Home » Law » Georgia Health Insurance Exchange

Georgia Health Insurance Exchange

Georgia’s health insurance marketplace consists of several trusted insurers and great coverage at an affordable price. Created by the Affordable Care Act and operated by the federal government (the Department of Health and Human Services and the Centers for Medicaid and Medicare Services), the exchange is an outlet for individuals, families and small business owners to compare, consider and purchase health insurance. It’s also a place (online) where individuals can find out if they qualify for subsidies to reduce their premiums and medical expenses.

The Georgia Health Insurance Exchange is federally-run, therefore you can shop for qualified health plans in a variety of ways, including HealthCare.gov, local medical centers and facilities throughout the community such as libraries and health clinics, over the phone, or with a licensed agent. East Coast Health Insurance is happy to help you find coverage on and off the exchange in Georgia, and let you know what tax credits you may qualify for. Our licensed agents are available to address your concerns at 888.803.5917.

Coverage is streamlined to promote ease of use when choosing a plan. Each qualified health plan (QHP) on the exchange has a similar selection of services, as they all must include ten essential health benefits, and only four levels of cost-sharing. Different companies and deductible options make for a range of premiums to choose from, which can’t be increased because of your health or gender under the health care law.


Who is Eligible

The Georgia Health Insurance Marketplace is designed to insure people without access to affordable coverage. Therefore, if you already have group coverage from an employer covering at least 60 percent of your overall medical costs, you likely won’t qualify. If your employer plan covers less than 50 percent, you can use the exchange. If your job doesn’t offer coverage, you will also be eligible. You can also apply if your spouse’s employer doesn’t offer to cover you. Many Georgians applying for the exchange are those with pre-existing conditions who were declined coverage before the health law. The exchange is part of the individual and small group markets, which does not include individuals age 65 or older, as they qualify for Medicare. Small business owners can also apply if they want to insure their workers.


Levels of Coverage

The marketplace provides four different options for consumers, regardless of the insurance company you decide upon. While premiums, copays, networks and deductibles vary between insurers, in order to sell on the exchange, companies must offer qualified health plans (QHPs). QHPs include bronze, silver, gold and platinum coverage tiers to illustrate the type of cost sharing and coverage to expect with the plan you choose. If you choose a bronze-level plan, you can expect a low monthly rate, or even free coverage for a small group of Georgians when combined with tax credits. However, for these plans the amount of cost-sharing is higher. Those who anticipate needing more care, or just want better protection can choose a gold or platinum plan.

In addition to the comprehensive health plans mentioned, a less expensive option is also available to younger consumers. Healthy Georgians up to age 30 can apply for a catastrophic health plan for a premium below the cost of a bronze plan. These plans include free preventive care, four office visits at a copay and emergency care subject to a deductible. This means, if you do have a medical emergency, you’ll be responsible for the entire out-of-pocket cost.

Coverage Levels on the Health Insurance Marketplace

Premium Tax Credit

The premium tax credit is the main draw of the exchanges, providing a discounted rate for coverage to many Georgia residents. Also called subsidies, they are awarded to individuals and families to help pay for coverage and care. Medical costs can be reduced by cost-sharing tax credits. If you don’t qualify for subsidies, it’s well advised to shop Georgia individual insurance plans outside of the marketplace, as premiums without the applied tax credit will be similar on and off the exchange.

Georgia residents may qualify for a tax credit if they are a U.S. citizen or legal resident and meet the following income requirements according to the current federal poverty line:

Income between 100-250% FPL: Subsidies for premiums and medical costs

Income between 251-400% FPL: Subsidy for premiums only

You can estimate your potential subsidy or find out if you’re eligible when you apply for a marketplace plan, or use a subsidy calculator. Our agents can help you determine eligibility for the exchange at 888.803.5917.

Tax credits are determined by the cost of the second least expensive silver plan in your area as a percentage of your income. Your share of premiums can only consume a certain percentage of income, which is assigned for six income groups from 100 to 400 percent of poverty.


Covered Services

While every health plan must include ten categories of essential health benefits (EHBs) in policies sold on the marketplace, specific benefits can vary from one company to another. EHBs are another perk of the exchange plans, and you can ensure that your plan is providing a comprehensive level of covered services that normally wouldn’t be covered before health reform. Requirements such as maternity, prescription drugs and mental health care were typically add-on benefits in the past. Certain plans sold off the exchange are also required to cover EHBs by federal law.

Essential Health Benefit Categories

  • Prescription drugs
  • Emergency services
  • Preventive and wellness services and chronic disease management
  • Hospitalization
  • Maternity and newborn care
  • Laboratory testing
  • Pediatric care, including dental and vision
  • Ambulatory patient services
  • Rehabilitative and habilitative services and devices (following an injury or for disabilities)
  • Mental health and substance abuse services, including behavioral health care


Health Plans

In Georgia, five companies are selling plans on the statewide insurance marketplace. Each offers high quality coverage for a low cost when you apply for tax credits. These include HMOs and PPOs, which gives a good variety for consumers to choose from. Thus far, the following carriers are actively selling plans on the Georgia exchange.

Average monthly rates for all age groups and regions of Georgia are $265 for the lowest cost bronze plan and $304 for the lowest cost silver plan.


How to Apply

You can apply for catastrophic or bronze through platinum plans in person at a community health center or hospital, on the phone or in person with a licensed agent, or online at HealthCare.gov. You can also call 800-318-2596 to request a paper application. Our licensed agents are qualified to sell exchange plans in Georgia and are available to help you find a plan at 888 803 5917.


Compare Georgia Marketplace Plans

Use the tool below to find which carriers serve your county and how much their coverage costs, with an estimate of the premium subsidy you might qualify for. To find out more about these plans and sign up for coverage, call an East Coast Health Insurance agent.


*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.