WHAT WE DO
In 2010, immediately after the passage of the Affordable Care Act (also referred to sometimes as ACA plans, obamacare, obama care, obama healthcare or affordable health care act), Georgia Health Insurance Marketplace was created as a privately funded organization dedicated to helping Georgia residents and Georgia small businesses to enroll in Affordable Care Act Marketplace plans and to also help Georgia residents find health care for every type of health insurance available, including major medical insurance, dental insurance, vision insurance, short term insurance, Medicare insurance, small business health insurance plans, telemedicine and ACA/IRS compliant alternative health plans.
All of the private health insurance plans available on our quoting, comparing and enrollment website are with health insurance companies offering health insurance quotes and confirmed enrollments for health insurance plans available in Georgia.
The totality of health care plans are available through AARP Health Insurance, Aetna, Aliera Healthcare, Alliant Healthcare, Ambetter, Blue Cross Blue Shield, Cigna Health Insurance, Coventry Health Care, Golden Rule Health Insurance, Humana Health Insurance, Kaiser Health Insurance, Mutual of Omaha, National General Insurance, NHIC, Omaha Insurance Company, United Healthcare and Unity Healthshare.
Affordable Care Act (ACA) plans are available through the only health insurance companies participating in the Georgia Health Exchange. Some may refer to this as government insurance. That is a misnomer. The private insurance companies participating in ACA plans offering private health care only include Alliant Healthcare, Ambetter, Blue Cross Blue Shield and Kaiser. For many Georgia residents, affordable health insurance is available, and for those who think they can’t afford an ACA plan, we can help. Those with cobra health insurance or student health insurance may not realize that affordable health insurance is available to them.
For those exploring health care reform, more affordable health care is available through short term health insurance, ancillary plans, accident plans, high deductible plans, telemedicine plans and alternative basic health plans. These health insurance plans are available through Aliera Healthcare, Golden Rule Insurance, National General Insurance Company, NHIC and United Healthcare Insurance.
Health care reform brought Georgia alternative “association” medical care plans including ACA and IRS compliant health benefits that may mean more affordable healthcare for families in middle and higher income brackets. Some of these plans offer PPO coverage with the largest PPO in Georgia (PHCS). Healthcare management is provided by Aliera Healthcare and Unity Healthshare and PHCS is the same health care
Provider and PPO network used by Georgia’s major health insurance companies. Although these are “non-denominational” health care, the health care system is sometimes referred to as “Christian Health Insurance.” And since they are not offered by insurance companies per se, these health plans cannot be classified as insurance
Georgia Health Insurance Marketplace is a Georgia Agency that helps Georgia residents to compare health insurance. We provide secure quoting, enrollment and confirmations through our Federal Health Insurance Marketplace Enrollment Partner website. Georgia residents can decide which is the best health insurance available to them and then choose a quality healthcare plan using our secure online health insurance comparison quoting and enrollment system.
For lower and middle income Georgia residents, family size and household income calculations may mean that the most affordable health insurance and the best health insurance with quality healthcare may end up being better and more affordable than cheap health insurance. We are here to help Georgia residents in all income brackets with intelligent choices using our easy to use secure health insurance quoting and health insurance comparison and enrollment confirmation system. The Georgia Health Insurance Marketplace SEED Mission Statement is as follows:
Simplify the enrollment process with both one-on-one human assistance and automated self-enrollment.
Educate Georgia residents about federal subsidies and medical cost sharing reduction opportunities.
Enroll Georgia residents with our proprietary Federal Insurance Marketplace Enrollment Partner
Document the enrollment with confirmations from both healthcare.gov and the private insurance company.
In 2013, immediately prior to the initial Marketplace Open Enrollment Period, we began providing (for all 159 Georgia counties), individual rates and monthly financial assistance calculations for all of Georgia’s federally participating private health insurance companies including (at that time and beyond) Ambetter, BlueCross Blue Shield, Coventry, Humana, Kaiser and United Healthcare.
In 2015, we formed a partnership with the nation’s most robust Federal Marketplace Enrollment Partner Website to provide Georgia consumers with the most secure enrollment website available. The Georgia Health Insurance Marketplace Representative’s name that appears on the individual consumer’s quoting and enrollment screen will always be the exact same Georgia Health Insurance Representative who will be able to help them from the beginning and throughout the year. We are accountable to Georgia residents.
From 2010-2018, we have helped tens of thousands of Georgia residents to correctly enroll in the most affordable health insurance plans available. Additionally, for those who did not originally enroll with us, we remedy prior unintentional consumer or representative mistakes made by the consumers themselves and/or y others.
Georgia Health Insurance Marketplace provides courteous and accountable quoting and enrollments for:
- Affordable Care Act (also known as obamacare or obama care or obama health care) Health Plans
- Dental Plans and Vision Plans
- Short Term Health Insurance including ancillary plans, accident plans and supplemental health care
- Medicare Plans (Medicare Advantage, Prescription Drug Plans and Medicare Supplement Plans)
- Employee/Employer Small Group/ Small Business Health Insurance plans
- Low-Cost ACA and IRS compliant Alternative “Association” Plans for individuals and employees
WHAT WE DO
CREATION, HISTORY, MISSION STATEMENT, RATE STUDIES, EDUCATING GEORGIA RESIDENTS
- We were created on July 10, 2011 shortly after congressional passage of the Affordable Care Act (ACA).
- 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).
HELPING GEORGIA RESIDENTS TO GET QUOTES & ENROLL / RE-ENROLL IN MARKETPLACE PLANS
- Enhanced Direct Enrollment makes quoting & enrollment/re-enrollment for marketplace insurance easier
- We provide comprehensive and easy to understand details for all Georgia state exchange health plans.
- Enrollment documented confirmations in the federal health insurance exchange are confirmed in real time
- Upon marketplace plan enrollment, Georgia residents are able to create their own marketplace dashboards
- We protect personally identifiable information before and after your application for marketplace plan is done
- We help Georgia residents with prior marketplace insurance plans to update applications and enrollment
- We don’t accept payment. Payment is made to the marketplace insurance company or via your dashboard.
- We help 365 days/year during both special enrollment (12/16-10/31) and open enrollment (11/1-12/15)
(1) We were created on July 10, 2011 shortly after congressional passage of the Affordable Care Act (ACA)
Georgia Health Insurance Marketplace was established on July 10, 2011 (shortly after passage of the Affordable Care Act) in preparation for the full implementation of the federal health insurance marketplace and the anticipated coordination with state health exchanges. We began as a privately funded organization and we are devoted only to enrolling Georgia residents into Affordable Care Act plans.
We provide all Georgia residents (with or without subsidy qualification) the ability to get real-time marketplace quotes (set to exact federal quoting algorithms) and then to enroll or re-enroll in Georgia state exchange health plans offered through the federally facilitated marketplace. Our goal is to make it easier for any Georgia resident to (1) get an accurate quote based on the information provided (2) enroll in the marketplace through the marketplace’s Enhanced Direct Enrollment platform (3) enroll in a marketplace plan with full confirmation from the marketplace and the chosen insurance company. (4) receive almost 365-day access and accountable follow – through. The state of Georgia has one of the highest uninsured rates (for health insurance) in the nation. Georgia also has one of the highest average hospital costs in the nation as well. Our goal is to improve health insurance access for all Georgia residents.
Since 2013, we have helped thousands of Georgia household residents (both with and without monthly federal subsidies) to “Get a Quote & Enroll / Re-Enroll” in the federal health insurance marketplace. We make every attempt to simplify the process while at the same time understanding that the process may not seem simple.
We exclusively enroll Georgia residents with private insurance companies participating in Georgia state exchange health plans in the health insurance marketplace. All of the plans available through Georgia Health Insurance Marketplace are mandated to include (by federal law) the following: (1) All pre-existing conditions approved with no medical underwriting whatsoever; (2) No rate increases due to claims history; (3) No coverage ceiling on costly hospitalization and surgery; (4) Inclusion of the 10 essential health benefits in all marketplace insurance plans including: hospitalization, emergency services, laboratory services, prescription drugs, preventive and wellness services, chronic disease management, ambulatory out-patient services, pediatric services, pregnancy / maternity / prenatal / postnatal services / newborn care, rehabilitative & habilitative services and devices, mental health and substance use disorder services, and more.
The initial awareness program by the Department of Health & Human Services placed an emphasis on the benefits but less emphasis on actually qualifying and enrolling. The unintended consequence was that the de-emphasis created unfounded marketplace insurance myths:
Household income estimating mistakes made by Georgia residents during health insurance marketplace enrollment are hair-trigger sensitive to the actual amount the Georgia resident will be paying. These mistakes affect Georgia residents from all socio-economic levels.
