Frequently asked questions about health insurance coverage options in Georgia
For now, Georgia uses the federally run health insurance exchange/marketplace, so enrollments are completed via HealthCare.gov. Georgia is planning to establish a state-run exchange platform that would be in use by the fall of 2023 (for 2024 coverage), but this is not without controversy and two members of Georgia’s Congressional delegation have asked CMS to delay the state’s transition away from 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 have eliminated the exchange in Georgia as of 2023 and instead had people enroll in health plans via brokers, agents, and insurance companies. But the waiver approval was revoked by the Biden administration and Georgia residents continue to have access to the HealthCare.gov platform in 2023, with enrollment growing to a new record high.
Georgia also received federal approval to create a reinsurance program that took effect in 2022.
Read more about the Georgia health insurance marketplace.
The open enrollment period for individual/family coverage runs from November 1 to January 15 in Georgia. This could change in future years if Georgia transitions to running its own exchange platform. Under federal rules, state-based exchanges can set their own enrollment deadlines, as long as they aren’t earlier than December 15. Most state-run exchanges allow enrollment to continue at least until January 15, but Idaho’s exchange does impose a December 15 end date for the open enrollment period.
Outside of open enrollment, you can only enroll or make a coverage change if you qualify for a special enrollment period. In most cases, special enrollment periods require a qualifying life event. But some special enrollment periods (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) are available without a specific qualifying event.
If you have questions about opportunities to enroll in health coverage or make a plan change, you can learn more in our guide to open enrollment and guide to special enrollment periods.
In Georgia, consumers who need to purchase their own health insurance will generally find that they can enroll in affordable individual and family health insurance through the ACA marketplace (HealthCare.gov). More than 93% of the Georgia residents who enrolled in private plans through HealthCare.gov for 2023 were eligible for premium subsidies that offset a significant portion of the average premium cost.
Georgians with lower incomes may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Georgia.
For the small minority of people who aren’t eligible for employer-sponsored coverage, Medicare, Medicaid, or subsidies in the marketplace, a short-term health insurance plan might be a lower-cost coverage option worth considering. But it’s important to understand the ways in which various consumer protections do not apply to these plans. Learn more about short-term health insurance in Georgia.
Ten insurers offer 2023 health coverage through the exchange/marketplace in Georgia, with coverage areas varying from one insurer to another (down from 11 in 2022, due to the exit of Bright Health at the end of 2022):
- Alliant
- Ambetter from Peach State Health Plan (Centene)
- Blue Cross Blue Shield Healthcare Plan of Georgia
- Kaiser
- Oscar
- CareSource
- Friday Health Plans
- Aetna/CVS
- UnitedHealthcare
- Cigna
Georgia’s exchange enrollment reached a new record high for 2023, with 879,084 people enrolling in private plans during the open enrollment period that ended on January 15, 2023.
See a summary of how enrollment has changed over the years in Georgia’s exchange.
Georgia has not accepted federal funding to expand Medicaid eligibility under the ACA, so the state’s uninsured rate has not dropped as much as it has in states that have expanded Medicaid. The state’s uninsured rate has seen a moderate decline, dropping from 18.8% in 2013 to 13.4% in 2019. Nationwide, the uninsured rate stood at 9.2% by 2019. 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 2023, nearly 880,000 Georgia residents enrolled in private health plans through the exchange. The vast majority of these enrollees were receiving premium subsidies that make their monthly premiums much less costly, and many 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 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 2023, Georgia’s House delegation includes five Democrats and nine 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 has generally been opposed to the ACA. Kemp has proposed sweeping modifications to Georgia’s insurance market using 1332 waivers (in part to eliminate the exchange in Georgia altogether), in addition to a partial expansion of Medicaid. As of 2023, Kemp is pursuing a transition to a state-run exchange platform, although some members of Georgia’s Congressional delegation have asked CMS to pause implementation of this.
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.
But Georgia is planning to partially expand Medicaid in the summer of 2023, albeit with a work requirement and without the enhanced federal funding the state would get if they opted for full Medicaid expansion. This is expected to cover only a fraction of the number of people who would be covered if Georgia were to accept federal funding to fully expand Medicaid.
The Trump administration granted approval for Georgia’s proposal to partially expand Medicaid and impose a work requirement. The Biden administration officially rescinded approval for Georgia’s work requirement and premium requirement in late 2021. But Georgia filed a lawsuit against the Biden administration over those rule changes, and a judge sided with Georgia in August 2022, clearing the way for the state to move forward with its plan to partially expand Medicaid with a work requirement. The Biden administration has not appealed that ruling.
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 late 2022, there were nearly 1.9 million Georgia residents enrolled in Medicare. Most are eligible for Medicare due to age, but 14% of Georgia Medicare beneficiaries are under the age of 65 and are eligible for Medicare because of a disability.
You can read more about Medicare in Georgia – including details about Medicare Advantage plans, Medicare Part D prescription drug plans, and the state’s rules for Medigap plans.
- 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’s three federally-funded Navigator organizations help 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.
- Georgia Cares State Health Insurance Assistance Program — A resource for Medicare beneficiaries and their caregivers, providing counseling and assistance with various Medicare issues.
