Affordable health insurance plans in Georgia are available for individuals, families and small businesses. Pre-existing conditions are covered without any waiting periods or surcharges, and Marketplace large federal subsidies can drastically reduce premiums. We provide free online quotes for Ga. consumers and help simplify the enrollment process. Compare the best policies in minutes.
Seniors can shop for the best Medicare Supplement/Medigap plans and lower out-of-pocket expenses. Advantage contracts are also available as an alternative to original Medicare coverage. Many of these plans include prescription drug benefits. Part D plans are also offered with many copay options. When you reach age 65, typically there is a seven-month enrollment window that allows you to review and apply for coverage without medically qualifying.
The Obamacare Impact
Whether you live in Atlanta, Macon, Savannah or any other city in the state, you may be eligible for a substantial federal subsidy to help pay your private healthcare Exchange premium. Courtesy of the ACA (Affordable Care Act) legislation, if your household income is under 400% of the Federal Poverty Level (FPL), you get free money. And if it’s under 250%, you qualify for special “cost sharing,” which can drastically reduce your deductible on Silver-tier plans. Copays and maximum out-of-pocket maximums also reduce.
In Georgia, and all other states, it is now mandated law that you must purchase coverage or pay a special tax based on 2.5% of your household income. During Open Enrollment (November 1st-January 31st), you can easily apply for a qualified policy from BCBS and many other carriers. If OE is missed, a “Special Enrollment Period” is available for many specific situations (divorce, baby, losing job etc…). You can also buy a “temporary” plan, which will be discussed later. The OE period is different for persons that have reached age 65. We discuss Senior Medigap and Advantage plans later.
The Georgia Health Marketplace (Exchange)
Cheap! Perhaps that best describes rates for individuals and families, since the average monthly cost of healthcare to consumers in the state is abut $65 per month for 2017 Exchange plans. This includes any applicable federal subsidies, which are instantly deducted from the premium.
In 2016, more than 300,000 persons were able to purchase Exchange coverage, and most applicants qualified for a subsidy. Also, more than 200,000 additional persons previously became eligible for PeachCare or Medicaid , which provides low-income families with quality coverage at a minimal or no cost.
Our state’s average price is the second lowest in the nation, with almost 90% of applicants qualifying for some type of financial assistance. Although there has not been an expansion of Medicaid like more than 30 other states, almost 100,000 persons were able to sign up for CHIP or Medicaid during the first year of the Exchange. It is expected that the eligibility requirements will be loosened sometime in the next five years.
Pre-Existing Conditions Are Covered
Pre-existing conditions are no longer excluded or considered when determining the premium of your policy. A prior lapse in coverage will also not impact your cost, although several restrictions and tax consequences apply if you miss Open Enrollment. “Special Enrollment Periods” (SEP) continue to be available if you lose existing qualified coverage through an employer, by moving to a different area, from a divorce, having a baby, and several other scenarios. If you do not qualify, an Off-Exchange short-term policy can purchased (more information below).
NOTE: If your employment situation changes, and your wages substantially increase (or decrease), a re-calculation of your subsidy is highly recommended. This can avoid a possible unexpected reduction in your tax refund, or a higher tax liability for the following calendar year. Remember – the federal subsidy is based on your projected household income the following year, not your income from the prior year. Also, if your household income substantially changes, adjusting your current subsidy may be needed to avoid paying a large tax bill, or unnecessarily overpaying each month for your policy.
Secondary policies can also be purchased privately. The best supplemental health insurance plans can help you pay for deductibles and other expected (or unexpected) expenses. These contracts are not subsidized and are not designed to be primary coverage or replace a policy that provides primary benefits. They will simply assist you when you have high out-of-pocket costs from a covered claim on your Marketplace plan.
NOTE: Medicare supplement plans help Seniors reduce out-of-pocket expenses, but they are not eligible for federal subsidies, and are not impacted by the vast majority of the Affordable Care Act. The Open Enrollment period is also different as it runs between October 15th and December 7th.
Sample 2017 Subsidy Calculations
There’s also a good chance that you qualify for a federal subsidy that could drastically reduce your premium…or possibly pay all of it. This financial aid is solely based on your household income modified adjusted gross income) and the number of dependents you declare on your tax return.
We can easily calculate your subsidy and we also included some examples below. Although amounts can vary, depending on your county of residence, for our examples, we used Fulton, Gwinnett, DeKalb, Cobb and Chatham counties. The amounts listed are the monthly dollars that would directly reduce the cost of your health insurance rate.