Educating Georgia consumers has been an important part of our original 2013 SEED Mission Statement: Simplify-Educate-Enroll-Document. We have made it easier to enroll in the health insurance marketplace and do everything possible to educate Georgia residents on some of the basic facts about Affordable care Act plans.
MYTH: “Obamacare (Affordable Care Act marketplace insurance) is only good for Georgia’s poor people.”
FACT: Since Georgia doesn’t have expanded Medicaid, many poor folks don’t qualify for any financial help. Family sizes of 1-2-3-4-5-6 earning LESS than $12k / $16k / $21k / $25k / $30k / $34k do NOT qualify.
MYTH: “Our household income is too high to qualify for monthly federal assistance to help pay for the plan.”
FACT: Family sizes of 1-2-3-4-5-6 earning LESS than $48k-$64k-$82k-$100k-$120k- $135k DO qualify
MYTH: “Lower middle-class and middle-class households don’t qualify for lower deductible silver plans.”
FACT: Family sizes of 1-2-3-4-5-6 earning (13-31k) (17-42k) (22-52k) (26-62k) (31-75k) (35-85k) DO qualify.
MYTH: “PPO primary care physicians/specialists are better than HMO primary care physicians/specialists”
FACT: Go into a physician’s waiting room. There’ll be patients with PPO plans & patients with HMO plans. Georgia physicians treat patients equally, whether the patient is in the physician’s PPO plan or HMO plan.
MYTH: “We did our application for a marketplace plan years ago and enrolled in the lowest priced silver plan.”
FACT: The “lowest priced silver plan” changes every year. You might be paying more than you need to be.
MYTH: “We did a marketplace application years ago, so we don’t need to update our yearly income.”
FACT: Updated household income is by far the most important factor affecting your monthly payment.
Unfortunately, there is still state-wide confusion about federal health insurance exchange plans in general and Georgia state exchange health plan enrollment in particular. In spite of the initial efforts by federal health insurance marketplace navigators in Georgia, there are still qualifying regulations that are misunderstood by many Georgia residents from all socio-economic backgrounds and circumstances. This confusion has led to some Georgia residents being rejected when they were actually qualified. It has also led to other Georgia residents never bothering to apply because they thought they couldn’t afford it. There are still many Georgia residents who are unaware that marketplace plans accept all pre-exiting conditions, without exception. Underwriting for medical conditions for marketplace plans is against federal law. That’s a direct opposite of short-term plans or alternative cost-sharing plans. Only marketplace plans are qualified Health Plans.
Since 2011, we’ve been at the forefront helping Georgia residents with health insurance marketplace enrollment. To re-enroll or enroll in the marketplace and then re-enroll or enroll in a marketplace plan should be a process that every Georgia resident should be able to do. These are 2 different processes. The federal government application and the enrollment into a chosen plan are very different. Even though one comes after the other, the process is such that Georgia residents first choose a plan based on their initial quote and then enroll to determine a confirmed amount of federal assistance and then enroll in a plan with the federal assistance becoming built into the plan on a confirmed basis.
The process of federal health insurance exchange enrollment is explained in detail on our homepage and in the Know More section of our website and it is a helpful learning tool that is generally easily understood. To apply for marketplace plan, and then re-enroll or enroll in the marketplace, all Georgia residents may start the process by clicking the “Get a Quote & Enroll / Re-Enroll” icon on our home page. By far the most important aspect is the initial quote. If a Georgia resident miscalculates household income or inputs family size incorrectly, then the initial quote can be an amount that is not a true indication of the amount of monthly financial federal assistance available. If on the initial quote, the applicant put in 3 different household incomes, there would in turn of course be 3 different quotes. All too often, Georgia residents are far too cavalier when it comes to diligently estimating household income for the calendar year in which they will be insured.
The new Enhanced Direct Enrollment platform introduced by the Health Insurance Marketplace has made it even easier for us to continue to help any Georgia resident to complete their application for marketplace plan on the federal health insurance exchange. The Enhanced Direct Enrollment system integrates the initial quote, the federal application, the federal eligibility notice, the federal confirmation, the confirmation of the plan selection, notification of the need for the Georgia resident to supply (upload) verification documents and the ability for Georgia residents to create their own Dashboard.
Every Georgia resident getting a quote and applying and enrolling receives documented confirmations from three sources: (1) the federal marketplace; (2) the Enhanced Direct Enrollment platform (HealthSherpa) and (3) the marketplace insurance company participating in Georgia state exchange health plans. The Enhanced Direct Enrollment platform is a fully integrated enrollment and confirmation system that allows Georgia residents easy access to their entire application, enrollment, confirmation, documentation history including the inclusion of their IRS Form 1095A (sent to each resident for use to coordinate with their federal tax return for the year in which they were most recently enrolled.
All marketplace insurance plans, including quoting, initial plan selection, enrollment application, plan confirmation, and enrollment confirmation documentation are administered through HealthSherpa, the only federally certified Enhanced Direct Enrollment system allowing Georgia residents the ability to directly enroll in the federal health insurance marketplace. We are fully integrated with the federal marketplace quoting and enrollment algorithms and all enrollments and confirmations are done in real time.
(2) Since the 2013 ACA implementation, we’ve helped thousands to enroll / re-enroll in ACA plans.
Since 2013, the year of the full implementation of Affordable Care Act health insurance enrollment and state health exchanges, Georgia Health Insurance Marketplace has helped thousands of Georgia residents to get a quote and enroll in the federally facilitated marketplace. The state of Georgia is a federally facilitated marketplace state which means unlike other states, the state of Georgia does not provide expanded Medicaid for adults over 19 who are under 100% of the federal poverty level. We make every effort to enroll those Georgia residents who are between 100% -400% of the poverty levels and to give guidance to those unable to qualify for monthly financial federal assistance.
We also help Georgia residents who already have an existing or prior health insurance marketplace enrollment. Those Georgia residents with existing applications and enrollments are able to get updated quotes on all plans and to either re-enroll in their existing plan or to enroll in a different plan (with the same insurance company) or to enroll in one of the other plans that may be more affordable. A prior year application for marketplace plan and/or a prior year marketplace plan enrollment may not offer the same contrasting rate affordability results as an application for the following year. It’s important for Georgia residents to know that plans change each and every year. And monthly rates are hair trigger sensitive to even slight changes in household income. Applications don’t update themselves. Some Georgia residents believe that the government updates their individual application based on their latest tax return. This is one of the many myths surrounding marketplace applications.
There are multiple factors affecting monthly payments such as change in household income and/or change in tax household family size and/or adding or deleting a dependent aged 19-25 and many other factors as well can all affect a federal health insurance exchange enrollment. Many Georgia residents initially enroll in the health insurance marketplace for the first time, but afterwards fail to annually update their upcoming estimated household income. When Georgia residents fail to update their household income information, they are putting themselves at risk for federal penalties at federal tax time due a household income that is not in sync with the federal tax return for the year of new coverage.
If a Georgia resident is enrolling or re-enrolling for 2020 Open Enrollment Period (11/1/2019-12/15/2019 OEP) or 2020 Special Enrollment Period (12/16/2019-10/31/2020), the estimated household income on the marketplace application should be based on 2020 income (the tax filing of which is done in 2021, not 2020). If this is NOT done, the result in an IRS Form 1095A (mailed after the end of the 2020 calendar year) that is dissimilar to the household income being reported on the upcoming federal tax return When Georgia residents apply for marketplace plan, it comes with future responsibilities as well. When Georgia residents enroll, they need to update their estimated upcoming household income every year and during the year if the Georgia resident is aware of an obvious change.
Our Enhanced Direct Enrollment platform and marketplace dashboard make it easier for Georgia residents to maintain the accuracy on their application for marketplace plan. Anticipated changes in household gross adjusted income on the upcoming 2020 tax return (not filed until calendar year 2021) will generally affect a Georgia resident’s monthly payment for marketplace insurance plans. This is triggered by a change in their monthly subsidy (APTC, Advance Premium Tax Credit). There are thousands of Georgia residents with an unchanged marketplace plan enrollment application from their original Open Enrollment Period who still have the exact same outdated household income data in their original application. And when they receive a poorly calibrated IRS FORM 1095A and pay a federal penalty, they still do not alter that application.
Unfortunately, an application for marketplace plan does not change itself from one year to the next. When Georgia residents enroll, they need to know that household income estimates have a direct effect on the Georgia resident’s monthly payment. There are penalties for underpaying and there is certainly no reason to pay more either.
Those already enrolled in marketplace insurance plans from a prior year who “Get a Quote and Enroll / Re- Enroll” will find that all of the data in their prior marketplace plan enrollment has been maintained in order to save Georgia residents even more time completing their application. Making household income changes from a prior year enrollment will generally be the most significant change to make, and a change that will make your monthly payment more accurate.
