Georgia Health Insurance
If you live in Georgia and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:
- Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
- Compare private health plans using U.S. News & World Report's health insurance ratings for Georgia
If you are enrolling for an Obamacare subsidized insurance plan through Healthcare.gov or a broker, the official deadline to sign up for health coverage in 2014 was March 31st.
From now until November 15, the start of the next open enrollment, you cannot get new yearly insurance unless you have a qualifying life event. See below for those options for coverage and how to avoid the penalty.
Do I Qualify for a Tax Break on Health Insurance?
Use the tool at right to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.
If You Qualify: Plans That Cost Less
Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Georgia. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage.
Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.
- If you missed the deadline to enroll, read about your options for coverage and how to avoid the penalty.
- For more information, read Why Get Health Insurance in the State Marketplaces
If You Don't Qualify: Private Plans
If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Georgia’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage. What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.
- Compare private plans in the U.S. News Health Insurance Ratings for Georgia
- Read more here: Hidden Costs of 'Affordable' Health Insurance
Do I Have To Buy Health Insurance?
You may have heard that everyone in Georgia must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more.
U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.
- See the pros and cons of getting health insurance: Why Do You Need Health Insurance?
- For more on the penalty, read Should I Pay the Penalty?
- If your health insurance policy was cancelled in fall 2013, you may be eligible to renew it for 2014 coverage. Call your insurer to verify whether your plan is still available. For more info, read Cancelled Health Plans Leave Consumers Puzzled
Where To Buy Health Insurance
Georgia's Official Marketplace
Health Insurance Marketplace is Georgia’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Health Insurance Marketplace, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:
- Social security numbers for everyone in your household
- Your employer’s name and address
- Your most-recent pay stub or recent records of your wages
- Information about other types of income you receive, such as alimony, unemployment benefits or a pension
Insurance Companies and Brokers
Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Health Insurance Marketplace website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.
U.S. News & World Report has teamed up with GetInsured, an online broker licensed to sell health insurance, to help you buy the subsidized health plan you want. The GetInsured customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.
Qualified Plans on Health Insurance Marketplace
Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.
You should also look at a Health Insurance Marketplace plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Health Insurance Marketplace plan makes sense given your income. Use the "Shop for Health Insurance Now" section on the top right of this page.
Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.
While five insurance carriers offer Obamacare exchange plans in Georgia for 2014, residents of the state’s northwestern counties have only two to choose from. According to The Dalton Daily Citizen, they are Blue Cross and Blue Shield of Georgia and Alliant Health Plans.
Anthem Blue Cross and Blue Shield. Anthem is the largest insurer in Georgia and the only insurer to offer statewide coverage on the exchange. The company is affiliated with the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. However, Georgia residents who buy an Anthem exchange plan may not have access to the entire network of doctors and hospitals. According to the Atlanta Journal-Constitution, the exchange network offers half of the doctors and a little over half the hospitals available in the BCBS regular network. The network does not include any Emory, Piedmont or WellStar hospitals, but offers the following Atlanta-based hospitals: Northside, Gwinnett Medical, Dekalb Medical, Grady Memorial, Eastside Medical and Children’s Healthcare of Atlanta. The following hospitals are also not in the exchange plan network: Hamilton Medical Center, Murray Medical Center in Chatsworth, Gordon Hospital in Calhoun, Hutcheson Medical Center in Fort Oglethorpe, Redmond Regional Hospital in Rome and Fannin Regional Hospital in Blue Ridge, reports The Dalton Daily Citizen. Anthem offers HMO exchange plans in Catastrophic through Gold tiers.
Alliant Health Plans. This nonprofit company serves residents of northwestern Georgia. Alliant officials claim that exchange enrollees have access to the regular network, which includes Hamilton Medical Center in Dalton and local doctors, reports The Dalton Daily Citizen. Alliant offers PPO exchange plans in Bronze through Gold tiers.
Ambetter from Peach State Health Plan (Peach State). Peach State, a subsidiary of Centene Corporation, offers health insurance to low-income individuals and families in Georgia. Ambetter from Peach State offers HMO exchange plans in Bronze through Gold tiers.
Humana Insurance Company. Established in 1974 in Louisville, Ky., Humana is one of the largest U.S. health insurers with over 11.5 million members. Humana offers PoS exchange plans in Catastrophic through Platinum tiers.
Kaiser Foundation Health Plan of Georgia. Established in 1985, Kaiser is Georgia’s largest nonprofit health insurance company with more than 240,000 members in 32 counties in Atlanta and Athens, according to the company. On the exchange, the company is offering its well-known HMO plan in Catastrophic through Gold tiers, but with a narrow network that contains a limited number of doctors and hospitals, reports The Atlanta Journal-Constitution.
Need More Help?
The Georgia Office of Insurance and Safety Fire Commissioner exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 404-656-2070 or emailed at RegServices@oci.ga.gov. Residents can file an insurance complaint online.
Frequently Asked Questions About Health Insurance
- Why Do You Need Health Insurance?
- Should I Pay the Obamacare Tax Penalty?
- How Can I Save Money on Health Insurance?
- What Should Women Look For When Buying Health Insurance?
- Are 'Affordable' Health Plans Really Affordable?
Last updated by Heilbrunn, Evi | June 12, 2014