Health insurance in Georgia
- Georgia utilizes a federally facilitated health insurance exchange.
- Open enrollment for 2021 health plans is November 1 – December 15, 2020. Residents with qualifying events can enroll or make changes to their coverage outside that window.
- Short-term health plans can be sold in Georgia with initial plan terms up to 364 days.
- Six insurers will offer 2021 coverage through the Georgia health insurance marketplace, with an overall average rate increase of about 4.8%.
- Georgia has not accepted the ACA’s Medicaid expansion, but is seeking federal approval for a partial expansion of Medicaid.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Georgia. Here, you’ll find information about the many types of health insurance – also known as medical insurance – available. You can find the basics of the Georgia health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Georgia; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of Georgia health insurance resources for residents.
Georgia’s health insurance marketplace
Georgia uses the federally run health insurance exchange/marketplace, so enrollments are completed via HealthCare.gov. The exchange is for people who buy their own health insurance, which includes the self-employed, early retirees who aren’t yet eligible for Medicare, and people who are employed by a small business that doesn’t provide health benefits.
Georgia has proposed a unique 1332 waiver — which is still under review by HHS — that would eliminate the exchange in Georgia and instead have people enroll in health plans via brokers, agents, and insurance companies. A Brookings Institute analysis noted that what Georgia is proposing with its insurance market isn’t lawful, and the federal approval process is likely to be lengthy.
Georgia is also seeking federal approval to create a reinsurance program, but that has been delayed until 2022.
Six insurers are offering 2020 insurance coverage through the Georgia health insurance marketplace, including newcomers Oscar Health and CareSource. All six will continue to offer plans for 2021, with average rate changes that range from a 19 percent decrease to a 10 percent increase. Across the whole market, the overall average rate change for 2021 is about a 4.8 percent increase.
Although service areas vary from one insurer to another, most exchange enrollees in Georgia have access to plans from at least three different health insurance companies. Much of the state has only one or two insurers offering plans, but the most populous parts of the state are included in more insurers’ service areas.
Read our overview of the Georgia health insurance marketplace – including news updates and exchange history.
Georgia open enrollment period and dates
Open enrollment for 2021 health plans runs from November 1, 2020 through December 15, 2020. This enrollment window applies both on-exchange and off-exchange. It’s an opportunity for individuals and families to renew their existing coverage, update the exchange if they’ve had any changes to their income or household size in the past year, or change to a different health insurance policy for 2021. It’s also a chance for new enrollees to sign up for coverage, with financial assistance — for premiums and/or out-of-pocket costs — based on household income (financial assistance is only available through the exchange; people who enroll directly through a health insurance company do not receive any subsidies).
Outside of the open enrollment window, Georgia residents can only enroll in individual major medical health plans if they experience a qualifying event.
Read more in our comprehensive guide to the open enrollment period for 2021 health coverage.
Medicaid expansion in Georgia
The benefits of Medicaid remain out of reach for many Georgians. Georgia has not accepted federal funding to expand Medicaid under the ACA, and the state’s Medicaid program is more restrictive than average, with only six states having lower income limits for Medicaid eligibility for low-income parents.
Georgia is seeking federal approval for a partial expansion of Medicaid, which would cover people with income up to the poverty level (as opposed to 138 percent of the poverty level, as called for in the ACA). But CMS rejected a similar proposal from Utah in 2019, so it’s unclear whether Georgia officials will be successful in their bid to receive federal Medicaid expansion funding without fully expanding Medicaid.
Read more about Medicaid expansion in Georgia.
Short-term health insurance in Georgia
Georgia does not have state-specific regulations for short-term health insurance plans, so the state defaults to the federal regulations.
That means insurers in Georgia can offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months. (Insurers can also offer plans with shorter maximum durations, however, and prohibit renewal if they choose to do so.)
Read more about short-term health insurance in Georgia.
How has Obamacare helped Georgia?
The states that have most successfully reduced their uninsured population through the Affordable Care Act have implemented a state-run or partnership exchange and/or expanded Medicaid. Georgia has done neither of these things, which is typically an indication of opposition to the ACA.
The state’s uninsured rate has seen a moderate decline from 2013, just before Obamacare plans took effect. Through 2016, the percentage of Georgia residents without health insurance dropped 5.9 percentage points from 18.8 to 12.9 percent (about a 31 percent decrease), according to U.S. Census data. But by 2018, the state’s uninsured rate had crept back up to 13.7 percent. Nationwide, the uninsured rate stood at 8.9 percent in 2018, and had been 14.5 percent in 2013. Georgia’s refusal to accept federal funding to expand Medicaid is a big part of why the state’s uninsured rate is higher than the national average.
But as of 2020, there were more than 433,000 Georgia residents enrolled in private health plans through the exchange. Ninety-one percent of these enrollees were receiving premium subsidies that make their monthly premiums much less costly, and 68 percent were receiving cost-sharing reductions, which make out-of-pocket medical expenses (deductible, copays, coinsurance) more affordable. All of these enrollees — as well as off-exchange enrollees and people with small-group coverage purchased since 2014 — have plans that provide coverage for the ACA’s essential health benefits. None of them have to worry about pre-existing conditions being excluded or about hitting a lifetime or annual benefit maximum if they get very sick. These improvements are all a result of the ACA.
Georgia and the Affordable Care Act
Georgia politics are dominated by Republicans at the federal and state levels, and the Affordable Care Act has generally been deeply unpopular with local lawmakers.
When the Senate voted on the Affordable Care Act on Christmas Eve, 2009, Republican U.S. Senators Saxby Chambliss and John Isakson both voted against the bill. Neither is still in the Senate, but their replacements, David Perdue and Kelly Loeffler, are both Republicans. Perdue was in the Senate in 2017 and voted in favor of repealing the ACA in 2017, although those repeal bills were never enacted. Loeffler joined the Senate in 2020, but hasn’t taken a position on whether the ACA should be overturned.
In the House, seven Georgia Republican and two Democratic representatives voted against the ACA in 2010, while four Democratic representatives voted yes. As of 2020, Georgia’s House delegation includes four Democrats and eight Republicans. During the 2017 legislative session, Representatives from Georgia were split along party lines in terms of their votes for or against ACA repeal.
At the state level, Gov. Brian Kemp has a very conservative approach to governing and is opposed to the ACA. Kemp has proposed sweeping modifications to Georgia’s insurance market using 1332 waivers, in addition to a partial expansion of Medicaid.
Medicare coverage and enrollment in Georgia
As of August 2020, there were nearly 1.77 million Georgia residents enrolled in Medicare. Most are eligible for Medicare due to age, but 17 percent of Georgia Medicare beneficiaries are under the age of 65 and are eligible for Medicare because of a disability.
Georgia health insurance resources
- Georgia Department of Community Health (DCH)
- Office of Insurance and Safety Fire Commissioner — Regulates and licenses health insurance products sold in the state, as well as the brokers and agents who sell them.
- Georgia Cares State Health Insurance Assistance Program — A resource for Medicare beneficiaries and their caregivers, providing counseling and assistance with various Medicare issues.
- Georgia Association for Primary Health Care, Inc. (GAPHC) — Georgia’s Community Health Centers, also serves as the state’s federally-funded Navigator organization, helping people enroll in coverage (private health plans or Medicaid) in the exchange.
- Medicare Rights Center — a national resource that includes a website and call center where people can get help with Medicare questions.
State-level reform in Georgia
Scroll to the bottom of this page for a summary of what’s happening at the state level with healthcare reform in Georgia.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.