In our earlier years (beginning in 2013 and shortly afterwards) when the federal health insurance exchange began in Georgia, there were 8 companies participating in Georgia. Today there are 4 companies and 1 of those 4 (Alliant) is available only in limited counties and only in extreme northeast and northwest Georgia. Georgia State exchange health plans change. Even in some metro Atlanta counties, there sometimes may be only 2 companies offering plans.
For example, Anthem / Blue Cross had actually departed the Atlanta metro area altogether in 2018 but belatedly returned again in 2019. We’ve been helping Georgia residents with these inevitable federal health insurance marketplace transformations from the very beginning. When Georgia residents originally apply and complete their original enrollment, the insurance company may later decide (and announce well in advance) that for the following year, it may be necessary for that company to leave a particular Georgia county.
Unless the Georgia residents pro-actively chooses a new plan during the next Open Enrollment Period (11/1- 12/15), the health insurance marketplace has no choice but to automatically enroll those affected Georgia residents into the new insurance company that is to replace the departing company. Only 1 marketplace insurance company (Ambetter) has remained consistent from the very beginning and is now offering plans in more Georgia counties (including all of metro Atlanta) than any other company in Georgia. In 2019, when Anthem / BlueCross exited large numbers of southeast and southwest Georgia counties, Ambetter replaced Anthem Blue/Cross. We were there facilitating the transition.
We are agnostic when it comes to federal health insurance exchange enrollment. All plans (Bronze, Silver, Gold) from every participating Georgia marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) are all available during both 2019 Special Enrollment Period (12/16/2018- 10/31/2019), 2020 Open Enrollment Period (11/1/2019-12/15/2019) and 2020 Special Enrollment Period (12/16/2019-10/31/2020).
(3) Enhanced Direct Enrollment makes quoting & enrollment/re-enrollment for marketplace insurance easier.
To enroll in a marketplace plan, the process is now easier and more seamless for Georgia consumers. The federal health insurance marketplace created the Enhanced Direct Enrollment platform for greatly improved enrollment. Many states participate in the federally facilitated marketplace. The state of Georgia is one of those states. A federally facilitated marketplace state is often a state that does not have what is called “expanded Medicaid.” This means that adults in Georgia households who have upcoming (2020) estimated household income projected to be below 100% of the federal poverty level, will not qualify for monthly federal financial assistance.
Through our Enhanced Direct Enrollment platform provided by HealthSherpa (the only Enhanced Direct Enrollment platform working with the federal health insurance marketplace), we streamline all quoting, applications and enrollments. Any Georgia resident who wants to re-enroll or enroll in the health insurance marketplace should understand the vital importance of making every attempt to accurately estimate your household income for the calendar year for which you are to be covered. 2019 coverage means 2019 household income estimate and 2020 coverage means 2020 household income estimate. Georgia residents will find our homepage tutorial to be extremely helpful in understanding the importance of estimating household income in preparation for your actual enrollment.
If you enroll in the federal health insurance marketplace during 2019 Special Enrollment Period (SEP 12/16/2018 through 10/31/2019) you are therefore seeking insurance for 2019 coverage. This means that your estimated household income must be based on your estimated 2019 calendar year household income final. That would be because you are requesting to be covered during the remainder of the calendar year 2019 and you will be filing your 2019 tax return in 2020.
If you apply for marketplace plan during the 2020 Open Enrollment Period (OEP 11/1/2019 through 12/15/2019) or during 2020 Special Enrollment Period (SEP 12/16/2019 through 10/31/2020) you are therefore seeking marketplace insurance for 2020 coverage and your household income estimate is to be based on your 2020 income (for the tax return filed in 2021). This means that your estimated household income must be based on your estimated 2020 calendar year household income final. That would be because you are requesting to be covered during the remainder of the calendar year 2020.
Our Enhanced Direct Enrollment quoting system mirrors the exact federal health insurance exchange quoting algorithms for all Georgia plans. If you put in an accurate household income estimate, then your monthly payment for your marketplace plan enrollment will be completely accurate. If a Georgia household submits the exact same household income and tax household size on their initial quote after clicking the “Get a Quote & Enroll / Re-Enroll” icon, that same quote will appear after the Georgia resident has completed their application for marketplace plan in the Health Insurance Marketplace’s Enhanced Direct Enrollment platform.
When you enroll in the marketplace, if there is any difference in the final quote, it would only mean that the initial 2020 yearly household income estimate (from all tax household family member’s income) was different than what was submitted immediately prior to receiving the initial quote. During the initial quote, a Georgia household could theoretically fill in 3 separate estimates for 2020 household income and the applicant would end up viewing 3 different quotes each time for all plans. Applications for can now be completed faster and documentation is also more comprehensive since enrollment includes comprehensive documented confirmations both from the health insurance marketplace as well as the Enhanced Direct Enrollment platform (HealthSherpa) and from the chosen insurance company.
(4) We provide comprehensive and easy to understand details for Georgia state exchange health plans.
Plan details for all marketplace insurance plans available for health insurance marketplace enrollment in Georgia. These plan details include plan costs (after your monthly savings / subsidy), doctor visits, urgent care center coverage, free preventive care, prescription coverage, labs and imaging, unlimited hospitalization (no ceilings), emergency room, mental health and substance abuse, pregnancy and birth coverage and so much more. Federal health insurance exchange plans are also referred to as Qualified Health Plans (QHP).
It’s important to know that we only enroll Georgia residents in Qualified Health Plans (QPP). These are the only plans in Georgia (and in the U.S) that provide monthly financial federal assistance (Advanced Premium Tax Credits or APTCs). These plans are only federally recognized plans for which Georgia residents will receive an IRS Form 1095 (and get converted to an IRS Form 8962) for the federal tax return.
If you are a higher income Georgia resident (over 400% of the federal poverty level based on your family size) and will not qualify for monthly financial federal assistance (APTC), enrolling in a lower priced high deductible bronze plan may be a more rational choice than enrolling in an alternative plan that does not provide your household with unlimited benefits regardless of any pre-existing medical condition.
Hospital costs in Georgia are among the highest in the nation and an unexpected medical event can put assets at risk if your liability is limited to a five-figure deductible. Over 40% of personal bankruptcies in Georgia are due to unexpected high medical bills. A higher income Georgia resident may not have their financial life disrupted that much by a $7000 deductible for a hospital bill, but most anyone is not prepared for a 6- figure surprise.
A short- term plan is not a Qualified Health Plan and is therefore not defined as “creditable coverage” Qualified Health Plans (QHPs) through the federal health insurance marketplace are the only plans that accept all pre-existing conditions, regardless of how severe. There is never any medical underwriting. That is against federal law. Unfortunately, that is not the case with short term plans and other less robust health plan alternatives.
It’s also important for every Georgia resident to know that Georgia state exchange health plans must all have the same essential health benefits and those benefits are dictated by federal law. Only marketplace insurance plans cover all pre-existing conditions (without exception) and all pre-existing conditions are covered immediately and without penalty. No other type of health plan does this. Affordable Care Act health insurance enrollment means that you have a choice of plans that provide you with the most robust amount of benefits unequalled by any other insurance plan, regardless of your medical condition. Again, medical underwriting for federal health insurance exchange plans is against federal law. No other type of health insurance provides the scope and depth of these plans.
Health insurance can be complicated when you enroll in the federal health insurance marketplace. We understand and provide comprehensive details for all Georgia plans. Georgia residents are able to compare pricing, co-pays and deductibles for every bronze, silver and gold plan prior to enrollment. All Georgia plans have 3 metal tiers. (bronze, silver, gold). Only silver plans offer the opportunity for cost sharing reduction, the lowering of co-pays and annual deductible. The deductible is often misunderstood and all marketplace insurance plans have many benefits that are not subject to the deductible. Generally speaking, the higher the deductible, the higher the cost.
It is a myth that the annual deductible must be paid before benefits begin. If however, you do end up having a very costly hospital bill or very costly medical procedure, you will eventually have to pay your deductible. Having an unexpected costly medical issue and having an active health insurance marketplace plan is far better than having no marketplace insurance at all. Since the beginning of record-keeping on the issue, over 40% of Georgia consumer bankruptcies are caused by unexpected hospital and medical bills.
Marketplace insurance plans with unlimited hospital benefits is often considered as a consumer’s primary defense against bankruptcy due to unexpected hospital and surgery bills. The deductible and co-insurance serve to substantially limit consumer liability for unexpected medical events, regardless of the size of the deductible. Another common myth is that doctors work for the insurance company or are somehow connected to only 1 particular insurance company. Although doctors in rural areas may be limited by the fact that there is only one health insurance marketplace private insurance company in their Georgia county, doctors do not work for the insurance company. When Anthem BlueCross left the metropolitan Atlanta area in 2018, those doctors continued to accept other marketplace insurance plans from other private companies who were still participating in Georgia state exchange health plans. The relationship between doctors who accept marketplace plans and doctors who are in a particular insurance company’s plan is greatly misunderstood. Doctors do not work for the insurance company and many doctors accept multiple plans.