$112 – 25 year-old with $20,000 income
$138 – 45 year-old with $25,000 income
$227 – 55 year-old with $30,000 income
$294 – 30 year-old couple with $30,000 income
$304 – 50 year-old couple with $50,000 income
$413 – 30 year-old couple with two children and $50,000 income
$668 – 50 year-old couple with two children and $50,000 income
$355 – 50 year-old couple with two children and $75,000 income
How Do You View And Compare Rates?
That’s the easy part. The “Get Free Quotes” box at the top of the page allows you to view the most affordable medical plans in your area from the top-rated companies. It only takes a few moments and of course, at your request, we’ll help explain the differences in plans and which policies best suit your needs. If you wish to apply for a policy, the process is quick and easy.
Comprehensive, catastrophic, short-term, HSA, high-deductible, self-employed and single-parent options are available. If you are eligible for Medicaid or Medicare, we’ll also show you the best choices from each of the major companies. A wide selection of low-cost GA student medical plans are available, regardless if you are considered full-time or part-time.
It makes financial sense to compare student Exchange policies to the University medical coverage that is offered. Typically, there are often huge differences in student pricing om plans purchased directly from the school. For example, although Kennesaw State and Emory have somewhat similar plans, Valdosta State and the University of Georgia student medical plans are much different.
Companies That Offer Health Insurance Coverage In Georgia
Exchange plans are offered by Ambetter (Peach State Health Plan), Blue Cross Blue Shield of Georgia, Humana, Kaiser Permanente, and Alliant. Since the first year of the Exchanges, many carriers have exited the Marketplace. Several of the larger companies that no longer coverage are Aetna, Assurant, Harken, Cigna, and UnitedHealthcare. However, off-Exchange and Group plan options are available through Aetna, Cigna, Federated Mutual, Freedom Life, National Foundation Life, UnitedHealthcare, and many of the companies previously mentioned that offer on-Exchange coverage.
The variety of available carriers has helped to stabilize premiums by providing more competition. All carriers must be approved by the Georgia Department of Insurance. The Regulatory Services Division oversees the licensing of companies, and ensures they are following all regulations and legislation. All life and health contracts are reviewed. By July of each year, proposed rate increases of more than 10% must be submitted to the DOI for review and accountability. Consumers can review the reasons provided that justify the requested increase, along with the final increase that was granted.
However, all companies do not offer policies in every county. Although Blue Cross Blue Shield is represented in all parts of the state, there are pockets (especially in the southwestern portion) where the number of participating carriers is very small. Some of these counties include Berrien, Brooks, Clinch, Cook Decatur, Early, Grady, Irwin, Lanier, Miller Seminole, Thomas and Turner. Prices for coverage in these counties (and others in the area) are the highest in the state.
Although Anthem offers policies in all counties, their entire network that covers more than 95% of hospitals, is not necessarily available. The passage of the Affordable Care Act (ACA) legislation forced many carriers to offer thinner network coverage to help pay for guarantee-issue plans. Often, there are multiple networks, with a separate option for unsubsidized plans that are issued “off-Exchange.”
In Georgia, Anthem BCBS utilizes about half of its network capability. For example, Piedmont and Emory hospitals are considered “outside of the network,” and therefore will result in higher out-of-pocket costs for consumers. Also not available for network usage are these hospitals: Redmond Regional, Hamilton Medical, Fannin Regional, and Hutcheson Medical Center.
Most Affordable 2017 Individual Plans
Kaiser Permanante KP GA Catastrophic 7150/0 – $7,150 deductible with maximum out-of-pocket expenses of $7,150 and 0% coinsurance. First three pcp and outpatient mental health care office visits are covered at 100%. Thereafter, the deductible applies. Mail order is available for up to 90 days for prescription drugs. One eye exam and a pair of glasses are allowed yearly.
Humana Basic 7150 HMOx – $7,150 deductible with maximum out-of-pocket expenses of $7,150 and 0% coinsurance (Similar to Kaiser plan). First three pcp and mental health office visits must only meet a $15 copay. Also, one eye exam and a pair of glasses are allowed yearly.
BCBSHP Catastrophic Pathway X Guided Access HMO 7150 – $7,150 deductible with maximum out-of-pocket expenses of $7,150 and 0% coinsurance. $40 copay for first three pcp office visits, and then deductible applies.
Ambetter Essential Care 1 – $6,800 deductible with 100% coverage after deductible is met. Exception is $20 copay for generic drugs. Vision and dental benefits can be separately added.
