You qualify for helping paying your premium if your modified adjusted gross income (MAGI) is between 100% and 400% FPL of Federal Poverty Guidelines. In Georgia, 100% of poverty is $11,880 for a single person household, and $16,020, $20,160, and $24,300 for households of 2, 3, and 4 respectively. The rate goes up an addition $4,140 per each additional member of the household. 400% of the Federal Poverty Guidelines is $47,520 for a single person household, and $64,080, $80,640, $97,200 for households of 2, 3, and 4 respectively. The amount goes up $16,560 per additional member of the household. Those that have income below 100% of Federal Poverty Guidelines fall into the Medicaid Gap and are not eligible for a subsidy to help them purchase coverage through the healthcare.gov Marketplace.
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Are You Confused About Your Options
Under the Affordable Care Act?
Under the Affordable Care Act?
No need to worry, Insure Georgia's trained and certified experts are #HeretoHelp! Our Navigators provide FREE, unbiased guidance on health insurance options available through the Marketplace, Medicaid, and our Children's Health Program (CHIP). Whether you are comparing plans that will meet your needs or addressing insurance related matters, our enrollment experts will be there from coverage to care.
Open Enrollment for 2018 health coverage began November 1st and ended December 15th.
Our Virtual Navigators are providing enrollment assistance Monday-Friday from 9AM to 5PM. Find out if you are eligible to enroll through a Special Enrollment Period by contacting Insure Georgia at 1.866.988.8246.
Find Frequently Asked Questions Here
When the ACA was written, it was assumed that all states would expand Medicaid to cover all able-bodied individuals with very low income rather than just the disabled or expectant mothers. Georgia and several other states did not expand or change their eligibility requirements for Medicaid. Because of this subsidies (Advance Premium Tax Credits) only were only created for those who have incomes of 100% or more of Federal Poverty Guidelines. Those who have incomes below that and do not otherwise qualify for Medicaid or other coverage are in the Medicaid gap and would have to pay full price for health insurance offered through the Marketplace. Example: A single person with an income of $12,000 may pay $21 per month for a HMO plan with a $250 deductible, $600 out-of-pocket maximum, and $10 primary care co-pays. If that person’s income was $11,000, she might pay $369 per month for a similar HMO plan with a $3,500 deductible, $5,200 out-of-pocket maximum, and $20 primary care co-pays.
Yes. Our navigators are trained to help you determine if you might be eligible for Medicaid or other programs. If you are not, we can still connect you with a local safety-net healthcare provider. These include Federally Qualified Health Centers, volunteer clinics, hospital indigent clinics, and other programs. Many of these programs provide varying types of service at little to not cost for those in the Medicaid Gap. Call our office at 1-866-988-8246 and we can help.
The Cost Sharing Reduction (CSR) is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. It is available to those who have incomes between 100%-250% of Federal Poverty Guidelines. The CSR could reduce your deductible to as little as $200 and copays to as little as $5. If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Give us a call at 1-866-988-8246 and we will help you determine your eligibility for the CSR.
If you do not qualify for an exemption, and you did not have minimal essential coverage for at least 9 months of the year, you will be forced to pay a penalty called the Shared Responsibility Payment. It is about $750 per adult and $350 per child per year or 2.5% of your household income that is above the tax return threshold for your filing status.
We can help. Our regional and virtual navigators are trained to help Georgians who have issues after enrollment. We can help you with appeals, complaints, recoding a change of income with healthcare.gov and many, many other issues. Call us at 1-866-988-8246 for help.
Many times you can keep your doctor. We can help you evaluate plans that your physicians or hospitals participate in. We can also help you compare those plans to other plans that may have lower costs but a smaller network for doctors and hospitals. We can even help you consider plans that cover medications you may be taking. Call us at 1-866-988-8246 for help.
If you operate a small business with one or more employees besides the owner(s), partners, or family members, you may be eligible to participate in the Small Business Health Options Program (SHOP). Through SHOP you can offer your employees quality health insurance and if you have fewer than 25 employees, you may even qualify for the Small Business Health Care Tax Credit worth up to 50% of your premium costs. We have staff that specialize in SHOP enrollment for small businesses. Give us a call at 1-866-988-8246 for help.