After the Georgia resident gets their quote, the display of plans will appear by cost ranking and in descending order. You will find it easy to scroll down to the areas where there are monthly payments that you know your household can afford. The bronze plans (the least expensive) will appear first. These Georgia state exchange health plans will have the highest annual deductible. The silver marketplace insurance plans will appear next. The silver plans are the only plans that include (if you qualify) what is called Cost Sharing Reduction (CSR).If you qualify for CSR, that means that the annual deductible (and co-pays and co-insurance) on all silver plans are reduced for your household. Just as household income determines your eligibility for monthly federal assistance, household income also determines your eligibility for eligibility for CSR.
When you apply for marketplace plan and enroll in the health insurance marketplace, the price of the plan will more than likely be the overriding determination in choosing a plan. The monthly payment is the amount you would pay after the determination of your monthly federal subsidy, also referred to as your advance premium tax credit or APTC. Your tax household (family size) and your estimated upcoming annual household income are the most important factor that will determine the monthly payment you will see on your quoting screen of available marketplace insurance plans.
Georgia households that apply for marketplace plan, qualify for monthly federal assistance and complete their enrollment will always need to choose a plan before the enrollment is complete. The available listing will show 3 important numbers: Original Plan Cost, Savings/Subsidy and Premium (your payment). Every person in a particular age group and county will essentially start out with the same original rate. The variations begin to happen after household size and household income are factored into the federal quoting algorithm.
Once a Georgia resident’s marketplace plan enrollment has been confirmed, your chosen marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) begins getting 2 monthly payments. One monthly payment comes directly from the health insurance marketplace (paid on your behalf as an Advance Premium Tax Credit) and the other payment will come directly from you. The sum total of those payments equals the original actual cost of the plan. In other words, your monthly payment equals the original plan cost minus your savings (subsidy). The premium (your monthly payment) has the savings / subsidy already subtracted from the original actual plan cost. That monthly payment is a direct reflection of the estimated upcoming calendar year household income you submitted on the initial quote. Your (“after savings / subsidy”) monthly payment is reflected on all plans. If a Georgia resident fails to meet any deadline for verification (income or otherwise), the federal government stops making their payment (on your behalf) and the insurance company sends the “unpaid’ partial premium payment to the Georgia resident. Usually the combined amount is too high and the Georgia resident eventually gets cancelled due to non-payment.
(5) Enrollment documented confirmations in the federal health insurance exchange are confirmed in real time.
Georgia Health Insurance Marketplace provides fully documented confirmations both from the health insurance marketplace and from the marketplace’s certified enhanced direct enrollment platform. The easy and logical steps to receiving fully documented federal health insurance exchange enrollment confirmations are fairly simple and intuitive. They summarize the income data input in the application and announce the monthly financial help and this allows the Georgia resident to go ahead and enroll in the plan they had originally chosen.
1.To apply for marketplace plan (or to re-enroll and choose a new plan) or (renew your existing plan), the Georgia resident must first click the “Get a Quote & Enroll / Re-Enroll” red icon on the website. This begins the process for you to enroll in the marketplace. It is a fairly easy and seamless process and many Georgia residents finish the process within 15 minutes depending on family size. Always have accurate dates of birth and social security numbers ready for all tax household family members, whether they are seeking coverage or not. Tax household family size can be verified by submitting complete information for all family members only.
2. Answer the initial for questions: (zip code) (who needs coverage) (how many members are in your tax household) and (estimated yearly household income for the calendar year of your upcoming coverage)
3. Choose health insurance from the menu of plans available to you through the federal health insurance marketplace. Look at the plan details and pay attention to the copays and deductible. The deductible is the main criteria that determines cost unless a Georgia resident qualifies for medical cost reduction.
4. Click “add to cart” once you have chosen either a bronze, silver or gold plan from the menu of federal health insurance exchange plans available. Once this is done, you will be directed to the beginning of the application, where you will first attest to the privacy statement and then verify your identity.
5 Start application for marketplace plan in order to enroll in the federal health insurance marketplace. At this point you are not applying to the private insurance company but rather the federal government in order to verify your qualifications for monthly financial federal assistance, or the advanced premium Tax Credit (APTC).
6. Agree to privacy statement from HealthSherpa. Health Sherpa works exclusively with the health insurance marketplace to help you qualify Georgia residents for coverage and is the federal marketplace’s only certified and approved Enhanced Direct Enrollment platform available. The privacy statement affirms that your information will be used only to qualify you to enroll in the health insurance marketplace. Information is used for that purpose and that purpose only. However, your information will be shared with other federal departments as needed to validate your qualifications to enroll and receive assistance. It is much less intimidating than it sounds.
7 Answer identity verification questions to verify that it is you (and/or family members) who is requesting health insurance marketplace enrollment. These are questions that you will know and are derived from a database of information with answers that Georgia residents should be able to answer. If two spouses are applying, it’s best if both look at the questions together.
8.Complete the application for marketplace plan. You will not be eligible to enroll in one of the federal health insurance exchange plans until you have completed the application. It is advised that you have all social security numbers and all correct dates of birth ready in advance for all family members (including those not applying for coverage) before you begin the application. Make a mistake on a date of birth or a social security number sometimes results in a citizen having to actually prove their citizenship. Exactitude is important.
9. Click “Download Letter” (*****and please read it). This is your federal eligibility notice which allows you to enroll in a marketplace plan and will be addressed to you. I will be from the Department of Health & Human Services and the health insurance marketplace. This is your initial confirmation prior to your completion of your marketplace plan enrollment and tells you that your next step is to choose a plan. Affordable Care Act health insurance enrollment is not considered complete until you choose a plan. *****NOTE: Full content overview of the federal eligibility letter is shown below. Be sure to read the federal eligibility notice (letter) carefully because there may be due dates involved and it’s vitally important that those due dates are not missed. Missing a due date can mean loss of monthly financial federal assistance, which can mean you may end up being without health insurance until the next year’s Open Enrollment Period (OEP11/1-12/15)
10. Click “Enroll in this plan”. This will be the same initial marketplace insurance you chose when you clicked “add to cart”. Once you enroll in a marketplace plan, you begin receiving further confirmation emails from the federal marketplace, from HealthSherpa and later on from the private insurance company and plan you chose. These emails are important. If you elected to receive communication via regular mail, you will receive that as well from both the marketplace (in London, Kentucky) and from the private insurance company you chose.
11. View the confirmation screen also inviting you to create your own Marketplace Dashboard (This is optional but you will find your own Marketplace Dashboard to be extremely helpful and useful). Your Dashboard enables you to see your application for marketplace plan, view plan details, change marketplace insurance plans, view monthly financial assistance amount (APTC, federal subsidy amount), make changes to your application, download your IRS Form 1095A and so much more. Your pre-populated username is the email address used in your application for marketplace plan. You’ll need to create your own 6+ digit password. Please remember your password. You will find your own Dashboard to be extremely helpful.
12. Receive further confirmation emails from the health insurance marketplace and receive further emailed confirmation from the marketplace’s Enhanced Direct Enrollment (HealthSherpa). Receive emailed confirmation of plan name, initial premium and applicable phone number to call to make your initial payment. Receive email and/or mail from your chosen marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) letting you know that you must make your initial payment in order for your coverage to begin. You will have the choice of making your initial payment via the phone number provided on your confirmation or you may a make your initial payment through your Dashboard.
***** Eligibility Notice (letter) from health insurance marketplace. When a Georgia resident completes their online application for marketplace plan and before they choose one of the state exchange health plans, they will first download (and/or view) their own confirmed eligibility notice (letter) online. The eligibility notice (letter) will confirm the following:
1) Whether or not you qualified for Open Enrollment (11/1-12/15) or Special Enrollment (12/16-10/31).
(2) Whether or not you qualified for financial assistance (APTC) and exactly how much you qualified for.
(3) Whether or not you qualified for cost sharing reductions (CSR) that lower co-pays and deductible.
(4) The yearly household income that was reflected in your application.
(5) The next step you need to make (choosing a marketplace plan / generally the original one chosen).
(6) Another next step you need to make (“possibly” requested document verification)** due in 60-90 days.
** During Open Enrollment Period (11/1-12/15) and Special Enrollment Period (12/16-10/31), all Georgia residents who have been requested to send/upload documentation verification by a certain date (usually income verification such as a copy of latest online pay statement), MUST make sure that the marketplace actually receives it by that requested deadline. If not, the marketplace will stop making monthly financial assistance payments (on your behalf) to your chosen marketplace insurance company. Generally, this results in a cancellation from the insurance company itself after they have sent you a new invoice for the unsubsidized monthly payment.