Kaiser Permanante KP GA Bronze 6200/40%/HSA – HSA-eligible plan with $6,200 deductible and maximum out-of-pocket expenses of $6,550. Coinsurance is 40%.
BCBSHP Bronze Pathway X Guided Access HMO 5850 – $5,850 deductible with maximum out-of-pocket expenses of $7,150 and 35% coinsurance. All non-preventive office visits and prescriptions must meet deductible.
BCBSHP Bronze Pathway X Guided Access HMO 0 For HSA - HSA-eligible plan with $6,550 deductible and maximum out-of-pocket expenses of $6,550 and 0% coinsurance.
Kaiser Permanante KP GA Bronze 5700/50 - $5,700 deductible with $7,150 maximum out-of-pocket expenses and 50% coinsurance. $50 and $70 office visit copays with $35 generic drug copay. All other drugs must meet 50% coinsurance and deductible.
Humana Bronze 6550 – $6,550 deductible with maximum out-of-pocket expenses of $6,550 and 0% coinsurance.
Humana Bronze 6150 – $6,150 deductible with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. Office visit copays are $20 and $40, while diagnostic testing and blood work must meet deductible and coinsurance.
Alliant SoloCare Bronze HDHP 40032 – HSA-eligible plan with $5,500 deductible, and $6,500 maximum out-of-pocket expenses. Coinsurance is 30%. Level 1, 2, and 3 drug copays are $15, $35, and $75 respectively. Tier 4 and Tier 5 drugs are subject to 50% coinsurance.
Alliant SoloCare Bronze HDHP 40031 – Similar to previous plan, but with $6,500 deductible and maximum out-of-pocket expenses of $6,500 and 0% coinsurance.
Ambetter Balanced Care 1 – $5,500 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. $30 and $60 copays on office visits with $100 Urgent Care copay. $10 and $50 copays on generic and preferred brand drugs.
Ambetter Balanced Care 2 – Very similar to prior plan with higher deductible $(6,500). Maximum out-of-pocket expenses are also $6,500 with 0% coinsurance. $30 and $60 copays on office visits with $100 Urgent Care copay. $15 and $50 copays on generic and preferred brand drugs.
Ambetter Balanced Care 4 – $7,050 deductible with maximum out-of-pocket expenses of $7,0500 and 0% coinsurance. $30 and $60 copays on office visits with $100 Urgent Care copay. $15 and $50 copays on generic and preferred brand drugs.
Kaiser GA Silver 2750/20%/HSA - HSA-eligible with $2,750 deductible, $6,000 maximum out-of-pocket expenses, and 20% coinsurance.
Kaiser KP GA Silver 3000/30 – $3,000 deductible with maximum out-of-pocket expenses of $6,000 and 30% coinsurance. Office visit copays are $30 and $60, with $100 copay for Urgent Care. Generic and preferred brand drug copays are $15 and $45. Other drugs are subject to 50% coinsurance.
BCBSHP Silver Core Pathway X HMO 5300 – $5,300 deductible with maximum out-of-pocket expenses of $6,700 and 25% coinsurance. $35 pcp office visit copay and $50 Urgent Care copay. $10 copay for generic drugs, and a $40 copay for preferred brand and non-preferred generic drugs.
BCBSHP Silver Pathway X HMO 3500 – $3,500 deductible with maximum out-of-pocket expenses of $4,850 and 25% coinsurance. $20 pcp office visit copay. Also, $5 copay for generic drugs.
Alliant Solocare Silver PPO 4007 - $1,750 deductible with maximum out-of-pocket expenses of $7,150 and 50% coinsurance. Office visit copays of $30 and $60 with $15 copay for generic drugs and $50 copay for brand drugs.
Alliant Solocare Silver PPO 40010 – $2,500 deductible with maximum out-of-pocket expenses of $7,150 and 50% coinsurance. Office visit copays of $30 and $60 with $15 copay for generic drugs and $50 copay for brand drugs.
Ambetter Secure Care 1 – $1,000 deductible with maximum out-of-pocket expenses of $6,350 and 20% coinsurance. $10 copay on generic drugs.
Kaiser KP GA Gold 1500/20 – $1,500 deductible with maximum out-of-pocket expenses of $4,750 and 20% coinsurance. Office visit copays are $20 and $40, with $75 copay for Urgent Care. Generic and preferred brand drug copays are $10 and $30. Other drugs are subject to 50% coinsurance.
