With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Georgia, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Georgia
Georgia ranked 38th in United Health Foundation’s 2014 America’s Health Rankings. Its strengths include a low prevalence of binge drinking, low incidence of pertussis infections (whooping cough), and high immunization coverage among children. Challenges included a low high school graduation rate, a high percentage of children in poverty and a high prevalence of low birthweight1
Georgia individual and family health insurance
When the Obamacare health insurance exchanges opened for 2014 enrollment, Florida defaulted to the federal health insurance marketplace, healthcare.gov. Individuals and families living in Florida may purchase health insurance coverage through the state’s federally facilitated exchange and in the private marketplace.
Those who buy health insurance through healthcare.gov may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
The U.S. Department of Health and Human Services reported that 316,543 individuals in Georgia selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Georgia enrolled in a marketplace plan increased to 541,080 during the open enrollment period.3
Georgia small group health insurance plans
In Georgia, small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program, SHOP Marketplace, at healthcare.gov and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from healthcare.gov.
Georgia State COBRA variations for small groups 4 5
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Georgia’s small group COBRA continuation variations are as follows:
|Mini-COBRA option||Yes—Georgia Extension Continuation Coverage|
|Eligible group sizes||All group health plans|
|Maximum continuation period – standard||3 months|
|Maximum continuation period employees age 60 and older||An additional 3 months after the first 3 months end until the person reaches age 65|
|Maximum premium increase||Those electing Georgia Extension Continuation Coverage will pay 100 percent of the plan’s premium, including the portion previously paid by an employer.Those 60 and older electing an additional extension will pay up to 120 percent of the plan’s premium (100 percent of premium, plus 20 percent processing fee).|
|State legislation reference||Georgia Official Code Title T33, Chapter 24, Sections 33-24-21.1 and 33-24-21.2|
|Department of Labor||866-487-2365|
|Georgia Department of Insurance||404-656-2085|
|Additional notes||Employees and their eligible dependents must have been covered under the plan for a minimum of 6 months and have a qualifying event—termination for reasons other than gross misconduct, reduction in hours of employment, employee enrollment in Medicare, divorce or legal separation, death of employee, loss of dependent child status under the plan.|
Georgia high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.6
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPS and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 138 percent of the federal poverty level.
Georgia opted not to expand its Medicaid program in 2014. As a result, many in the state fall into a coverage gap—their incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance available to those who purchase health insurance from healthcare.gov.
The information below is specific to Georgia’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Georgia Department of Community Health|
|Where to apply||healthcare.gov|
|Residency requirements||Georgia resident, U.S. citizen, qualified non-citizens|
|Eligibility||You may be eligible if your income is low and you:7 | Think you are pregnant, are a child or teenager, are 65 or older, are legally blindHave, have a disability, or need nursing home care.|
|More information||DCF dch.georgia.gov/medicaidAdditional programs include Family Medicaid for children under 19, parents and children under certain circumstances, and pregnant women; Women’s Health Medicaid coverage for breast and cervical cancer treatments for women; Emergency Medical Assistance for emergency healthcare expenses for non-citizens and others who are not eligible for Medicaid.8|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Georgia’s CHIP program:
|Program name||PeachCare for Kids|
|Where to apply||peachcare.org/Guidelines.aspx | healthcare.gov|
|Phone number||877-GA-PEACH (877-427-3224)|
|Eligibility||Low-income, uninsured children under 19 living in Georgia, U.S. citizen, qualified non-citizens.|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Printing Industries Benefit Trust. “An Employee’s Guide to Georgia Extension Health Benefits Continuation.” Last revised October 2010. Retrieved from http://www.piasc.org/pdf/insurance/GeorgiaCOBRA.pdf.
5 Georgia Code Title 33, Chapter 24, Sections 33-24-21.1–33-24-21.2. Retrieved from http://ga.elaws.us/law/33-24.
6 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
7 Georgia Department of Community Health. “Applying for Medicaid.” dch.georgia.gov. Retrieved from https://dch.georgia.gov/applying-medicaid.
8 Georgia Department of Community Health. “Right from the Start Medicaid.” dch.georgia.gov. Retrieved from https://dch.georgia.gov/right-start-medicaid.