(6) Upon marketplace plan enrollment, Georgia residents are able to create their own marketplace dashboards.
Georgia Health Insurance Marketplace enables every Georgia resident who chooses to enroll in the marketplace and then enroll in a marketplace plan, to have the ability to create their own health insurance marketplace Dashboard. It is very important to understand the difference between enrolling in the marketplace and enrolling on a plan. Enrolling in the marketplace provides the framework for enrolling in a plan. The marketplace application and the all- important Eligibility Notice (letter) from the federal Department of Health & Human Services is the first step. Once you have clicked “Enroll in this Plan” (after downloading and reading your Marketplace Eligibility Notice), then and only then is your information transmitted directly to your chosen plan. Once your plan receives the information from the marketplace, it may take them 48-72 hours to process your information into their records. This may take longer during Open Enrollment Period (11/1-12/15) since the entire country is either enrolling or re-enrolling during that all too brief 45-day period.
Although creating your own dashboard is optional, you’ll find it to be very helpful, particularly (for example) when a Georgia resident needs to retrieve their own pre-populated IRS Form 1095A in order to file their 2020 federal tax return.
The ability to create your own Dashboard does not happen until after you’ve fully completed your application for marketplace plan. Once you’ve completed your enrollment in one of the Georgia state exchange health plans on the federal health insurance exchange, you’ll view your confirmation screen. Your confirmation screen in the Enhanced direct Enrollment platform will give you all of the information you need including advising you if you have a 60-90-day deadline to provide supporting documentation.
Your confirmation screen will also confirm the following: (1) the name of your chosen insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) (2) your chosen metal level (bronze, silver, gold) of marketplace insurance plans offered by your chosen company, (3) your monthly payment (the amount you will pay after your monthly federal financial assistance has been subtracted) (4) the phone number of your private insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) so that you can make your initial payment. (5) You also have the option of making your initial payment through your soon to be created Dashboard. However, you can create your Dashboard without having to make your initial payment through your Dashboard.
Whichever option you choose, please understand that an Affordable Care Act health insurance enrollment is not complete until you’ve made your initial payment to the marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar). None of these companies will mail you your health insurance card until they have received your initial payment. Your enrollment is “incomplete” until you’ve made your initial payment. Every year, far too many consumers decide to wait and pay until after they have received their card, only to discover later that they were never enrolled at all because they never paid by the start date deadline.
You’ll also receive an email from email@example.com with the subject being: Action required. This “action required” email will generally refer to making your initial monthly payment. That icon also gives you the opportunity to create your own Dashboard by making your initial payment. You can click the pay icon to create your dashboard. However, making your initial monthly payment through your Dashboard is completely optional. In order to create your own Dashboard, you’ll click the icon on the confirmation screen. Your username for your Dashboard will be immediately populated as the email address you used when you first began to apply for marketplace plan. In order to activate your Dashboard, you will need to create your own 6+ digit password.
Your Dashboard enables any Georgia resident who completed their federal health insurance enrollment to:
(1) Change Plans: All federal health insurance exchange plans can be changed within the allowable window.
(2) Pay your initial payment (optional): Payment is then transmitted to your marketplace insurance company.
(3) Download your eligibility letter: This is your original federal health insurance marketplace eligibility notice.
(4) Upload documents: Verify health insurance marketplace enrollment documents (if they were requested).
(5) View existing application for marketplace plan: View all information inside your submitted application.
(6) Report application changes: You can do this any time after you enroll in the health insurance marketplace.
(7) View history: Plan name(s), effective date, monthly subsidy, application ID #, submit date, documents, etc.
(8) View plan details: Plan summary including PCP visits, hospitalization, emergency room, labs, imaging, etc.
(9) Download your own IRS 1095A Form: Pre-populated mandatory form needed to complete 2020 tax return.
(10) And much more. Helpful for anyone who has completed Georgia state exchange health plan enrollment.
Creating a Dashboard is not required but Georgia consumers will find it to be of enormous benefit. Please be sure to remember that your username will already be pre-populated by the email address that was in your application. All you need to do is create a password of greater than 6 digits. In order to protect your personally identifiable information (PII), you will be advised if you need to initially provide another password that is less similar to others in the system.
Your Dashboard can be of even greater importance when it is time to do your federal tax return for the year in which you had marketplace coverage. There will be no need to wait for that all-important IRS Form 1095A to finally arrive via the U.S Mail.
With that in mind, if you had a change of address after you were initially enrolled in a plan, your Dashboard is an easy way to make both the marketplace and your insurance company know of the change. If you instead call your insurance company directly to report the address change, they will either not take it (because you have a marketplace plan) or advise you instead to make the change through the marketplace. Even if they do take the address change themselves, this will NOT mean that the marketplace is automatically aware of the change. As it relates to that all- important IRS 1095A Form, it will end up getting mailed to your outdated address and you may never receive it. Creating your dashboard, and then using your Dashboard to download your latest IRS 1095A form is a far more advisable option.
(7) We protect personally identifiable information before/after your application for marketplace plan is done.
Georgia Health Insurance Marketplace is required by federal and state laws to protect the personally identifiable information (PII) of any Georgia resident making application for marketplace plan.
To apply for marketplace plan and complete federal health insurance exchange enrollment in Georgia state exchange health plans, Georgia residents are required to share personally identifiable information (PII) in order to qualify for monthly federal financial assistance. By their very nature, enrollment means that your personally identifiable information will have to be communicated to multiple federal agencies including the Internal Revenue Service (IRS) due to the taxpayer funded nature of the enrollment itself.
This is unavoidable. In order for your application process to go faster, it is highly advisable that before you start your application, you have all of the correct dates of birth and social security number of all family members handy. This includes family members in your tax household who are and who are not applying for coverage.
Also, make absolutely sure that the name(s) on the application is an exact match of the name on the social security card. However, it is not necessary to include the middle name. This is particularly important for married females who may or may not have changed their name on their social security card when they got married.
An application with an incorrect date of birth or an incorrect social security number may end up triggering a request for “documentation of immigration status” because the applicable date(s) of birth and social security number(s) were input incorrectly by you in the application marketplace.
Another required item to have handy will be the phone number for a company employer. This information is necessary for every employed family member (with job income) even of they are not applying for coverage. Neither the marketplace nor the insurance company will actually be calling your employer. However, it is required information nonetheless if there is any income originating from a job. Any request for employer address is totally optional and therefore unnecessary.
Every marketplace insurance company able to accept Georgia state exchange plan enrollment actually receives 2 payments every month. The health insurance marketplace (through the Department of Health & Human Services) makes 1 payment each month (on your behalf) to your chosen private insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar).
That 1 payment (monthly financial assistance) each and every month represents what is called your advance premium tax credit (APTC). The other payment is made by you, the Georgia resident, and sometimes your payment may only represent a relatively small percentage of the actual cost of the federal health insurance exchange plan. (Real cost of marketplace insurance plan) minus (APTC) equals (Consumer payment).
Many Georgia consumers who enroll in the federal health insurance marketplace are benefitting by having substantial amounts of monthly federal assistance (paid each month on their behalf) by the federal health insurance marketplace.
Generally speaking, it is not unusual for lower and lower-middle income Georgia married couples (100%-250% of the federal poverty level) between the ages of 55-64 to receive anywhere from $12,000-$20,000+ in annual financial federal assistance. It becomes understandable that when Georgia resident household(s) complete marketplace plan enrollment and choose marketplace insurance plans, they are required to submit personally identifiable information (PII) in order to qualify for monthly federal financial assistance
PII such as names of all tax household family members, street address, email address, dates of birth of all tax household members, social security numbers of all tax household members, all household income sources and much more. The reason why Affordable Care Act health insurance enrollment requires all of this PII is to make certain that the Georgia household actually qualifies for the financial help in the first place. The Enhanced Direct Enrollment platform used by Georgia Health Insurance Marketplace is the only secure health insurance marketplace enrollment platform certified and approved by the marketplace. Protecting the personally identifiable information of a Georgia household completing a Georgia state exchange health plan enrollment is our top priority.
Georgia residents who enroll in the health insurance marketplace and choose federal health insurance exchange plans need to feel comfortable knowing their personally identifiable information is protected. It should be important for Georgia residents to know that the Georgia Health Insurance Marketplace secure website is a consumer-friendly public site that honors the strict privacy of Georgia residents. If you’ve ever gone online in the past looking for health insurance and suddenly your phone becomes bombarded with unwanted phone-calls from unknown phone numbers from unknown private health insurance agents all over the country, you can take comfort in knowing that it is impossible for this to ever happen as a result of visiting Georgia Health Insurance Marketplace. We guard your privacy and we respect your privacy. We enable Georgia residents to apply for marketplace plan through the federal health insurance marketplace and enroll in a marketplace plan through online enrollment and fat the same time be assured that your personally identifiable information (PII) has been thoroughly protected.
