Frequently asked questions about health insurance
coverage options in Georgia
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 proposed a unique 1332 waiver — which was approved by CMS in November 2020, under the Trump administration — that would eliminate the exchange in Georgia as of 2023 and instead have people enroll in health plans via brokers, agents, and insurance companies.
Georgia has also received federal approval to create a reinsurance program that will take effect in 2022.
Read more about the Georgia health insurance marketplace.
Open enrollment for 2021 health plans ended on December 15, 2020, but the federal government is currently offering a one-time COVID-related enrollment window, which continues through August 15, 2021. A qualifying event is not necessary to use this window, as it’s operating more like open enrollment than a special enrollment period.
This enrollment period is an opportunity for uninsured residents to sign up for coverage, but it also gives existing enrollees a chance to switch to a different plan if it would better suit their needs. This is particularly important given that the American Rescue Plan has made premium subsidies larger and more widely available in 2021, but some people will need to switch plans in order to take full advantage of this.
Six insurers are offering 2021 insurance coverage through the Georgia health insurance marketplace. For 2021, their average rate changes ragned from a 19% decrease to a 10% increase. Across the whole market, the overall average rate change for 2021 was about a 4.8% 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.
517,113 people enrolled in private plans through Georgia’s marketplace during the open enrollment period for 2021 health plans. This was significantly higher than the 463,910 people who enrolled the year before.
And the COVID-related enrollment window through August 15 is likely to result in increasing enrollment throughout much of the year. In just the first several weeks of this window (February 15 to March 31), more than 40,000 Georgia residents signed up for coverage.
In the same time period in 2020, just over 11,000 people enrolled, during special enrollment periods triggered by their own individual qualifying events. A qualifying event is not necessary during the COVID-related enrollment window, through August 15, 2021.
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% (about a 31% decrease), according to U.S. Census data.
By 2018, the state’s uninsured rate had crept back up to 13.7%, although it dropped slightly, to 13.4%, in 2019. Nationwide, the uninsured rate stood at 8.9 percent in 2018, and had increased to 9.2% by 2019, but Georgia’s uninsured rate declined slightly in 2019. But Georgia’s uninsured rate is still well above the national average, due in large part to the state’s refusal to accept federal funding to expand Medicaid.
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% 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 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. Their replacements, David Perdue and Kelly Loeffler, were both Republicans, but they lost their Senate seats to Jon Ossoff and Raphael Warnock in a run-off election in early 2021. Ossoff and Warnock are Democrats who both support the ACA, including measures to improve it.
In the House, seven Georgia Republican and two Democratic representatives voted against the ACA in 2010, while four Democratic representatives voted yes. As of 2021, Georgia’s House delegation includes five Democrats and seven 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.
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.
The Trump administration granted approval for Georgia’s proposal to partially expand Medicaid, albeit with a work requirement. The state’s proposal is expected to only cover a fraction of the people who would be eligible for coverage if the state simply expanded Medicaid as called for in the ACA, to all adults under age 65 with income up to 138% of the poverty level. And the Biden administration has notified states that Medicaid work requirements are a non-starter, so the terms of the state’s waiver approval are being reconsidered by the new administration.
Read more about Medicaid expansion 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.
As of January 2021, there were more than 1.78 million Georgia residents enrolled in Medicare. Most are eligible for Medicare due to age, but 17% of Georgia Medicare beneficiaries are under the age of 65 and are eligible for Medicare because of a disability.
- 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.