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Are You Confused About Your Options
Under the Affordable Care Act?

No need to worry, Insure Georgia's trained experts are #HeretoHelp! Our Patient Navigators provide FREE, unbiased guidance on health insurance options available through the Marketplace, Medicaid, and the Children's Health Program (CHIP). Whether you are comparing plans that will meet your needs or addressing insurance related matters, we can help.

Open Enrollment for 2019 health coverage begins November 1st and ends December 15th. 

Our Patient 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.



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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.

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 patient 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.

We can help. Our patient 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.

You have no doubt heard that the republican leadership has released draft legislation aimed at repealing and replacing the Affordable Care Act (Obamacare), but what you may not know is that there are several other plans under consideration as well. As we continue to analyze the text of the newest republican plan, we thought you all may be interested in some of the details of these “other” plans.

The chart below shows you how three of the plans stacks up against the Affordable Care Act in ten major areas. First, the “Better Way” framework was released by House Speaker Paul Ryan in 2016 and until now represented the republican consensus. Second, the Empowering Patient’s First Act was introduced by former representative (and current Secretary of Health and Human Services), Dr. Tom Price during the 2015 legislative session. Although this plan is no longer officially under consideration, we included it as it represents the current Secretary’s views on the subject. Third, the “Obamacare Replacement Act” was introduced by Representative Rand Paul earlier this year and is generally thought to represents the more libertarian republican viewpoint. 

 

Affordable Care Act

Better Way (Ryan)

Patient’s First (Price)

Obamacare Replacement (Paul)

Exchanges

Establishes healthcare marketplaces for the purchase of individual insurance; tax credits only provided on exchange

Calls for marketplaces but does not specify that they will be run by the government; tax credits available regardless of where insurance is purchases; individual and association health pools

Does not directly address; tax credits available regardless of where insurance is purchases; individual and association health pools

Continue ACA exchanges; tax credits available regardless of where insurance is purchases; individual and association health pools

Dependent Coverage (<26)

Dependents are allowed on parent’s plans until age 26

Retain requirement

Retain requirement

Retain requirement

Guarantee Issue

Requires insurers to offer coverage regardless of health status 

Requires insurers to offer coverage regardless of health status for one-time open enrollment period; thereafter, only requires issue if continuous coverage; creates high risk pools

Requires insurers to offer coverage regardless of health status for open enrollment period every two years; thereafter, only requires issue if continuous coverage; creates high risk pools

Requires insurers to offer coverage regardless of health status only when consumer has been continuously covered for 18 months

Essential Health Benefits

Requires all plans cover a set of essential health benefits

Repeals ACA essential health benefit standard

Repeals ACA essential health benefit standard

Repeals ACA essential health benefit standard

Rating

Establishes a 3:1 rating rule; rating only for age, location and smoking status

Proposes a 5:1 rating rule; rating not allowed based on health status; does not address other factors

Repeals 3:1 rating rule; rating not allowed based on health status; rating is allowed on other factors; allows for 50% premium surcharge for non-continuous coverage

Repeals 3:1 rating rule; repeals prohibition on rating factors

Annual and Lifetime Limits

Prohibits Annual and Lifetime limits on insurance coverage

Prohibits Lifetime limits; does not address Annual limits

Repeals both Annual and Lifetime limit prohibitions

Repeals both Annual and Lifetime limit prohibitions

Medicaid Expansion

Prompts states to expand Medicaid to all consumers under 138% FPL; provides 90% of costs for newly eligible

Phase down enhanced reimbursement for newly eligible; sets further reimbursement on a per beneficiary amount

Repeals Medicaid expansion

Retains Medicaid expansion

Individual/ Employer Mandate

All individuals must have minimum essential coverage or pay a fine

Repeals requirement

Repeals requirement

Repeals requirement

Tax Credits

Advanced refundable tax credits for those under 400% FPL based on lowest priced silver plan

Advanced refundable tax credits based on consumer’s age

Advanced refundable tax credits based on consumer’s age

Retains ACA tax credits

Cost Sharing Reductions

Reduced co-pay and deductible amounts for those between 100% FPL and 250% FPL

Repeals ACA cost sharing reductions

Repeals ACA cost sharing reductions

Retains ACA cost sharing reductions