Finally, it’s important for Georgia residents to know that the Georgia Health Insurance Marketplace secure website is a consumer-friendly public site that honors the strict privacy of Georgia residents. We never share your information with any other private entity. On the upper portion of your quoting screen you will see a name of a Georgia Health Insurance Marketplace authorized and certified representative. That person will be the only individual who will have access to your quote and application and enrollment and Dashboard. The inclusion of that name is for your convenience and lets you know that there is an identifiable individual available to help you only at your request. There will never be an initiated call from Georgia Health Insurance Marketplace. You deserve to be able to complete your own application undisturbed in the privacy of your own home without receiving any unwanted follow-up calls.
Moreover, using a “fake” name or “fake” email address or “fake” phone number when you click our red “Get a Quote & Enroll / Re-Enroll” icon may put you at risk for that information to become pre-populated onto your federal application. Undoing that false information can be problematic, particularly when you reach the “initial” part of your federal application that includes your Privacy Statement attestation from HealthSherpa and your Identity Verification questions in the marketplace’s Enhanced Direct Enrollment platform.
If you’ve ever gone online in the past looking for health insurance .and suddenly your phone becomes bombarded with unwanted phone-calls from unknown phone numbers from unknown private health insurance agents all over the country, you can take comfort in knowing that it is impossible for this to ever happen as a result of visiting Georgia Health Insurance Marketplace. We guard your privacy and we respect your privacy.
We enable Georgia residents to apply for marketplace plan through the federal health insurance marketplace and enroll in a marketplace plan through online enrollment through our secure enrollment website
(8) We help Georgia residents with prior marketplace insurance plans to update applications and enrollment.
The Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” red icon lets Georgia residents know that they are able to Re-Enroll or Enroll in the federal health insurance marketplace. Any Georgia resident who already has an existing plan should make every effort to update their application and their enrollment every year. Doing this can help avoid a mis-calibrated IRS Form 1095A, which can result in a penalty for household income not aligned between the prior application and the future tax return for the calendar year in which the marketplace coverage was in effect.
For those who want to apply for marketplace plan for the first time or for those already enrolled who want to re- enroll and view any new Georgia state exchange health plans, the “Get a Quote & Enroll / Re-Enroll” red icon is a meaningful and useful quoting, enrollment and re-enrollment tool that begins the process, whether you already have a prior application or not. For those who had enrolled previously, the data in your application will already be populated in order to save you time. Many Georgia residents already have a prior application for marketplace plan. Almost as many Georgia residents also have a health insurance marketplace enrollment application that hasn’t been revisited or updated in years. This usually ends up causing delayed problems and unnecessary surprises during federal tax time.
Affordable Care Act health insurance enrollment applications don’t update themselves. If a Georgia resident hasn’t made a household income change (or any other applicable change), the outdated and incorrect data remains. When a Georgia resident chooses to enroll in the marketplace and then enroll in a marketplace plan, these choices come with responsibilities. Annual household income updating during 2020 Open Enrollment Period (OEP11/1/2019-12/15/2019) is highly recommended. Since the bulk of the existing application has already been filled out, a Georgia resident with an existing application will not have to spend that much time making sure that the application is up to date.
Georgia residents who already have marketplace plan enrollment applications and current marketplace insurance plans, should immediately update their application for marketplace plan as soon as possible either prior to or during the 2020 Open Enrollment Period (OEP 11/1/2019-12/15/2019). If it is updated before 11/1/2019, the new 2020 rates will not be available. However, you can input what you “think” you put in as your household income, then find your existing plan. If the monthly premium matches exactly, then you know that your current income is an exact match to what you put in the application over a year ago (or more). If it does not match, then you should go further and see what outdated household income is in your existing application. If you click the “Get a Quote & Enroll / Re-Enroll” icon between 11/1-12/15, then you will see the new rate for your existing plan and you’ll also see how it compares to either newer plans with your same company or other companies if they are available.
Residents who already have marketplace insurance may update their application here in order to:
Avoid a tax penalty (IRS Form 1095A) due to outdated income inside existing marketplace application.
Avoid paying too much (or too little) because your income may have changed since your last application.
Avoid paying too much due to automatic re-enrollment. There are newer marketplace insurance plans now.
Many Georgia residents with prior applications and enrollment in 2018 never bothered to “Get a Quote & Enroll / Re-Enroll” but instead enabled their existing health insurance marketplace plan to “auto-re-enroll” them on 12/16/2018, the day after the 2019 Open Enrollment Period (2019 OEP 11/1/2018-12/15/2018) was over. Here are several actual examples of the changes that appeared with federal health insurance exchange plans for Georgia state exchange health plan enrollment from 2018 OEP to 2019: Kaiser’s 2018 lowest silver plan had a rate hike making its 2019 lowest silver plan almost non-competitive. Ambetter’s 2018 lowest silver plan remained for 2019 and an even lower 2019 new silver plan was added. Georgia residents with those 2018 plans who didn’t “Get a Quote & Enroll / Re-Enroll” remained unaware.
One of the most relevant and important services we provide is helping those Georgia residents who have already enrolled in the marketplace during a prior year. Those Georgia residents who already have marketplace insurance can easily update their marketplace application through the marketplace’s new Enhanced Direct Enrollment platform. Whether you re-enroll or enroll in the health insurance marketplace, Georgia residents will find our Enhanced Direct Enrollment platform to be a good experience. Just click “Get a Quote & Enroll / Re-Enroll” to get started. Getting a quote and enrolling or re-enrolling in the federal health insurance exchange doesn’t have to be complicated. Georgia Health Insurance Marketplace tries to make it a little easier for all Georgia residents with our Enhanced Direct Enrollment.
(9) We don’t accept payment. Payment is made to the marketplace insurance company or via your dashboard
When you apply for marketplace plan, your application for marketplace plan is not considered to be complete until you have made your initial payment (premium). If you qualified for monthly financial federal assistance (APTC / Advanced Premium Tax Credit), this means that there will actually be 2 payments made each month (on your behalf) to your own chosen marketplace insurance company. Those participating Georgia state exchange health plans are Alliant, Ambetter, Anthem, CareSource, Kaiser and Oscar. One payment is made by the government and one payment is made by you. If you fail to make your initial payment before the start date of your new plan, your enrollment will be cancelled. Don’t let this happen. Your confirmation page will give you the payment phone number for your selected private insurance company. You will also get an invoice from them through the mail. However, whatever the circumstance, make sure you make your initial payment before the effective date.
When Georgia household qualify for financial assistance, the monthly payment alone does not represent the full cost of the marketplace plan. The full monthly cost of marketplace insurance plans minus monthly financial assistance from the federal health insurance exchange equals the Georgia household’s monthly payment. If you never make your initial payment, the payment already made by the government on your behalf will be returned and your policy will not go into effect and you will have to wait until next year’s open enrollment in order to enroll again.
Your federal health insurance exchange enrollment will always have an effective date. When you re-enroll or enroll in the health insurance marketplace during Open Enrollment Period (OEP 11/1-12/15), your effective date will be January 1. The initial payment (also called a binder payment) is vitally important. Generally speaking, companies won’t send out cards until the payment is made. If you do receive a card prior to making your initial payment, you’ll discover that an attempt (intentional or unintentional) to use the card prior to the initial payment being will result in the applicable medical office letting you know that your coverage is not in force yet due to non-payment.
During Special Enrollment Period (SEP 12/16-10/31), the effective date will depend on the exact date that you completed your marketplace plan enrollment. If completed prior to the 15th of any given month, the effective date will be the 1st of the following month. If completed after the 15th of the month, the effective date will be the 1st of the month after the following month.
Those private insurance companies available for Affordable Care Act health insurance enrollment carry with them enormous liability for every Georgia policyholder. When you enroll in a marketplace plan, all pre-existing conditions and unlimited hospitalization costs are covered. Because they carry unlimited liability (there is no ceiling with marketplace plans), the timeliness of your payment to them becomes important. Once a company cancels you and your plan enrollment, there is no special enrollment period for those who lost their coverage due to non-payment. It’s a “non-qualifying” life event.
This liability begins on the first day of the effective date. Federal health insurance exchange plans have no waiting periods. Full coverage is immediate once you have made your initial payment. The federal health insurance marketplace makes their payment (on your behalf) prior to the beginning of the month. When you re-enroll or enroll in the marketplace, you are expected to make your payment before the effective date.
