Health Insurance Marketplace in Georgia
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Georgia has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Georgia’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
Seedco, a national organization helping low-income households and communities move toward economic prosperity since 1987, will act as lead agency for a consortium of partners in each state and oversee all aspects of the proposed program, providing technical assistance, financial oversight, compliance protocols, and partner facilitation. Seedco and its partners will support the activities of Navigators in Georgia and Tennessee, many of whom will be roving.
The University of Georgia’s College of Family and Consumer Sciences and Cooperative Extension Service (UGA CES) plans to place navigators in several offices outside the Atlanta metro region. UGA CES plans to create awareness through community workshops, engage a network of existing partners to reach uninsured Georgia residents and provide direct services to consumers seeking assistance.
Who you can contact for more help
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in Georgia
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- Emory University (Center for Critical Care) GA – Health Care Innovation Award
- University Of Alabama At Birmingham GA – Health Care Innovation Award
- Innovative Oncology Business Solutions, Inc. GA – Health Care Innovation Award
- TransforMED GA – Health Care Innovation Award
- University Of North Texas Health Science Center GA – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- Memorial Health University Medical Center Savannah, GA – BPCI Initiative: Model 2
- Amedisys Home Health Care Monroe, GA – BCPI Initiative: Model 3
- d/b/a North Georgia Home Health Agency, an Amedisys Company Trenton , GA – BCPI Initiative: Model 3
- Coosa Valley Home Health, an Amedisys Company Rome, GA – BCPI Initiative: Model 3
- Central Home Health Care, an Amedisys Company Tucker, GA – BCPI Initiative: Model 3
- Northeast Georgia Regional Commission Athens, GA – Community-based Care Transition Program
- Central Savannah River Regional Commission Augusta, GA – Community-based Care Transition Program
- Atlanta Community-Based Care Transitions Program (Atlanta CCTP) GA – Community-based Care Transition Program
- Community Health Care Systems, Inc.- Tennille Community Health Center Tennille, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- First Choice Primary Care Macon, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Georgia Mountains Health Services, Inc. Morganton, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Southwest Georgia Health Care D/B/A Crisp Urgent Care and Medical Center Cordele, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- TenderCare Clinic Greensboro, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- West End Medical Centers, Inc. Atlanta, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Georgia Highlands Medical Services Cumming, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Primary Care of Southwest Georgia, Inc Thomasville, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- AAPHC – Baker County Primary Health Care Newton, GA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Visiting Nurse Housecall, LLC Atlanta, GA – Independence at Home Demonstration
- Jason Stein MD, SFHM Atlanta, GA – Innovation Advisors Program
- Providence Women’s Health Care Roswell, GA – Strong Start for Mothers and Newborns Initiative
- The Nurse Midwifery Practice at Athens Regional Medical Center Athens, GA – Strong Start for Mothers and Newborns Initiative
- Center for Black Women’s Wellness Atlanta, GA – Strong Start for Mothers and Newborns Initiative
- The Midwife Group and Birth Center Savannah, GA – Strong Start for Mothers and Newborns Initiative
- Southwest Georgia Public Health District 8-2 Albany, GA – Strong Start for Mothers and Newborns Initiative
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Georgia
On November 16, 2012, Governor Nathan Deal (R) announced that the Georgia had stopped planning for an exchange.1 In the previous year Governor Deal issued an Executive Order to create the Georgia Health Exchange Advisory Committee to assess whether and how Georgia should establish a health benefit exchange.2 The 25-member Committee included state officials, insurers, brokers, business representatives, consumers, and providers.3 The Committee also formed subgroups to develop recommendations on governance, operations and finance, and insurance markets. In October 2011, the subgroups released reports that included recommendations to establish a ‘Georgia Health Insurance Marketplace Authority’ as a quasi-governmental, non-profit corporation with a single governing body that maintains two separate risk pools for businesses and individual consumers.4,5,6 In December 2011, the Committee submitted final recommendations to the Governor in support of creating a small business health insurance marketplace through a wholly private or limited quasi-governmental entity, but did not commit to building an individual exchange.7
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Georgia did not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Georgia- HMO Urgent Care 60 Copay.
The Georgia State Office of Planning and Budget received a federal Exchange Planning grant of $1 million in 2010.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Georgia is not participating in Medicaid expansion.
The federal government will assume full responsibility for running a health insurance exchange in Georgia beginning in 2014.
1. Press release from Governor Nathan Deal. “Georgia Will Not Set Up Exchange.” November 16, 2012.http://gov.georgia.gov/press-releases/2012-11-16/deal-georgia-will-not-set-state-exchange
2. Executive Order issued on June 2, 2011.http://gov.georgia.gov/vgn/images/portal/cit_1210/21/41/17217485106_02_11_01.pdf
3. Georgia’s 2011 Health Insurance Exchange Advisory Committee Appointees.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/15/45/173596255Advisory%20Committee%20Appointees%20-%20Updated%20072111.pdf
4. Georgia Health Insurance Exchange Advisory Committee Governance Subcommittee Presentation. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/42/178821132Governance%20Subcommittee%20Presentation.pdf
5. Insurance Markets Subcommittee Report for the Georgia Health Insurance Exchange Advisory Committee. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/41/178821134Insurance%20Markets%20Subcommittee%20Report.pdf
6. Health Insurance Exchange Advisory Committee Operations and Finance Subcommittee. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/40/178821136Operations%20%20Finance%20Subcommittee%20Report.pdf
7. Report to the Governor. Georgia Health Insurance Exchange Advisory Committee. December 15, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/28/4/179765813GHIX%20Final%20Report%20to%20the%20Governor.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation