Georgia Health Insurance: 2023 Coverage Guide

Georgia Affordable Healthcare Insurance

Before you begin shopping for health insurance, it's important to first understand what your options are so you make the right purchase. After you figure out which type of insurance and the level of coverage you need, you can begin comparing rates. It’s also important to remember to enroll during the open enrollment period. Unless you have a qualifying event, you may have to wait another year if you miss the deadline. Let’s get started!

When Is Open Enrollment in Georgia?

November 1, 2022 – January 15, 2023 

How to Get Health Insurance in Georgia

To figure out which type of insurance and which tier coverage best suits your needs, it’s a good idea to consider your healthcare costs and services for the previous year. How often did you see a care provider? How much in copays and coinsurance did you pay? Would a higher tier plan have saved you money? We can help you decide. Just keep reading!

Once you have a good grasp of how much coverage you need, you can compare health insurance companies and health insurance quotes. After you submit a form to SmartFinancial you’ll get several competing health insurance rates to choose from, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in Georgia?

HMOs, EPOs, PPOs and POS plans are the most popular types of health plans available in Georgia. You can also find short-term health insurance and catastrophic plans, which may be limited in coverage but cost much less. Marketplace plans are offered in bronze (60% coverage), silver (70% coverage), gold (80% coverage) and platinum (90% coverage).

Does Health Insurance Cover Pre-existing Conditions?

It’s illegal for marketplace health plans to deny health insurance coverage based on pre-existing conditions.

Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• Lost or quit a job. If you lost, changed or quit a job and have no health coverage, you can buy a plan outside the open enrollment rate. You can also buy when you start a new business.
• Turned 26. You can no longer remain on your parent’s health plan when you turn 26, but you can buy a plan outside the open enrollment period.
• Moved to another state or out of a coverage area. Some health plans are only valid in certain areas. If a move makes you ineligible for coverage, you can buy a new health plan outside the open enrollment period.
• Cobra coverage ended. When you elect Cobra, it has a deadline. Once you reach the deadline, you may buy a new health plan, even if it’s outside the open enrollment period.
• Divorce. If you shared a health plan with a spouse but the two of you divorced, you can buy a health plan outside the open enrollment period.
• Marriage. Newly married couples may buy a new health plan together or separately outside the open enrollment period.
• Birth or adoption of a child. Parents can buy their new child a new health plan outside the open enrollment period.
• Death of spouse or partner. When a partner or spouse with whom you shared health coverage passes away, you can buy a new health plan outside the open enrollment period.
• Spouse or partner loses coverage. When a partner or spouse loses coverage for qualifying reason, you may buy a new health plan together or separately.

Is Health Insurance Required in Georgia?

No, the only states that still require health insurance are California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC. Otherwise, there is a tax penalty. Even though it’s not required in Georgia, buying health insurance can prevent medical bankruptcy.

How Much Is Health Insurance in Georgia?

The average cost of health insurance in Georgia for a 40-year-old is about $490 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Georgia

The best way to save on health insurance in Georgia is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs

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Medicare in Georgia

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Georgia?

16% of the people living in Georgia get their healthcare through Medicare.

How Much Is Medicare in Georgia?

If you do not qualify for Medicare, you can buy it for $499 a month for Part A in 2022 and a standard monthly premium for Medicare Part B was $170.10 or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Georgia

If you’re enrolled in social security, you may automatically enroll in Medicare. You may have to sign up if you do not receive payments. You can also enroll by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Georgia?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

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Georgia State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Georgia Health System are listed below:

• Georgia: Overall Ranking: 46 of 51
• Georgia: Overall Performance: Below U.S. Average
• Georgia: Access and Affordability: 49
• Georgia: Prevention and Treatment: 39
• Georgia: Avoidable Hospital Use and Cost: 32
• Georgia: Healthy Lives: 35
• Georgia: Health Care Disparities: 47

Georgia Health Insurance Coverage

The people of Georgia have different kinds of health insurance while some Georgia residents are not insured at all. See the breakdown below:

• Private coverage: 42%
• Medicaid: 17%
• Medicare: 16%
• Uninsured: 15%

Report: America's Health Insurance Plans

Georgia Health Insurance Companies

• Kaiser Foundation Health Plan of Georgia, Inc.
• Aetna Health Inc. (Georgia)
• Aetna Life Insurance Company (Georgia)
• Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.
• Aetna Health Inc. - Georgia (Coventry Health Care of Georgia, Inc.)
• Alliant Health Plans, Inc.
• Blue Cross Blue Shield of Georgia, Inc.
• Cigna Health and Life Insurance Company - Georgia
• Connected General Life Insurance Company - Georgia
• Humana Employers Health Plan of Georgia, Inc.
• United Healthcare Services, Inc. (Georgia)
• UnitedHealthcare Insurance Company (Georgia)
• UnitedHealthCare of Georgia, Inc.
• Cigna HealthCare of Georgia, Inc.
• Harken Health Insurance Company (GA)
• Humana Insurance Company (Georgia)
• QualCare, Inc. (Georgia)