Georgia Governor Brian Kemp calls health insurance in Georgia “too dang high.” So he’s overhauling the individual health insurance market to lower premiums. But first, the federal government has to approve his proposal. Until then, Benzinga will help you find affordable plans. We’ve done some research to make it easier for you to navigate the health insurance market in the Peach State.
Get Health Insurance in Georgia
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The Best Health Insurance in Georgia:
- Best Overall in Georgia: Alliant Health Plans
- Most Popular: BCBS of Georgia
- Most Affordable: Ambetter from Peach State Health Plan
- The Best Health Insurance in Georgia:
- What is Health Insurance?
- Average Cost of Health Insurance in Georgia
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance not Cover?
- Best Health Insurance Providers in Georgia
- Choose a Health Plan in Georgia
- Frequently Asked Questions
What is Health Insurance?
Health insurance is a type of insurance that helps you pay for your medical care. When you purchase a health insurance plan, also called a policy, you enter a contract and agree to pay a monthly premium or fee to an insurance company.
In Georgia, 49% of the state’s residents have health insurance through employers. In that case, your employer pays part of your insurance, most often through a managed care plan. Those plans have an agreement with health care provider networks to care for members at lower rates.
But you can purchase health insurance through a spouse’s plan, independently through a broker, COBRA or directly from an insurance company.
Depending on your income, you may qualify for insurance through the federal government and the state with Medicare and Medicaid. Medicare helps residents 65 and older with health care costs and Medicaid assists low-income families and children.
Average Cost of Health Insurance in Georgia
The average cost for a Bronze plan is $354, $460 for a Silver plan and $538 for a Gold plan in 2019.
Georgia residents spent an average of $6,587 per year on health care expenditures in 2014, which is less than the national average, according to a Kaiser Family Foundation report. This was the latest data available.
Types of Health Coverage
Whether you’re shopping for health insurance in Georgia through an insurance carrier broker or on Georgia’s Marketplace, you can choose from health insurance plans from major brands with 5 levels of benefits. They include:
- Bronze: Your insurance covers 60% of your medical costs on average. You pay 40%.
- Silver: Your insurance covers 70% of your medical costs on average. You pay 30%.
- Gold: Your insurance covers 80% of your medical costs on average. You pay 20%.
- Platinum: Your insurance covers 90% of your medical costs on average. You pay 10%.
- Catastrophic: These are high-deductible plans designed for people 30 and younger. Catastrophic plans are required to cover preventive care and the 1st 3 primary care visits at no cost to you, even if you haven’t met your deductible.
Health insurance brands offer these types of plans:
- Health maintenance organizations (HMOs): An HMO offers health care services through a network of physicians and facilities. You’ll have to choose a primary care doctor who can refer you to a specialist when you need it. HMO plans typically offer the least amount of freedom to see the doctor you want and require the least amount of paperwork to complete.
- Preferred provider organizations (PPOs): A PPO also offers health care services through a network of health care providers and gives members lower out-of-pocket fees to see providers within the network. If you see an in-network doctor, you’ll pay a $10 co-pay, for example. But if you see an out-of-network doctor, you’ll have to pay the entire bill up front and get an 80% reimbursement from the insurance carrier or pay a deductible. But you can visit a specialist without a physician referral if the specialist is within the network.
- Point-of-service plans (POS): A POS gives you time to choose a primary care doctor from a list from the POS plan providers. You can get some out-of-network coverage outside the network, but you have to get a referral from your doctor to see a specialist. POS plans may offer more health improvement and education programs like nutrition, smoking cessation, weight loss, diabetes management workshops and cover more preventive care services.
- Traditional health insurance: These plans also are called fee-for-service plans and are similar to auto insurance, where you pay for a certain amount of your medical care services upfront as a deductible. Then the insurance company pays the majority of the bill.
- Exclusive provider organization (EPO): An EPO is a managed care plan that only covers services when you use doctors, specialists or hospitals in the plan’s network, except in emergency situations.
What Does Health Insurance Cover?
Insurance plans sold in the Marketplace must cover 10 essential benefits under the Affordable Care Act. They include:
- Ambulatory patient service: Your insurance covers outpatient care you receive without a hospital admission such as visiting a doctor or an urgent care center.
- Emergency services: If you’re rushed to the hospital by ambulance or receive care emergency care, your insurance will cover it.
- Hospitalization: Your insurance will cover overnight hospital stays and surgeries while you’re admitted to the hospital.
- Pregnancy, maternity and newborn care: Your insurance covers prenatal checkups, care during delivery and checkups and care your baby needs. Additionally, your insurance coverage includes services you may need for birth control and breastfeeding.
- Mental health and substance use disorder services: If you need counseling, psychotherapy or in-patient or outpatient behavioral treatment for drug and alcohol addiction, your insurance will cover services.
