Know More

HOUSEHOLD SIZE: This is your “tax household family size”. This is the number of family members who’ll be included in your upcoming federal tax return including family members not applying for marketplace coverage.

HOUSEHOLD SIZE: This is your total household income including income from family members who will be in your federal tax return but will not be applying for marketplace coverage. This is “estimated” (NOT prior year) annual household income for the calendar year of your upcoming marketplace coverage. The federal marketplace wants you to have an affordable monthly payment that is commensurate with your upcoming household income(s) for the calendar year in which you will have health insurance marketplace coverage.

WILL QUALIFY: If your family size is ABOVE 100% of the federal poverty level for your family size OR if your family size is BELOW 250% of the federal poverty level for your family size, choosing a silver plan will lower your copay and deductible. (To see where your family size stands, refer to the color-coded family size household charts for Cost Sharing Reductions on our homepage).

The LOWER your household income for your family size, the LOWER your co-pay and deductible. There are 3 household income categories (based on family size) that determine the degree of lower copays and deductible. Family sizes of 1/2/3/4/5/6 earning 200-249% of the poverty level qualify for LOW copays and deductible. Family sizes of 1/2/3/4/5/6 earning 150-199% of the poverty level qualify for LOWER copays and deductible. Family sizes of 1/2/3/4/5/6 earning 100-149% of the poverty level qualify for LOWEST copays and deductible. (To see where your family size stands, refer to the color-coded family size household charts for Cost Sharing Reductions on our homepage).

WILL NOT QUALIFY: If your family size is ABOVE 250% of the federal poverty level for your family size, you can still choose a silver plan (or a bronze or gold plan), but you will not qualify for lower copays and deductible. (To see where your family size stands, refer to the color-coded family size household charts for Cost Sharing Reductions on our homepage).

JOB(s)

(1) Income from a job is NOT based on “take home pay”. It’s based on your pay BEFORE payroll reductions.

(2) Go online to your employee payroll account to determine either your (latest pay period gross earnings from your latest pay period) or your (“average” gross earnings of your latest pay period).

(3) Use an “average” if your latest pay period was not a typical representation (unusually high or unusually low number of hours that was not “typical”).

(4) Know how often you’re paid: (weekly = 52x/yr); (bi-weekly = 26x/yr); (2x/month =24x/yr); (monthly = 12x/yr)

(5) Or do your own informed and honest upcoming annual income estimate using your ($ HOURLY WAGE) X
the typical number of (HOURS PER PAY PERIOD) X your (NUMBER OF PAY PERIODS PER YEAR).
Example: $12.50 per hour X 80 hours per bi-weekly pay period X 26 pay-periods per year = $26,000/year.
Example: $12.50 per hour X 88 hours per twice a month pay period X 24 pay-periods per year = $26,400/year
Example: $12.50 per hour X 176 hours per monthly pay period X 12 pay-periods per year = $26,400/year
Example: $12.50 per hour X 40 hours per weekly pay period X 52 pay-periods per year = $26,000/year

SELF-EMPLOYMENT / 1099 CONTRACT WORK

(1) Unlike gross income from a job, income from self-employment and /or 1099 contract work is based on NET PROFIT or NET INCOME (after work related expenses)

(2) Although this can be difficult to estimate for the upcoming year, here are several suggestions.

(a) Use your latest month’s OR your average month net profit or net income and multiply by 12 (12 months)

(b) Use your latest tax return (Your IRS Schedule C Profit & Loss section on your tax return) as a guide and try to determine as honestly as possible whether or not the following year will be equal, better or worse than the annual net profit net income shown on that prior year return.

SOCIAL SECURITY INCOME & SOCIAL SECURITY DISABILITY INCOME

Regardless of whether or not your social security benefits are taxable or non-taxable, multiply your latest monthly social security income X 12 to estimate your upcoming annual social security income.

Don’t forget, if you enroll in a marketplace plan, you MUST file a federal income tax return for the calendar year in which you are covered. If you don’t file, you’ll lose your monthly financial assistance for the following year.

In other words, if you are enrolling (or re-enrolling) for the 2020 calendar year, you must file your 2020 tax return in 2021. If you fail to do this, you will lose your monthly financial federal assistance when Open Enrollment Period (OEP 11/1/2020-12/15/2020) comes up again and you’ll have no monthly financial federal assistance for your 2021 marketplace coverage year.

