Marketplace Plans


Alliant, Ambetter, Anthem (BlueCross), Kaiser

(1) Over the past 5 years Georgia Health Insurance Marketplace has received 1000’s of calls from Georgia consumers

Asking us to update and/or repair existing marketplace applications that were:

(a) : Either done over the phone with a federal call center marketplace sub-contractor representative
(b) : Or done online at the federal website by the consumer him/herself.
(2) Georgia households should know which BROAD “projected household income” they are in (NO/YES/NO).
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* The state of Georgia does not have expanded Medicaid. This means that a Georgia household MUST have “projected
2019 household gross income” ABOVE 100% of the federal poverty level in order to qualify for monthly financial
assistance. If you think your original or existing marketplace application may show your projected gross household
income for your household size of (1) / (2) / (3) / (4) / (5) to be BELOW $12,140 (1)/ $16,460 (2)/ $20,780 (3)/
$25,100 (4)/ $29,420 (5), contact Georgia Health Insurance Marketplace immediately (404.975.3313).
(a) : Either done over the phone with a federal call center marketplace sub-contractor representative

(3) For each household size (based on the family size in your projected 2018/2019 tax return):

(a) There are generally 5 income sub-categories (w/n the 100%-400% category) that determine monthly payment.:
(b) There are generally 4 income sub-categories (w/n the 100%-400% category) that determine annual deductible.

(4) The biggest mistake consumers make is paying too much for their health insurance. This is usually caused by answers
to questions on “projected gross household income”. Even the most diligent consumers can be math challenged
whether communicating to one of those call center representatives or doing it online themselves. We repair application
mistakes that either have you paying too much or that create IRS Form 1095A issues later on. We intelligently update
your federal application before you get auto-re-enrolled at a higher rate by your existing insurance company. If you are
currently uninsured, we will complete a pre-enrollment application for you prior to the upcoming Open Enrollment

(5) In addition to financial assistance, there is another important benefit that lowers your annual deductible. This is
called “cost sharing reduction” and there are 4 different income range sub-categories for each household size. Without
getting into examples for every household size, here’s an example for a family of 3.

A “same zip code/same ages” enrolled family of 3 with projected household income of $31,169
Will qualify for a MUCH LOWER annual deductible than
A “same zip code/same ages” enrolled family of 3 with projected household income of $31,170

(6) The upcoming Marketplace Open Enrollment Period (11/1/2018-12/15/2018) determines your 2019 monthly
payment. Your 2019 monthly payment is based on your household’s projected gross income for 2019, not your 2017 tax
return or your expected 2018 final. This can be very meaningful for the self employed and/or 1099 workers.
Applications for the self employed are almost never done correctly by those part-time subcontractors at marketplace
call centers. We take extra time with the self employed and 1099 workers.

(7) Many Georgia consumers have gone years without ever updating their marketplace applications and each year take
an unexpected pounding from their health insurance company. These marketplace applications don’t update themselves
and outdated applications can also cause federal form 1095A tax issues.

(8) Consumers who have an existing marketplace plan often get prematurely “auto-re-enrolled” by their existing health
insurance company based on outdated information. When Open Enrollment ends, it’s generally too late to either change
plans or change companies. Call us now before Open Enrollment begins.\

(9) ) If you had a 2017 marketplace plan and you also have a 2018 marketplace plan, but you either failed to file your 2017
tax return (in 2018) or failed to submit your federal form 1095A to your tax preparer, you may become disqualified for
your applicable financial assistance and your tax refund will be delayed until you’ve remedied the situation. File your
2017 return (in 2018) before the 11/1/2018-12/15/2018 Open Enrollment Period.

(10) ) There are many Georgia residents under 65 who because of a disability are enrolled in both Medicaid and Medicare.
Although both of these programs prevent them from enrolling in a Marketplace Plan, they may be unaware that there
are many additional free medical benefits available to them. If you are one of these folks, we will see if we can enroll in
an important program with no additional cost to you whatsoever.


Alliant, Ambetter, Anthem (BlueCross), Kaiser