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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 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.

MacArthur Amendment Waiver Program

Under this waiver program, states would be able to do any of the following if certain assurance are made.
  • States could increase the age rating rules, which under the AHCA allows older adults to be charged no more than five time the premium as younger adults.
  • States could change the current list of essential health benefits and create their own.
  • States could replace the late-enrollment penalty with health status rating if the state also creates and maintains a risk mitigation program to assist sicker consumers.

All requests for waivers would need approval from the Secretary of Health and Human Services and could only be in effect for 10 years. Further, states would need to explain how their proposed plan helps the following:
  • reducing average premiums for health insurance coverage in the State;
  • increasing enrollment in health insurance coverage in the State;
  • stabilizing the market for health insurance coverage in the State;
  • stabilizing premiums for individuals with pre-existing conditions; or
  • increasing the choice of health plans in the State.

Additional Funding for the Patient and State Stability Fund

As we have discussed previously, the AHCA establishes the Patient and State Stability Fund to be used by states to provide financial assistance to hi-risk consumers, stabilize and reduce individual market insurance premiums, promote participation in the individual insurance market, promote preventive care, or reduce out-of-pocket costs.
The amendment offered by Mr. Upton makes available an addition $8 billion dollars between 2018 and 2023 to states that have received a waiver under the waiver program discussed above. These additional funds are to be used to assist individuals that reside in a state with an approved waiver, have a pre-existing condition, have not maintained continuous coverage, and need to purchase health insurance in the individual market.