RETIREMENT / PENSION INCOME: Multiply latest or average monthly amount received x 12 months.
REAL ESTATE INCOME: Latest or average NET monthly real estate profit (after expenses) x 12 months.
INVESTMENT INCOME: Total of latest or average income statements or use prior year tax return as a guide.

MYTH: Household income is based only on the income of the family member(s) applying for coverage
FACT: Household income is based on the income of members applying and not applying for coverage.

MYTH: Household family size is based on the number of family members applying for coverage.
FACT: Household family size is based on the tax household family size based on the upcoming tax return.

MYTH: Household income is based on the household income of the last tax return or last year’s income.
FACT: Household income is based on the income estimate for the calendar year in which you will be covered.

MYTH: Federal marketplace plans on the Georgia state exchange are only for low-income Georgia households
FACT: Georgia family sizes of 1-2-3-4 making less than apprx $13k-$17k-$22k-$26k receive no financial help.

MYTH: Middle class Georgia families receive no financial assistance to help them pay for marketplace plans
FACT: Family sizes of 1-2-3-4 earning less than apprx $49k-$67k- $85k-$102k do receive financial help.

MYTH: Georgia households with modest income don’t have lower deductible plans available to them.
FACT: Family sizes of 1-2-3-4 earning less than apprx $31k- $42k-$53k-$64k have lower deductible plans.

MYTH: PPO Doctors are better than HMO Doctors and all marketplace plans are HMO Doctors
FACT: A doctors waiting room will have patients with HMO plans and PPO plans all seeing the same doctor.

MYTH: There are other plans other than marketplace plans that will cover all pre-exiting conditions
FACT: Only marketplace plans will always cover pre-exiting conditions no matter what the situation.

MYTH: I can enroll in a marketplace plan anytime I want throughout the year.
FACT: Everyone can always enroll or re-enroll during Open Enrollment Period (OEP 11/1-12/15). Enrolling during Special Enrollment Period (SEP 12/16-10/31) requires a qualifying life event that generally has occurred in the past 60 days.

It’s a relatively unknown fact Georgia hospitals are among the nation’s most expensive and the primary recipient of any Georgia resident’s annual deductible may likely be due to a hospital visit. From the 2014 Open Enrollment Period (2014OEP 11/1/2013 – 12/15/2013), the overall annual deductibles for federal health insurance exchange plans has risen every year, and every year companies participating in Georgia have changed their suite of available plans (Bronze, Silver, Gold) with varying deductibles. All companies have multiple plans in the 3 metal categories.

For those Georgia residents already enrolled in a prior year’s plan who don’t check the latest availabilities, they will be unaware of the possible change in their own plan’s deductible. The federal health insurance exchange in Georgia changes in so many ways each and every year. To see the latest plans (and deductibles) available in Georgia and to re-enroll in your same plan (or choose a new one), just click the red “Get a Quote & Enroll / Re-Enroll” icon.

The 2020 Open Enrollment Period (2020 OEP 11/1/2019-12/15/2019) is the only opportunity for a Georgia resident with an existing marketplace application and enrollment to change plans (or re-enroll in their same plan by updating their application). At 12:01AM, December 16, 2019, the window of opportunity to apply for marketplace plan is gone until 2021 Open Enrollment Period (2021 OEP 11/1/2020-12/15/2020). The bell has already rung.

Unless you qualify for a 2020 Special Enrollment Period (2020 SEP 12/16/2019-10/31/2020), it becomes a lost opportunity. Qualifying for Special Enrollment Period means that you must have a Qualifying Life Event. These include (a) A loss of individual or group coverage (but NOT due to non-payment) in the prior 60 days or the upcoming 60 days; (b) Moving from outside of Georgia into Georgia in the past 60 days; (c) Change in immigration status in the last 60 days; (d) Adding a 19 year old previously on Georgia’s PeachCare for Kids (Medicaid) in the past 60-90 days or upcoming 60-90 days (and had a marketplace plan already in place);. (e) Having a change in family size due to birth, death, marriage or divorce in the past 60 days (and had a marketplace plan already in place); and certain other Qualifying Life Events.