Georgia Health Insurance Marketplace never accepts initial payments or ongoing payments for Georgia state exchange health plan enrollment. Instead, a Georgia consumer who completes their application for marketplace plan will make their initial payment and their ongoing payments directly to the private insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar). There is also an option for you to make your initial payment (but not ongoing payment) through your own Dashboard. Your payment is transmitted directly to your chosen company. However, every enrolling Georgia resident always has 3 different options for making their initial payment. It doesn’t make any difference to us. Just understand that we cannot accept any payments on behalf of Georgia resident.
Through the health insurance marketplace Enhanced Direct Enrollment platform, there are 3 options:
(1) After clicking “Enroll in this plan”, call the phone number provided for your chosen marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) that appears on your enrollment confirmation screen.
(a) You must provide the name, date of birth and social security number of the primary policyholder.
(b) During Open Enrollment Period (OEP November 1 through December 15) it is highly recommended that you allow your chosen marketplace insurance company 3-4 working days (sometimes more) to fully process your marketplace plan enrollment. Understand that the 45-day Open Enrollment Window is a very compressed time when private insurance companies are overloaded with new enrollments and re-enrollments from marketplace applications. Also keep in mind that private insurance companies do not and cannot accept direct enrollments without them first going through the marketplace. Authorization and enrollment must always come from the marketplace first.
(c) An application for marketplace plan is a process that tens of thousands of Georgia households all do within a confined 45-day period during every open enrollment period. As long as you make your initial payment prior to either December15th (highly recommended) or at the latest any time prior to January 1st, your health insurance marketplace plan will be fully in force on the 1st day of your effective date. Don’t forget to pay your chosen company before the due date or you may be uninsured for the remainder of the calendar year.
(2) The email from “firstname.lastname@example.org” “Subject: (Action required)” also provides you with the phone number for your chosen marketplace insurance company and gives you the additional option to pay through your Dashboard. HealthSherpa is the Enhanced Direct Enrollment certified platform that works with the health insurance marketplace. Your Dashboard is an invaluable and very useful post-enrollment tool that provides Georgia households with literally everything about your health insurance marketplace enrollment.
(a) Your Dashboard accepts the initial payments only and not accept ongoing payments.
(b) The initial payment through your dashboard is transmitted directly to your chosen insurance company
(c) All of your data from your application for marketplace plan is also transmitted directly to the company.
(d) To make your initial payment through your Dashboard, you will need to create a 6+digit password. Your username is pre-populated as the email address used in your health insurance marketplace enrollment
(3) Wait to receive an email and/or regular mail invoice from your chosen private marketplace insurance company Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) and they will also give you several options as well.
(a) You may call their payment line phone number (the same number provided on your enrollment confirmation screen and in the email from “email@example.com” “Subject: (Action required)” They will take your initial payment and can also set up your payments for automatic future payment. This is highly recommended in order to avoid a lapse of coverage or temporary suspension or cancellation due to missed payments(s).
(b) You can create an online account with your chosen insurance company enabling you to make your initial payment and to make ongoing future payments or ongoing automatic payments online.
Again, Georgia Health Insurance Marketplace does not accept either initial payments or ongoing payments for Georgia state exchange health plans through the health insurance marketplace. Payments are made directly to your chosen private marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) and are only made through any of the 3 options detailed above.
(10) We help 365 days/year during both special enrollment (12/16-10/31) and open enrollment (11/1-12/15).
(Nov. 1, 2019 – Dec. 15, 2019); (2020 Open Enrollment Period); (2020 OEP); (11/1/2019-12/15/2019).
Your estimated 2020 final household income (to be reported in 2021) determines your financial assistance.
(Dec 16, 2019 – Oct. 31,2020); (2020 Special Enrollment Period); (2020 SEP); (12/16/2019-10/31/2020).
Your estimated 2020 final household income (to be reported in 2021) determines your financial assistance.
(Nov. 1, 2020 – Dec. 15, 2020); (2021 Open Enrollment Period); (2021 OEP); (11/1/2020-12/15/2020).
Your estimated 2021 final household income (to be reported in 2022) determines your financial assistance.
(Dec 16, 2020 – Oct. 31,2021); (2021 Special Enrollment Period); (2021 SEP); (12/16/2020-10/31/2021).
Your estimated 2021 final household income (to be reported in 2022) determines your financial assistance.
The health insurance marketplace open enrollment period occurs each year over a 45-day period from November 1 through December 15.
During this 45-day period, any Georgia household (with or without a prior application for marketplace plan) may apply for marketplace plan and enroll in the federal health insurance marketplace.
Those Georgia residents who already have marketplace insurance can easily update their application for marketplace plan through the new Enhanced Direct Enrollment platform. The information in their existing application has already been pre-populated in order to save them time.
Household income can change from year to year and Georgia state exchange health plans Alliant, Ambetter, Anthem, CareSource, Kaiser and Oscar (in the bronze, silver and gold levels) also change from year to year.
Even slight changes to household income estimates (for the year of upcoming coverage) can sometimes have a dramatic effect on a Georgia household’s monthly payment after the Advance Premium Tax Credit (APTC). Just like an annual federal tax return, marketplace plan enrollment on the federal health insurance exchange does not update itself.
If a Georgia household does not update their application for marketplace plan, they will be auto-re-enrolled on December 16th, the day after open enrollment period ends.
During Open Enrollment Period (OEP 11/1-12/15), it is highly recommended that Georgia households with existing marketplace insurance plans click the Georgia Health Insurance Marketplace “Get a Quote & Enroll / Re-Enroll” icon to make sure they aren’t paying too much (or too little). Receiving an IRS Form 1095A that reflects inaccurate household income may result in a surprise when the upcoming federal tax return is filed.
During Special Enrollment Period (SEP 12/16 – 10/31), Georgia residents with a Qualifying Life Event (QLE) may enroll in the health insurance marketplace or change marketplace insurance plans outside of the annual Open Enrollment Period.
There are 4 different kinds of qualifying life events and these events must have occurred in the past 60 days in order to qualify for Special Enrollment Period, although anticipated loss of health coverage within the next 60 days s also permitted
(1) Loss of health coverage: (Job related, individual, student plans, losing eligibility for Medicare, Medicaid. CHIP and Georgia PeachCare for Kids for those Georgia children turning 19).
(2) Changes in household: (Getting married or divorced, having a baby or adopting a child, death of a family member in the tax household)
(3) Changes in residence: (Moving to Georgia from another state, moving to a different Georgia zip code or moving to a different Georgia county) ***
(4) Other Qualifying Life Events: (Changes in household income that affect the coverage you originally qualified for, becoming a U.S citizen, leaving incarceration (jail or prison)
***NOTE: In every case above, a Georgia resident must prove that they had qualifying health coverage for one or more days during the 60 days before a move
(11) In 2013, we conducted our first comprehensive rate study for all of the state of Georgia’s 159 counties.
In the summer of 2013, in anticipation of Georgia’s inaugural Affordable Care Act health insurance enrollment, Georgia Health Insurance Marketplace conducted a comprehensive set of rate studies in order to understand the wide rate variances (and accompanying APTCs) for all of Georgia’s districts encompassing all 159 Georgia Counties. The first open enrollment period was marked by massive confusion by many Georgia households. Of all the state health exchanges, the state of Georgia (among others) is a federally facilitated marketplace state. This means that the state of Georgia does not have expanded Medicaid. This also created confusion because many Georgia residents whose household income was below 100% of the federal poverty level, did not actually qualify for monthly federal financial assistance.
Since 2013 was the first year for Georgia state exchange health plans, we had a learning curve ourselves and we wanted to be fully prepared to deal with the many questions that would arise. We began to understand the federal algorithms that led to particular monthly rates for households within various percentages of the federal poverty level.
The study underscored the importance of being able to explain why one particular family with similar socio- economic data might pay more or less than a similar Georgia family. When an application for marketplace plan was completed, we were able to comfortably explain to a Georgia resident why he or she was paying more or less than others they knew.
Since monthly rates are not derived from health conditions but rather by numbers (zip code, family size, household income, how many are applying, etc), it became awkward in the early days to explain the rate divergence.
During the early years, there were also 7-8 different private health insurance companies participating in the health insurance marketplace in Georgia. Today there are 4. At the time, since each private insurance company had its own group of actuaries to determine the pre-subsidy rates for each of the counties in which they were participating, there were often marked differences in “original rates”’ (before the subsidy) amongst all of the companies.
Since marketplace insurance plans included unlimited coverage for pre-exiting conditions, no one company had any track record of the amount and size of medical claims they might expect. To put the initial situation in an even greater sense of flux, there were some Georgia counties with 4-6 different participating companies and other Georgia counties with only 1. These counties with only one participating provider were usually counties in Georgia’s lower income counties in southeast and southwest Georgia.