Kaiser KP GA Gold 500/20 – $1,500 deductible with maximum out-of-pocket expenses of $4,750 and 20% coinsurance. Office visit copays are $20 and $40, with $75 copay for Urgent Care. Generic and preferred brand drug copays are $10 and $30. Other drugs are subject to 45% coinsurance.
What About PeachCare?
In 1999, PeachCare began offering quality medical coverage to children under the age of 18 that did not qualify for Medicaid benefits. If household income is below 247% of the Federal Poverty Level, typically, a child is eligible, although a full determination must be made. Income will be verified before coverage is offered.
Comprehensive benefits include office visits, prescriptions, preventive (including annual physicals and immunizations), mental healthcare, emergency-room treatment, visits to specialists, along with dental and vision benefits. There is a wide selection of primary care providers available and the Georgia Care Management Association will help as a liaison.
Coverage is free for anyone under age five. The monthly rate increases to $10 for children age 6 or older. For households with two or more children, the monthly rate is dependent on household income, and will be either $15 or $20 per month. Copays are extremely low, typically less than $5. Preventive and emergency treatment does not require any copay or coinsurance. The maximum out-of-pocket expense in a year is 5% of your household income. If reached, your premium payments are also waived.
All applicants must be US citizens and legal residents of the state of Georgia. There also must not be any current coverage in force (including Medicaid). Maximum household income limits are shown below:
1-Person Household – $27,918
2-Person Household – $37,647
3-Person Household – $47,376
4-Person Household – $57,105
5-Person Household – $66,834
What Is The SHBP?
The “SHBP” is the Georgia State Health Benefit Plan, which provides healthcare benefits to more than 600,000 retired and active state teachers and other employees. There are actually three separate contract plans and they are “Public School Employees,” “Teachers, and “State Employees.” Since it is self-funded and also self-insured, companies and members pay premiums that are used to disperse benefits.
Working employees that are not Medicare-eligible can consider Health Reimbursement Arrangement contracts in Gold, Silver, or Bronze tiers.Initially, when the account is opened, some “spending dollars” will be transferred to the account. Popular low-cost Medicare Advantage options are also offered to former employees that have reached age 65. Rates are typically less than conventional Medigap Supplement plans, and often, Part D prescription coverage is included.
The three major companies that offer coverage are Blue Cross and Blue Shield of Georgia, UnitedHealthcare and Kaiser Permanente. Blue Cross and UnitedHealthcare will also offer Medicare Advantage plans to anyone who is retired. “Standard” and “Premium” plans are available. Of course, you must be enrolled in Medicare to be eligible for Advantage benefits.
Open Enrollment typically begins in October and ends sometime in November. It Occurs earlier than the standard Marketplace Open Enrollment and is also shorter (About 17 days instead of 90 days).
Rates have been fairly stable in recent years, with no major price increases. Most SHBP members are quite satisfied with the increase in carriers that are offering plans, compared to only one company (BCBS) in 2014.
Off-Exchange Plans (Under Age 65)
Purchasing a policy “off-Exchange” means that the government website is completely bypassed and no federal subsidy will be paid. Naturally, if your household income is less than 250% of the Federal Poverty Level (FPL), this concept may not be very cost-effective.
However, if your income is high enough that a subsidy is not available, these types of plans are occasionally slightly less expensive than the “on-Marketplace” policies that they mirror. Also, the provider network may be larger and more robust, giving you more facilities to choose from. Since each situation is unique, comparing both options is most prudent, especially if you’re not familiar with contract benefits. Also, if expensive out-of-state treatment is required, these options should be studied.
Georgia Senior Health Insurance – Medicare Supplement, Prescription Drug (Part D), And Medicare Advantage Plans
Medicare Supplement plans are offered by many major companies. Ten policy options are available, with Plan F offering the most comprehensive coverage. You must be enrolled in Parts A and B to qualify for a Medigap (Supplement) policy. If you are buying a policy after Open Enrollment ends, medical underwriting may apply.
Affordable And Popular Options
Medico High Deductible Plan F – One of the cheapest available policies. $2,180 deductible with 100% coverage (0% coinsurance) after deductible is met. This option is ideal if you rarely utilize non-preventative benefits.
Humana High Deductible Plan F – Similar to previous Medico plan, although slightly more expensive.
Temporary Ga Policies – They’re Cheap!
Non-compliant short-term plans are often purchased because of the extremely low premiums and same-day approval feature that many carriers offer. Although they are underwritten (not guaranteed-approval) and many pre-existing conditions are not covered, these contracts are popular if existing or prior coverage lapsed and you need to obtain benefits ASAP.