Bottom line, (with the exception of a Qualifying Life Event), a Georgia resident who had an enrollment from the prior year and got automatically renewed on 12/16/2020 because they failed to apply for marketplace plan again during 2020 Open Enrollment Period, will need to keep that plan until January of 2021 when they apply for 2021 Open Enrollment period (2021 OEP 11/1/2020-12/15/2020)

Every year after Open Enrollment period has ended, thousands of Georgia residents seem to finally notice their new January bill (or auto-pay) from their existing insurer and come to realize that they can’t afford it. They try to change plans either with their same company or with another company that might be more competitive. Unfortunately, the bell has already rung. To apply for marketplace plan, it should always be done during Open Enrollment Period, even if you already have an existing enrollment in the same plan as your prior year. To see the updated companies and plans and deductibles and co-pays in your Georgia county (and zip code) and to re-enroll in your same plan (or choose a new one), click the red “Get a Quote & Enroll / Re-Enroll” icon.

From time to time, the health insurance marketplace incorporates changes that are often not that well publicized. Those with prior marketplace applications and enrollments may never be aware of these changes until after they receive their pre-populated IRS 1095A form and it is converted to the IRS Form 8962 on their upcoming tax return.

Since divorce and separations are unfortunately becoming more commonplace in Georgia, many recently divorced or separated will be shocked to discover that ma recent change in the health insurance marketplace

2019 Original Rate ($600) MINUS 2019 financial assistance ($400) = $200 actual prior 2019 payment.
2020 Original Rate ($700) MINUS 2019 financial assistance ($400) = $300 estimated new 2020 payment

The result of this change was that some Georgia residents had their income reduced by such a substantial amount that they became either (a) ineligible for monthly financial federal assistance (because they dropped below 100% of the poverty level for their new family size) or (b) their income was reduced so much that they had a beneficial increase in their monthly financial federal assistance (a mixed blessing).

Those Georgia residents with existing health insurance marketplace applications and enrollments should always pay close attention to expected household income size changes and household income changes as it relates to the federal poverty level. To see the updated monthly financial federal assistance for your Georgia household along with the companies and plans and deductibles and co-pays in your Georgia county (and zip code) and to re-enroll in your same plan (or choose a new one), click the red “Get a Quote & Enroll / Re-Enroll” icon.

Private health insurance companies participating in the Georgia Marketplace either mail and/or email Georgia policy holders a massive amount of information throughout the year. At some point, many of those policyholders become numb to the frequency and fewer and fewer of these communications are opened, much less read.

The problem is that at the height of the Georgia policyholder’s sustained indifference comes in late-September through mid-October. That is when some of the companies participating in the marketplace begin to mail out their upcoming rate increases. Unfortunately, the manner in which they communicate these rate increases is highly confusing. They really can’t be blamed.

These private health insurance companies participating in the Georgia marketplace have no idea what your upcoming monthly financial federal assistance will be, so they can only use your prior (last year’s) monthly financial federal assistance. Although the private insurance companies know what your original rate will be (before your upcoming monthly financial federal assistance), they are forced to use the prior year’s monthly financial federal assistance amount.

Generally speaking, monthly financial federal assistance amounts are calibrated so that they “try” to “gobble up” as much of your original rate increase as permitted based on your household income. However, when the private health insurance company communicates their upcoming original rate, they juxtapose the NEW original rate (not payment) with the OLD monthly financial federal assistance. Although they communicate in the letter that your upcoming monthly payment for next year is only an estimate, their estimate is unintentionally because it appears to the Georgia consumer that their upcoming monthly payment is going to have a huge increase. When the Georgia resident with an existing application and enrollment from the prior year is shocked by the 50% increase, in this case from $200 per month to $300 per month (per the example below):

2019 Original Rate ($600) MINUS 2019 financial assistance ($400) = $200 actual prior 2019 payment.
2020 Original Rate ($700) MINUS 2019 financial assistance ($400) = $300 estimated new 2020 payment

Rather than be concerned about an exaggerated “estimate”, those who are already enrolled in a prior year plan should still enroll in the federal health insurance marketplace anyway to discover what their “actual new 2020 payment would be. Assuming the estimated upcoming household size and income was about the same 2019 vs 2020, the actual 2020 payment would possibly be more like $225 per months once you clicked the red “Get a Quote & Enroll / Re-Enroll” icon to discover your actual monthly financial federal assistance for 2020.

