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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 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 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.

Last night, a package of amendments, called a Manager’s Amendment, was released for the American Healthcare Act (AHCA). Many of the amendments are of a technical nature to correct typographical errors, change section numbers, and adjust the effective dates of certain provisions. While many of these amendments impact the legislation in a significant way, we have focused our analysis on the major policy changes this packages of amendments makes to the original bill.

Medicaid Expansion 

The original bill continued to give state the option to expand Medicaid until 2020. This has now been amended to only allow states to expand Medicaid until the end of 2017.

States that have already expanded Medicaid will still receive an enhanced reimbursement for newly eligible individuals until 2020. After 2020, enhanced reimbursement will only be available for individuals enrolled before 2020 that remain continuously enrolled.

States that have not expanded Medicaid, but choose to do so by the end of 2017, will not receive enhanced reimbursement at all.  

Medicaid Work Requirements

The newly released amendments will also allow states to impose a work requirements in Medicaid for nondisabled, nonelderly, nonpregnant adults as a condition of coverage. This means that, like some other safety net programs, individuals will need to show that they are employed or are participating in certain other activities (like job training or education) to retain Medicaid benefits.

Increased Medicaid Funding for Elderly and Disabled

As we have discussed previously, the original bill changes the way Medicaid is funded. Instead of matching the money Georgia spends on Medicaid, the AHCA will pay Georgia a certain amount of money per person that is enrolled in Medicaid. We further discussed that this amount of money would be initially based on how much Georgia spends this year and will be increased each year. This increase is based on a standard formula that applies to all types of Medicaid enrollees. The newly release amendment changes this standard formula for elderly and disabled enrollees to increase the amount states receive for these two populations.

Medicaid Block Grants

The newly released amendment also allows states the option of choosing to fund their Medicaid program for certain populations by receiving what is called a block grant from the government rather than receiving a set amount per beneficiary.  Under a block grant, states would get a fixed federal grant to be used to fund the federal share of its Medicaid program and be given considerable flexibility in determining who and what would be covered. States would only be allowed to utilize block grants to fund Medicaid for their adult and children populations; Medicaid programs for the elderly and the disabled would still be reimbursed on a per enrollee basis.

Financial Assistance for Older Individuals

Many in the media predicted that this amendment would adjust the tax credit amount for those between ages 50 and 64 to provide for additional financial assistance. The newly release amendment does NOT do this. Rather, the press release issued by the Energy and Commerce Committee implies that changing the tax credit for older individuals will be handled when the Senate takes up the bill.