How It Works and Who It’s For

Georgia Access is for individuals and families who:

• Live in Georgia

• Are lawfully present in the U.S.

• Are not incarcerated

• Are not enrolled in Medicare

The Marketplace is intended for those without access to affordable employer coverage, Medicaid, or Medicare. Most enrollees qualify for financial assistance, such as premium tax credits and cost-sharing reductions, based on income and household size. Georgia Access also offers multiple ways to enroll: directly online, through certified agents, web brokers, or insurance companies.

Open Enrollment Period in Georgia

• Window shopping: Opens October 28, 2024

• Open Enrollment: November 1, 2024 – January 16, 2025 (one day longer than the federal exchange)

• Enroll by December 15: Coverage starts January 1, 2025

• Enroll December 16 – January 16: Coverage starts February 1, 2025

If you want coverage to begin January 1, you must select your plan by December 20, 2024.

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage (including Medicaid, employer coverage, or PeachCare for Kids)

• Marriage or divorce

• Birth or adoption of a child

• Change in residence (moving to Georgia, a new ZIP code, or county)

• Gaining U.S. citizenship or legal presence

• Release from incarceration

• Turning 26 and aging off a parent’s plan

Most SEPs last 60 days from the event. For loss of Medicaid/PeachCare for Kids, Georgia Access extends the SEP to 90 days.

Types of Health Insurance Plans Available

Georgia Access offers plans in several metal tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs

• Expanded Bronze: Slightly more coverage than standard Bronze

• Silver: Moderate premiums and costs; required for cost-sharing reductions

• Gold: Higher premiums, lower out-of-pocket costs

• Platinum: Highest premiums, lowest out-of-pocket costs

• Catastrophic: For those under 30 or with a hardship exemption; low premiums, high deductibles

Plan Types:

• HMO: Lower premiums, limited network, referrals required for specialists

• PPO: Higher premiums, larger network, out-of-network coverage, no referrals needed

• EPO: Hybrid of HMO and PPO; must use network providers, no referrals needed, no out-of-network coverage except emergencies

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes up to 400% of the federal poverty level (FPL), with expanded eligibility through 2025. In 2024, over 90% of Georgia enrollees received subsidies, lowering average premiums from $583 to $75 per month.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing deductibles, copays, and coinsurance.

• Medicaid/CHIP: Medicaid covers low-income adults, children, pregnant women, and people with disabilities. PeachCare for Kids (Georgia’s CHIP) covers children in families with higher incomes.

How to Compare and Choose a Plan in Georgia

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Make sure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs

• Families: Look for pediatric dental/vision, family out-of-pocket limits

• Retirees: Marketplace coverage can bridge the gap until Medicare at 65

Top Insurance Providers on the Georgia Exchange

For 2025, nine private insurers offer Marketplace coverage:

• Ambetter (largest Marketplace carrier, expanding in rural areas)

• Anthem Blue Cross and Blue Shield (expanding to more counties)

• CareSource

• Cigna

• Kaiser Permanente

• Oscar

• UnitedHealthcare

• Aetna

• Alliant

Coverage areas and plan options vary by county.

Navigating Georgia’s Online Enrollment Portal

How to Apply:

Visit Georgia Access and create an account.

Enter household and income information to check eligibility for subsidies.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from Georgia Access certified Navigators, agents, and counselors.

• Call the Georgia Access Contact Center for support.

• Accessibility and language support services are available for all Georgians.

Alternatives to the Marketplace

• Short-term health plans: Coverage up to 364 days, renewable up to 36 months; not ACA-compliant, may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies, but must meet ACA requirements.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may appeal to some for cost-sharing.

Common Mistakes to Avoid During Enrollment

• Failing to review all plan options and updates

• Forgetting to update income or household information

• Missing enrollment deadlines

• Choosing the wrong metal tier for your needs

• Not checking if your providers are in-network

State-Specific Health Programs or Initiatives

• Georgia Access Reinsurance Program: Helps reduce premiums for those not eligible for subsidies

• Medicaid and PeachCare for Kids: Expanded eligibility and continuous coverage for children and low-income families

• Enhanced Direct Enrollment: Unique to Georgia, allows enrollment through web brokers as well as the state portal

Georgia Access aims to make health coverage more accessible, affordable, and tailored to residents’ needs, with robust support and consumer protections.