2019 Original Rate ($600) MINUS 2019 financial assistance ($400) = $200 actual prior 2019 payment.
2020 Original Rate ($700) MINUS 2020 financial assistance ($475) = $225 actual new 2020 payment

Massive anecdotal evidence (not empirical evidence) from Georgia residents with prior applications and enrollments indicates that many are shocked by the contrast of what was in their original or latest application for marketplace plan enrollment and what “should be” in their updated application for marketplace plan enrollment. Changes in employer and employment; changes in street address and phone number; email address changes; even changes in Georgia county of residence, tax household family size and most importantly changes in household income are all common occurrences.

When the data in an outdated marketplace plan enrollment becomes out of synch with the upcoming IRS Form 1095A, this negligence can become financially dangerous. Updated county and zip code information, updated tax household family size and most importantly updated household income all have a direct and distinct effect on the accuracy of the IRS Form 1095A.

Those Georgia residents with an existing application and enrollment from a prior year should always update their marketplace plan enrollment every Open Enrollment Period (2020 OEP 11/1/2019-12/15/2019). Between 11/1/2019 up until 12/15/2019, click the red “Get a Quote & Enroll / Re-Enroll” icon to see what information you need to update. It won’t take you long because all of the personally identifiable information (PII) will already be pre-populated to save you time.

If a Georgia resident with an existing application and enrollment in a 2019 marketplace plan who does not visit their prior marketplace application, they will be “auto-re-enrolled” without having any knowledge of what their new 2020 monthly financial federal assistance will be nor what their new 2020 monthly payment will be.

They will be auto-re-enrolled in the same plan (with the same company) they had in 2019 (if still available). However, should they get a surprise new January 2020 bill on the mail or online from their existing plan, once December 2019 has come and gone, they will be unable to enroll in the health insurance marketplace in order to choose a different plan with the same company or a different plan with a different company.

Given the streamlining of the marketplace’s new Enhanced Direct Enrollment platform, there’s little or no reason why a Georgia resident with an existing 2019 application and enrollment shouldn’t act in their own best interests by starting the brief process by clocking the red “Get a Quote & Enroll / Re-Enroll” icon in order to see what that January bill may look like after updating their estimated 2020 household income. Since the 2019 application may have been based on the 2017 adjusted gross income per the 2017 income, the chances of the application being in need of updating may be fairly high. Georgia residents who wisely choose to re-enroll and enroll in the health insurance marketplace every Open Enrollment Period (2020 OEP 11/1/2019-12/15/2019) end up having far less stress at tax time. They can be reasonably assured that their IRS 1095A form will be calibrated correctly

The answer is very basic. When a private company participating in the Georgia marketplace announces (well in advance of course), the Georgia resident of that county has 2 choices during upcoming Open Enrollment Period (OEP11/1-12/15).

(a) Do nothing and have the marketplace auto-re-enroll you on 12/16 in another marketplace plan still available in your Georgia county and zip code.

(b) Choose your own replacement plan based on your updated household income. Since you already had an existing application and enrollment for the immediate prior year, your application will be pre-populated to save you time and you can easily enroll in a marketplace plan on your own without having your plan selection dictated to you.

The only time that an we can ever re-call that an auto-re-enrollment dictated by the marketplace worked out (from one company to another in the same county) was in 2019 Open Enrollment Period after Anthem BlueCross dropped out of literally scores of counties throughout Georgia.

All of the Georgia residents who had the lowest priced Anthem BlueCross Silver plan were automatically re- enrolled by the federal government on 12/16 into the more competitive lowest priced Ambetter Silver plan.

Many Georgia consumers either had no 2019 rate increase at all or in many cases their monthly payment even went down from 2018 to 2019. The majority of the doctors in the former Anthem BlueCross network also simultaneously moved to Ambetter.

Although this is an exception, it’s generally recommended that a Georgia resident make their own decision when they enroll in a marketplace plan during a time of flux in their particular county.

