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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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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 senate has released their version of a healthcare reform bill entitled the Better Care Reconciliation Act of 2017. Learn about the major provisions of the proposed legislation below and how they might impact you. 

Individual Mandate

Under the Affordable Care Act (Obamacare) all individuals legally residing in the United States are required to get and keep health insurance unless the individual qualifies for an exemption. This requirement is sometimes referred to as the “Individual Mandate.” Anyone that does not comply with this mandate must pay a fee called the Shared Responsibility Payment when he or she completes her tax return each year. This amount is currently around $700 per person or 2.5% of the consumer’s total income.

The BCRA removes the penalty for failing to purchase insurance. If passed no one would have to pay a penalty.


Employer Mandate

Like the Individual Mandate, the Affordable Care Act (Obamacare) also mandated that certain employers provide health insurance to its employees. This is sometimes referred to as the “Employer Mandate.” This mandate requires employers with 50 or more full time equivalent employees to provide health insurance to at least 95% of their full-time employees and families. If employers fail to offer this required coverage, they must also pay a penalty.

The BCRA removes the penalty for employers as well. If passed employers covered by the Employer Mandate would not have to pay a penalty.

Advanced Premium Tax Credits (APTCs)

Under the ACA, many of you who purchase a plan though the marketplace (healthcare.gov) are eligible for a tax credit, called an Advanced Premium Tax Credit. These credits are advanced (or paid) directly to your chosen insurance company each month to lower your premiums. Under current law, APTCs are available to those of you with a household income between 100% and 400% of federal poverty guidelines. The specific amount of the tax credit available to you depends on what percentage of your income you are expected to contribute to the cost of your health insurance. This percentage depends on your income, with lower-income families being expected to contribute less (around 2%) than higher income families (around 10%). Your tax credit is then calculated by finding the difference between what you are expected to pay and what it would cost you to purchase a specific plan, called the benchmark plan, in your area. This benchmark plan is the next to the cheapest silver plan that is available in your area.

For example, let’s say your family of four has an income of around $36,000 a year, or 150% of federal poverty. According to the government, you would be expected to contribute around 4% of your income, or $1,440, to the cost of your health insurance. In your county, let’s say that the second cheapest silver plan has a premium of $797.52 per month, or $9,570 over the entire year. Your tax credit would be the difference between the cost of the plan ($9,570) and the amount you are expected to contribute ($1,440). So you would be entitled to an annual tax credit of $8,130 or $678 per month.

Another example, let's say you are an older couple (both 63 years old) at the same percentage of federal poverty, or $24,360 per year. According to the government, you would be expected to contribute around 4% of your income, or $975, to the cost of your health insurance. In your county,
let’s say that the second cheapest silver plan has a premium of $1,926 per month, or $23,124 over the entire year. Your tax credit would be the difference between the cost of the plan ($23,124) and the amount you are expected to contribute ($975). So you would be entitled to an annual tax credit of $22,149 or $1,846 per month.

The BCRA retains Advanced Premium Tax Credits, but changes who is eligible and the amount.


Under the proposed legislation, individuals with annual household incomes between 350% and 400% are no longer eligible for a tax credit. Individuals with annual household incomes below 350% are still eligible for a tax credit. The current legislation calculates the tax credit in much the same way as the ACA with two notable exceptions. First, the BCRA increases the percentage older consumers with more income are expected to contribute to their health insurance costs. Younger lower-income consumers continue to be expected to contribute around 2% of their income, but older higher-income consumers are expected to contribute up to 16.2% of their income. Second, the BCRA changes how the benchmark plan is chosen. Under the BCRA, the benchmark plan will be a less expensive plan with fewer benefits.

Cost Sharing Reductions

Some of you are also eligible for another type of financial assistance called Cost Sharing Reductions. This assistance is paid directly to your chosen insurance company and reduces your out-of-pocket expenses for copays, deductibles, and co-insurance. Under the ACA, Cost Sharing Reductions are available for those earning between 100% and 250% of federal poverty guidelines.

Under the BCRA, Cost Sharing Reductions are funded until 2019 and then repealed.

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 BCRA retains this requirement.

Essential Health Benefits

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

The BCRA retains this requirement. (There is, however, some concern that this could be changed by a program that allows individual states to obtain a waiver from the government.)

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 BCRA 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 BCRA 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 BCRA 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 BCRA 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 BCRA retains this requirement until 2019, but thereafter this is left to individual states to decide.

Rating Rules for Age Classes

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

The BCRA 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 BCRA retains this requirement.


Medicaid Financing

Medicaid is a public insurance option that until the Affordable Care Act covered five main groups of people: pregnant women, low-income families, disabled individuals, people who need long term care, and children. The program is jointly funded by states and the federal government. In Georgia, the federal government provides about $6.80 for every dollar the state spends on Medicaid. Currently, there is no cap on the amount of money the federal government will match.

The BCRA changes the way Medicaid is funded. Instead of matching the money Georgia spends on Medicaid, the BCRA will pay Georgia a certain amount of money per person that is enrolled in Medicaid. This amount would be initially based on how much Georgia has spent over the past few years and will be increased each year.


Medicaid Expansion

The ACA extended coverage to non disabled low-income individuals. The federal government provides about $8.00 for every dollar a state spends on covering these newly eligible individuals. Like core Medicaid, there is no cap on the amount of money the federal government will match.

The BCRA continues to give states the option to expand Medicaid, but the enhanced reimbursement rate for these individuals will gradually phase out over several years. In 2020, states would be paid a set amount per person enrolled just like the core Medicaid groups above.

Funding Changes

The BCRA defunds the Prevention and Public Health Fund, which provides grants for prevention, wellness, and public health initiatives.

The BCRA freezes funding to Planned Parenthood for one year and prohibits the use of tax credits to purchase health insurance plans that covers certain pregnancy termination services.

The BCRA increases current funding or creates the following:

  • Establishes the State Stability and Innovation Program. This program provides short term financial assistance to health insurers to stabilize the insurance market. ($50 billion over four years) It also provides long term financial assistance 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. ($54 billion from 2019 to 2026)
  • Increases funding to Community Health Centers
  • Increases funding to the Medicaid Disproportionate Share Hospital

Repeal of ACA Taxes

The BCRA repeals the following ACA taxes:

  • Medicare payroll tax on high income employee wages
  • Tax on tanning beds
  • Tax on health insurers
  • Tax on pharmaceutical manufacturers
  • Tax on medical devices