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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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Find Frequently Asked Questions Here

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.



The Affordable Care Act introduced a good number of regulations that controlled what plans insurance companies could offer, what those plans had to cover, who those plans had to cover, and what could be charged for those plans. Under the AHCA, many of these protections remain.

Guaranteed Issue (Pre-Existing Conditions)

Under the ACA, insurance companies are not allowed to refuse to sell you insurance because of a pre-existing medical condition you may have. Insurance companies must also cover treatment for any pre-existing medical conditions you may have.

The AHCA retains this requirement.

 

Essential Health Benefits

Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits.

The AHCA retains this requirement.

 

Lifetime and Annual Limits

Under the ACA, insurance companies are no allowed to set a dollar limit on what they will spend for your care during the entire time you are enrolled or during the entire year.

The AHCA retains this requirement.

 

Preventive Services

Under the ACA, plans must cover a specified set of preventive services – like vaccines and screening tests – at no cost to you.

The AHCA retains this requirement.

 

Premium Rating Classes

Under the ACA, insurance companies can only base the price of plans offered on your age, location, and whether you use tobacco. They are not allowed to base the price on your gender, race, or health status.

The AHCA retains this requirement.

 

Dependent Coverage

Under the ACA, dependent children can stay on their parent’s health insurance plan until they are 26 years old.

The AHCA retains this requirement.

 

Medical Loss Ration

Under the ACA, insurance companies are generally required to spend at least 80% of the money they take in from premiums on health care costs. The remaining 20% may be spent on administrative costs and profit. If insurance companies do not spend enough money on health care costs, they are required to issue a rebate check to all those they insure.

The AHCA retains this requirement.

 

Rating Rules for Age Classes

Under the ACA, older adults may be charged no more than three times the premium as younger adults.

The AHCA changes this requirement to allow older adults to be charged no more than five times the premium as younger adults

 

Metal Tiers

Under the ACA, insurance plans are divided into four major categories depending on what percentage of your total health care costs they will cover. These categories – Bronze, Silver, Gold, and Platinum – are designed to show you how you and your plan share costs. Bronze plans have the lowest monthly premiums, but the highest costs when you need care. Platinum plans have the highest monthly premiums, but have the lowest costs when you need care.

The AHCA repeals this requirement.

 

Continuous Coverage Penalty

To encourage you to get and keep continuous health coverage, the AHCA adds an additional rule that will allow insurance companies to charge you more if you do not keep coverage. Under the rule, when applying for health coverage, the insurance company will look back to see how many days out of the last year you were uninsured. If you were uninsured for more than 63 days, the insurance company can charge you a flat 30% surcharge on top of your base premium. The next year, assuming you have remained covered, the surcharge would go away.