Generally speaking, annual co-pays and annual deductibles for federal health insurance exchange plans go up every year after being approved by both federal and state authorities and these co-pay and deductible increases are generally made public on or before November 1, the 1st day of Open Enrollment Period (OEP 11/1/2019-12/15/2019).

Also generally speaking, Silver plans have lower co-pays and annual deductibles, particularly if your tax household family size estimates upcoming annual household income at 100%-250% of the federal poverty level (see the easy to read color coded chart for Cost Sharing Reductions (CSR) on our homepage).

Finally, most everyone knows by now that there are no cost penalties for pre-existing conditions in federal health insurance exchange plans. That is against federal law if a Georgia resident enrolls in a marketplace plan. This is not the case with short term plans or alternative plans.

Example, if two single twins the exact same age living in the exact same zip code with the exact same income, but with one having been recently afflicted serious pre-exiting conditions and the other one as healthy as an ox, both twins would have the exact same monthly payment .Now let’s take it a step further. They both had a low priced high deductible bronze plan in 2019 and are ready for 2020 Open Enrollment Period (11/1/2019 – 12/15/2019).

The twin who recently developed some pre-exiting conditions and may anticipate large hospital bills in 2020 might elect to change from his high deductible lower cost Bronze plan to a lower deductible Silver plan. The twin whose as healthy as an ox and always has been may elect to stay with his lower priced high deductible bronze plan. Either way, they are both protected by a liability ceiling by enrolling in federal health insurance exchange plans. It is common knowledge that over 40% of personal bankruptcies are caused by catastrophic hospital bills.

There are times when Open Enrollment period may be an opportunity to realign monthly payment priorities and go from a higher deductible plan to a lower deductible plan. Always be aware of newly announced changes in the plans available in your Georgia county and zip code. An informed choice during open Enrollment Period can sometime be a Georgia resident’s first line of defense against bankruptcy. Your hospital and major medical benefits are unlimited by federal law, and so is your personal liability.

Annual federal poverty levels (by tax household family size) increase each and every year for health insurance marketplace enrollment. Our quoting algorithms are in real time and are mirror images of the federal marketplace. If your household income is the same in the Enhanced Direct Enrollment marketplace application as it was when you saw your original quote after clicking the red “Get a Quote & Enroll / Re-Enroll” icon, then your monthly payment will remain exactly the same. Put in a different household income and you’ll get a different quote.

The state of Georgia is a federally facilitated marketplace state. What that means is that, a Georgia household must make over 100% of the federal poverty level and less than 400% of the federal poverty level in order to receive monthly financial federal assistance (also referred to as the Advanced Premium Tax Credit / APTCs). (Please see the color-coded charts by family size on our homepage).

The % of the federal poverty level (and its annual changes) also affects your household’s ability to qualify for lower copays and lower annual deductibles when you enroll in a silver plan. This is called Cost sharing Reduction and it is an additional benefit above and beyond the monthly financial federal assistance (APTC) Those Georgia families qualifying for lower copays and lower annual deductibles have household income (per their tax household family size of between 100% – 250% of the federal poverty level). (Please see the color- coded charts by family size on our homepage).

Georgia Health Insurance marketplace updates all of our income charts each and every year as soon as the new poverty levels are announced. Click the red “Get a Quote & Enroll / Re-Enroll” icon and first see how dramatically your monthly rate changes based on your tax family size annual household income. This is yet another reason that those with an existing applications and prior year enrollment should always be cognizant of how fluid health insurance marketplace enrollment can be.

CREATION, HISTORY, MISSION STATEMENT, RATE STUDIES, EDUCATING GEORGIA RESIDENTS.

Please refer to our ABOUT Page (What We Do) for a more detailed description.

We were established as a privately funded entity July 10, 2011 after passage of the Affordable Care Act.

Since the 2013 ACA implementation, we’ve helped thousands to enroll / re-enroll in ACA plans.

In 2013, we conducted our first comprehensive rate study for all of the state of Georgia’s159 counties.

In 2014, we affirmed our state of Georgia SEED Mission Statement: Simplify-Educate-Enroll-Document.

From 2014-2019, we continued the systematic comprehensive yearly state-wide rate studies for Georgia.

Our primary focus has always been to educate Georgia residents on ACA quoting and enrollment.

Our secondary priority is to educate Georgia residents on qualifying for cost sharing reductions (CSR).