- Rehabilitative and habilitative services and devices: Your insurance will pay for your rehab and devices you may need to gain or recover skills for injuries, disabilities or chronic conditions.
- Laboratory services: Your insurance will cover the cost of lab specimens like blood draws.
- Preventive and wellness services: Besides chronic disease management, your insurance will pay for services like weight loss management, getting your blood pressure checked and smoking cessation and nutrition workshops.
- Pediatric services: Your insurance will cover eye exams and dental treatments when your child needs oral and vision care. These services aren’t considered essential for adults.
These essential health benefits are broad and are considered minimum requirements for all Marketplace plans, but services covered in Georgia may vary based upon the state’s requirements. Georgia also requires insurance carriers to provide services for:
- Cancer screenings
- Diabetic supplies
- Bone marrow transplants
- Heart transplants
What Does Health Insurance not Cover?
Your health insurance won’t pay for cosmetic surgery, new eyeglasses or even dental care unless it’s medically necessary. Here’s a list of other services and treatments your health insurance likely won’t cover:
- Adult dental services: If you need to see a dentist, consider investing in a dental insurance plan. Your health insurance carrier may also offer a dental plan you can bundle for a discount or you can find a cheap plan independently of your carrier.
- Adult vision services: Besides eye exams, your health insurance won’t cover glasses or contacts. If you need these services, you can purchase a vision plan or pay out of pocket at an inexpensive vision care center.
- Hearing aids: Most health insurance carriers will not pay for hearing aids, but you can find assistance through organizations such as the AARP, which has a hearing loss program. You can find financial assistance programs through the Hearing Loss Association of America.
- Uncovered prescription drugs: If your insurance won’t pay for your prescriptions, you can ask your doctor for a covered substitute drug or to request that your insurer make an exception for your situation. If you’re denied, you can file an appeal with your carrier. Consider contacting the drug manufacturer to request free medication.
- Acupuncture and alternative therapies: If your insurance company considers reflexology, massages and other therapies experimental or unessential, you can appeal to attempt to get it covered.
- Weight loss surgery: Your insurance may cover weight-loss counseling or nutrition workshops, but it probably won’t cover bariatric surgery or other weight-loss surgeries.
- Cosmetic surgery: Health insurance companies will cover plastic surgery only as a medical necessity.
- Infertility treatment: In Georgia, coverage for fertility testing and treatment is based on your insurance plan. Many services such as in-vitro fertilization are not covered but some are.
- Sterilization reversal: Most insurance plans won’t reverse a vasectomy.
- Private nursing: Most insurance plans do not cover private nursing services.
- Travel vaccines: Travel vaccines are viewed as nonessential and something you choose by most carriers, so they aren’t covered.
- LASIK: This type of corrective eye surgery is considered elective and nonessential by companies, so your health insurance most likely won’t pay for it.
Best Health Insurance Providers in Georgia
When you’re looking for health insurance in Georgia, you have fewer options compared to the rest of the nation. Most providers don’t cover the entire state, but here are the best health insurance providers in Georgia.
1. Alliant Health Plans
Alliant Health Plans offers health insurance coverage for individuals, families, and groups in some Georgia counties. Alliant Health Plans is expanding its coverage for individual and group health plans to 10 additional Georgia counties in 2020.
You can also add dental benefits to your coverage through a partnership with Dominion National, a dental insurer and provider of dental and vision benefits. The partnership offers access to more than 9,000 PPO dentist listings in Georgia. Call 866-403-2785 to purchase a plan or ask more questions.
2. Blue Cross Blue Shield of Georgia
One of the largest and older health insurance carriers in the state, BCBSGa, also known as Anthem, serves more than 3.2 million members in Georgia. That number includes more than 235,000 individuals who are not covered by an employer plan.
Besides offering plans for employers and individuals, the carrier also serves seniors with Medicare Supplemental Insurance, group life and disability insurance as well as dental, vision and 360° Health. Its network includes 192 hospitals and more than 16,000 primary care doctors and specialists. For more information, call 1-800-331-1476.
3. Ambetter from Peach State Health Plan
Ambetter is known for its affordable health insurance — it beats other carrier rates in Georgia and has lower premiums than Alliant for each of its plans. In 2020, it’s highlighting the Ambetter Balanced Care 12, a Silver HMO, which offers $10 copays for primary care doctors, $20 copays for emergency room visits and $30 copays for specialist visits. An individual deductible is $950. To purchase a plan or for more information, call 877-687-1180.
Choose a Health Plan in Georgia
If you’ve been wondering how to get health insurance in Georgia, it’s available through the Georgia Marketplace on healthcare.gov, but the governor recommends that you go directly to carriers until marketplace rates are reduced.
You also should understand that the health plan you choose will vary depending on your county. No carrier covers the entire state, and in many counties, only 1 carrier is offered on the state exchange. All metal tiers also are not offered in each county, so ask lots of questions before you choose a plan.