plan is Anthem Catastrophic Pathway X Guided Access HMO 8150 plan having a monthly premium of $257.
In the Bronze category, the cheapest health plan is the Ambetter Essential Care 1 plan having a monthly premium of $319.
In the expanded Bronze category, the cheapest health plan is the CareSource Marketplace bronze plan having a monthly premium of $308.
In the Silver category, the cheapest health plan is Ambetter Balanced Care 11 having a monthly premium of $367.
In the Gold category, the cheapest health plan is Ambetter Secure Care 5 having a monthly premium of $412.
In the Platinum category, the cheapest health plan is SoloCare Platinum PPO 40023 Murray plan having a monthly premium of $503.
Yes, short-term health plans can be sold in Georgia with the initial plan terms of up to 364 days and can be renewed for up to 36 months, as the state follows federal regulations for the short-term plans. A short-term health plan is really a good option for people who have missed open enrollment or who are currently between jobs. Individuals looking to purchase short-term plans should be aware that these plans do not cover essential health benefits.
Individuals shopping for health insurance plans in Georgia will find plenty of options, as of right from employer-sponsored health plans, to ACA-compliant individual and family health plans, to short-term plans, to government-funded Medicare and Medicaid plans.
Georgia’s exchange has four participating insurers in 2019 which were Alliant, Ambetter or Centene, Blue Cross Blue Shield of Georgia, and Kaiser. All these four carriers will continue to offer exchange plans in the year 2020, and the exchange has been joined by the two more carriers Oscar Health and CareSource for offering coverage in 2020.