In less than 24 hours, an application can be approved and coverage (depending on the policy and carrier) can be kept for as long as 12 months. Although major medical benefits are fairly robust, often, there are out-of-pocket expenses for prescriptions, office visits and therapy. Also, depending on the length of time you don’t have qualified Exchange coverage a pro-rated penalty may be charged based on household income.
We listed below several examples of available short-term rates. Prices are monthly and are based on a policy issued in Columbus (Muscogee County). Applicant is 30 year-old male and in above-average health with no major conditions.
$34 – $7,500 deductible plan from HCC Life.
$38 – $5,000 deductible plan from HCC Life.
$43 – $2,500 deductible plan from HCC Life.
$69 – $3,500 deductible plan from Assurant.
$70 – $2,500 deductible plan from UnitedHealthcare.
$80 – $500 deductible plan from HCC Life.
$93 – $1.000 deductible plan from UnitedHealthcare.
$102 – $5,000 deductible plan from The IHC Group.
$150 – $250 deductible plan from HCC Life.
NOTE: Temporary policies can often be renewed one time. This means that after the first renewal, although your existing carrier may not offer coverage, another carry will, assuming you meet their underwriting criteria. And ironically, after a year, you can return to the original company and re-apply for another policy.
Affordable health insurance rates in Georgia. With the help of federal subsidies, guarantee-approval underwriting, and comparing multiple plans, we’ll help you find those low-cost plans that provide the benefits you need at the cheapest price.
Blue Cross is lowering prices for 2015 effective dates. The combination of better rates from BC along with three new companies entering the Marketplace, is giving Georgia residents a larger number of plans to choose from. This may help the rural southern portion of the state, where enrollment was very low in 2014.
The southwestern part of the state experienced some of the highest rates in the US last year. The Albany area does not have as many network providers as other areas, and the percentage of uninsured is high. It is expected that those numbers will improve next year.
The “coverage gap” in Georgia still exists although increased 2015 enrollment numbers could help close the gap. Typically, many Asians, African Americans, Hispanics, and other persons that reside outside of large cities don’t qualify for a federal subsidy since they make too much money. But they also don’t receive Medicaid benefits because they’re household income is too large.
This dilemma is being addressed with more outreach programs that seek to find these persons in rural communities, although the lack of Medicaid expansion in the state is always an ongoing challenge. For 2015, more than 250,000 persons will be victims of “the gap.”
Southwest Georgia’s premiums have significantly reduced for 2015. For example, average rates in the Albany area have reduced by more than 20%. And there are more carriers to choose from. In addition to Blue Cross and Blue Shield, Time, Coventry, (Aetna) and UnitedHealthcare are now offering several affordable Bronze and Silver-tier plans.
Enrollment rates are also expected to increase due to more community awareness and several local outreach programs that are expected to simplify the sign-up process. The Phoebe Putney Health System, which includes many doctors and specialists in the area, will undoubtedly be much busier after the first of the year treating patients.
Although there are many new policies available, most residents that re-enroll, tend to keep their same coverage. If their income has drastically changed, they may qualify for a much bigger subsidy, or become eligible for Medicaid.
According to the HHS, More than 180,000 residents applied for coverage during the first month of Open Enrollment. Most persons bought a policy for the first time. Only three other states with a federally-run Exchange had higher sign-up numbers (North Carolina, Florida, and Texas). The final figures are expected to exceed 300,000, and possibly reach 400,000.
Georgia carriers have begun to request rate increases for 2016 with the DOI. Although not yet approved, we have highlighted some of the largest proposed changes by company and plan below:
64.2% – Time Individual QHP
37.8 % – Alliant SoloCare
21.6% – Blue Cross Blue Shield – HMO Off-Exchange
20.3% – Aetna Managed Choice – COSTCO
19.4% – Humana NPOS
18.6% – UnitedHealthcare Compass
18.5% – Aetna Managed Choice
Kaiser added another feather to its cap as the NCQA (National Committee For Quality Assurance) awarded its highest rating to the carrier’s commercial plan. This is the 11th consecutive year that Kaiser has earned the highest rating (5 out of 5). Aetna and Blue Cross and Blue Shield followed Kaiser in the rankings.
The “Commonwealth Fund” published its annual State healthcare rankings. And once again, the results are not good for the state of Georgia, who dropped to 46th place, down a notch from last year. Although more residents enrolled in coverage over the last 12 months, and the number of adult smokers decreased, prevention, treatment, and affordability of medical help were among the lowest-rated in the country.