Georgia Health Insurance

Four Georgia insurers offer Marketplace coverage for 2020. Most Georgians who enroll receive help with premium costs.

The Peach State is home to 10.1 million residents.¹ Nearly half of the population get private health insurance through an employer. Meanwhile, about 4% get it through the Marketplace. Just over 1 in 5 residents have coverage through government programs.²

Georgia and the Affordable Care Act (ACA)

More Georgia residents have qualified health insurance since Obamacare began in 2013. About 19% of the population was uninsured back then compared to 14% as of 2018. That drop amounted to an additional 418,900 insured residents.³

More Georgians would have access to qualified coverage if the state expanded Medicaid to childless adults under 65 who earn up to 138% of the federal poverty level (FPL). The ACA gave states the option to expand Medicaid to these individuals in 2014. Because Georgia has declined Medicaid expansion, this has left a coverage gap of 267,000 uninsured residents who would otherwise qualify.⁴

Buying Georgia Health Insurance for Individuals, Families, and Self-Employed Business Owners

Georgia’s ACA health insurance plans are available to individuals, families, and self-employed entrepreneurs with no employees. Plans come in bronze, silver, gold, and platinum. Each metal level covers a percentage of your health insurance costs. For instance, bronze plans pay for 60% of covered expenses and are usually the cheapest.

You can apply for coverage through the federal Marketplace at Healthcare.gov. Enrolling in a plan lets you access free preventive care and many other essential health benefits, such as hospitalization, outpatient care, and prescription drug coverage. Plans must also offer dental and vision coverage to children. ACA plans are not allowed to deny you coverage based on your health or any pre-existing condition.

Georgia Health Insurance Marketplace Enrollment 

Nearly 459,000 residents signed up for ACA coverage during the 2020 Open Enrollment Period (OEP), which ended on December 18, 2019 — an extension of the usual December 15 deadline.⁵ 

Normally outside of the OEP, you can only buy a plan if you have a qualifying life event, such as moving or getting married. The next OEP for the 2021 plan year starts on November 1, 2020.

Health Insurance Companies in Georgia 

Six Georgia health insurance companies offer 2021 Marketplace coverage. These are:

• Alliant Health Plans
• Ambetter of Peach State
• Anthem Blue Cross and Blue Shield
• CareSource Georgia Co.
• Kaiser Permanente
• Oscar Health Plan of GA

Health Insurance Costs and Obamacare Subsidies in Georgia

The average premium for Obamacare silver plans serves as a benchmark for how affordable Marketplace plans are. For the 2020 plan year, a 40-year-old in Georgia paid an average monthly premium of $463 for a silver Marketplace plan. The U.S average was $462 per month during this time.

For 2021, the state approved an average increase of 4.8%, or another $27 a month for an unsubsidized plan.⁶

The majority (91%) of the state’s Marketplace enrollees in 2019 received Obamacare subsidies to reduce their monthly premiums. Another 68% received cost-sharing reductions, which only apply to silver plans.⁷ You may qualify for subsidized coverage if you make between 100% and 400% of the federal poverty level (FPL). This range amounts to $12,480 to $49,960 for an individual as of 2019.

The average subsidy received among Georgia Marketplace enrollees was $538 in 2019.⁸

Georgia’s Publicly-Funded Health Insurance Programs

You can get public health insurance in Georgia through Medicaid, the Children’s Health Insurance Program (CHIP), and Original Medicare.

Among Georgia’s 10.1 million residents, just over 1 in 6 have Medicaid or CHIP. About another 1 in 9 people have Original Medicare.

Georgia Medicaid for Low-Income Families, Children, Pregnant Women, the Aged, and Disabled.

Just over three in 10 Georgia residents are considered low-income, which means they earn at or below 200% of the FPL ($25,520 or less in 2020).⁸ You may qualify for Medicaid in Georgia if you earn up to this amount. However, some groups such as children and pregnant women have higher income limits.¹⁰

About a quarter of Georgians on Medicaid are adults 65 and older and people with disabilities. The other 75% are children 18 and younger and able-bodied adults under 65. The latter excludes adults ages 19 to 64 who don’t have children. Because Georgia has not expanded Medicaid, these individuals don’t qualify.¹¹

Georgia CHIP Program for Low-Income Children

Uninsured children under 19 who don’t qualify for Medicaid can get coverage through PeachCare for Kids, Georgia’s Children’s Health Insurance Program (CHIP). Your child may enroll if you earn no more than $41,768 for a family of two as of 2019. The income limit increases by about $10,918 for each additional person.

Georgia’s Health Insurance Premium Payment Program for Working Medicaid Enrollees

If you have both Medicaid and health insurance through your job, Medicaid may pay your job-based premiums if you can’t afford to do so. Financial assistance is provided through Georgia’s Health Insurance Premium Payment Program (HIPP).

Georgia Medicare Plans For Seniors and Younger Adults With Disabilities 

Most Georgia residents (83%) on Medicare qualify because they’re at least 65. Coverage is also available to adults under 65 with disabilities and chronic illnesses.

There are two main ways you can receive Medicare Part A hospital and Part B medical insurance in Georgia: 

Original Medicare: Enrolls about 1.1 million Georgians.

1. Provided directly by the federal government and can be used at any Medicare provider nationwide
2. Doesn’t cover most prescription drugs as well as routine dental, vision, and hearing care
3. You can pair it with a separate Medicare Part D prescription drug plan and a Medigap plan (known as Medicare Supplement). Medigap helps cover some or all of your out-of-pocket costs, such as copays and deductibles

Medicare Advantage: Enrolls nearly 608,000 residents 

1. Sold by private insurance companies and uses provider networks
2. Most plans include prescription drug coverage, and some offer routine dental, vision, and hearing coverage
3. Has a maximum out-pocket limit, unlike Original Medicare

Georgia Short-Term Health Plans if You’re In Between Jobs or in a Coverage Gap

Georgia doesn’t regulate short-term health plans. Instead, it defaults to federal rules and allows insurers to offer short-term health insurance.  Coverage can last up to 364 days with an option to renew up to 36 months.

Consider short-term coverage if you need basic benefits while in between jobs or waiting for coverage to start at your new one. These plans aren’t ACA-compliant, so insurers can deny you a policy based on your health status or a pre-existing condition.

Short-term plans generally cost less than ACA-qualified health insurance but offer fewer benefits. Because of the latter, you could spend more on out-of-pocket medical costs in the long run.

This guide on Georgia health insurance can help you decide which coverage is right for you.