The state of Georgia has more counties (159) than any other state in the union (except for Texas). With all of the state exchange health plan enrollment in Georgia’s poorest counties being represented by only one insurance company, this eventually led to the original company leaving and another one coming in to replace it. Primary Care Physicians in those underserved counties had to quickly change from one marketplace insurance company to another. This was also a point of confusion since many primary care physicians were unaware of this until it had already happened. We were there from the beginning through the initial state of flux
Since that time, Georgia Health Insurance Marketplace has helped tens of thousands of Georgia residents to re-enroll and enroll in the federal health insurance marketplace. Even though things have settled down somewhat, we continue to do fully comprehensive annual rate studies (for each Georgia county) in order to be aware of the rate changing landscape.
We’ve come a long way since 2013 and we will continue to help all Georgia residents to: (a) Obtain marketplace quotes that will qualify them for the maximum allowable financial assistance; (b) Choose among plans that are affordable and make sense for their household; (c) Easily enroll or re-enroll using our new Enhanced direct enrollment platform; (d) Get enrollment documented confirmations in real-time; (e) create their own marketplace dashboard so that they can manage their own application, enrollment and documents.
We are here to help Georgia residents almost 365 days per year. Our new health insurance marketplace certified Enhanced Direct Enrollment platform now makes it easier for any Georgia household to be able to fully compare prices, savings, benefits, plan details, co-pays and deductibles all before they apply for marketplace plan and receive full documented confirmations.
(12) In 2014, we affirmed our state of Georgia SEED Mission Statement: Simplify-Educate-Enroll-Document.
Although marketplace plan enrollment in Georgia continues to increase each year, the state of Georgia has always had one of the lowest percentages of residents enrolled in health insurance. There are multiple reasons for this: (a) Georgia’s socio-economic demographic history; (b) Georgia is one of the largest states east of the Mississippi in geographic physical size and the vast majority of the state is rural; (c) The state of Georgia has never had expanded Medicaid which means that many adults over 19 who have incomes below 100% of the federal poverty level are not qualified to receive any federal or state financial assistance. Although marketplace plan enrollment continues to increase each year
In spite of the federal government’s massive informational rollout to educate the nation about federal health insurance exchange enrollment, there are still countless of examples of misinformation that impede progress:
(a) Applicants thinking that household income is based on “take-home-pay’ instead of gross pay before taxes.
(b) The lower paid self-employed and 1099 sub-contractors who only report 1099s rather than their net profit.
(c) Applicants who think that their qualifying household income is only for those applying for coverage.
(d) Middle-income households who never enroll because they think their household income is too high.
(e) Households with an unemployed 19-25-year-old who think it’ll cost more if they add them to the policy.
(f) Applicants who think their marketplace insurance won’t go into effect until they’ve met the deductible.
(g) Applicants who don’t know that bronze plans include a free annual check and many other benefits.
(h) Enrollees cancelled mid-year because they never responded to a request to supply income documents.
(i) Enrollees cancelled due to non-payment because they developed a pattern of being 30-60-90 days late.
(j) Enrollees who lose their financial assistance because they never filed a tax return for the following year.
Our mission statement from the very beginning was to do our part to improve the state of Georgia’s low health insurance enrollment ranking by giving Georgia consumers the important information they need before they begin their application for marketplace plan. Far too many Georgia households deprive themselves of knowing the true amount of monthly financial assistance they qualify for because they were either cavalier about estimating their upcoming household income or simply didn’t have the mathematical know-how to estimate it. We understand. Many Georgia residents have weaknesses in math. The calculating aids in our Enhanced Direct Enrollment platform make every effort to help even the most challenged to apply for marketplace plan and be successful.
Our SEED mission statement was (and is) Simplify, Educate, Enroll, Document
Simplify the rate quoting and enrollment process for Georgia state exchange health plan enrollment. Once a Georgia resident clicks the “Get a Quote & Enroll / Re-Enroll” icon, the instructions are very basic and easy to understand. Reading over the important tutorial on our website prior to doing so should give most any Georgia consumer enough confidence so that they know they are starting the initial building block of their quote correctly. Since that becomes only an “initial” quote, there are further household income and household size questions inside the marketplace’s new Enhanced Direct Enrollment application that will make it easier to further refine the quote resulting in a confirmed eligibility notice upon completion.
Educate Georgia residents on the informed way to enroll in the federal health insurance marketplace. We made every attempt to provide easy to understand color graphs. These color-coded graphs (by tax household family size) were meant to clearly show the relationship between the size of the tax household and estimated yearly household income for the year in which the Georgia household ids requesting coverage. Additionally, we provided color coded graphs that show which Georgia households will not only qualify for monthly federal financial assistance but will also qualify for an equally important benefit, cost sharing reductions that lower co- pays and deductibles and co-insurance
Enroll Georgia residents with compliance with Affordable Care Act health insurance enrollment protocols. Our Enhanced Direct Enrollment (EDE) platform is provided by the HealthSherpa the federal marketplace’s first and only Enhanced Direct Enrollment platform. Our rate quoting mirrors the marketplace algorithms with exactitude. This means that the quote you receive in the beginning of the quoting process will be exactly the same after the federal eligibility notice has been generated (assuming the size of tax household and household income estimate are the same of course). The new application format is easier to understand and navigate and the reliability and real-time confirmations of the enrollment and documentation process are unequaled and without compromise.
Document the enrollment after Georgia residents enroll in the health insurance marketplace. All Georgia residents who complete the “Get a Quote & Enroll / Re-Enroll” process receive online documentation confirmation in real-time from the Health Insurance Marketplace, 465 Industrial Blvd, London, Kentucky 40750- 0001. The eligibility letter documentation confirms: (a) monthly and yearly financial assistance meaning the Advanced Premium Tax Credit (APTC); (b) Confirmation of household income submitted in the application; (c) Which family members are to be covered; (d) Whether or not the household is approved for cost sharing reductions (the lowering of co-pays and deductibles) available on silver plans; and (e) Notification of any documents that need to be sent within a 60 and or 90 day period. Additionally, the Georgia resident receives further confirming documentation form HealthSherpa the only certified Enhanced Direct Enrollment partner working with the marketplace. Plan confirmation and the phone number of the applicable private insurance company are also provided. Either by email and/or mail (per the applicant’s preference specified in the application), the participating private insurance company also confirms the enrollment as well.
(13) From 2014-2019, we continued the systematic comprehensive yearly state-wide rate studies for Georgia.
After the first open enrollment period in 2013, we began a comprehensive summary of all of Georgia’s federal health insurance exchange geographical districts in order to gain a deeper understanding of the rate structures of all of the offered plans. In the early years, Alliant, Ambetter, BlueCross BlueShield, Coventry, Humana, Kaiser and United Healthcare all participated. However, Coventry, Humana and United Healthcare all eventually stopped offering individual marketplace insurance.
In 2018, Anthem (BlueCross) also stopped offering individual marketplace insurance plans in the metropolitan Atlanta area as well but then returned again in 2019. The plans that remained steadily from the very beginning (Alliant, Ambetter and Kaiser) experienced growing plan enrollment. Those plans that dropped out did so because they lost billions (in Georgia and in other state health exchanges). Over time we became acutely aware of the details involving the ebb and flow of all of the different rate structures of all Georgia health plans.
Every year since then, prior to the applicable annual open enrollment period, we conduct our own ongoing marketplace plan rate studies for all Georgia state exchange health plans in all 159 Georgia counties. During the late summer and early fall months (preceding the November 1 start of the annual open enrollment period), we receive information from all private insurance companies offering Georgia state exchange health plan enrollment. This information gives us a better understanding of plan changes for the upcoming open enrollment and those changes become available to the public on our Enhanced Direct Enrollment quoting system as well.
During that same period, we are revising federal poverty levels by family size. These change every year as the cost of living goes up. A Georgia household’s percentage of the federal poverty level and the number of family members (enrolling or not) in the tax household have a direct bearing on the Georgia household’s monthly rate quote for both open enrollment period and special enrollment period. Federal health insurance exchange enrollment for those Georgia households between 100%-400% of the federal poverty level means that when they complete their application for marketplace plan, they will be paying a percentage of the actual plan cost.
As the actual plan costs increase, the monthly subsidies generally do as well. When you apply for marketplace plan, your monthly payment is designed to be equal than or less than a pre-specified percentage of your estimated household income based on your tax household size. The accuracy of your household income estimate is vitally important when you re-enroll or enroll in the federal health insurance marketplace. Each year, the participating private insurance companies all have contrasting rate increases.
Every year, marketplace insurance plans, acting independently, announce different rate increases for the state of Georgia. However, they are only able to announce their overall rate increase for the composite of the counties in which they are participating. While their plans in one set of counties may be minimal, rate increases in other counties may be more significant. This is another reason why every Georgia household already enrolled in a plan should revisit all of the health insurance marketplace plans available.
This is important because the data inside every Georgia resident’s own personalized upcoming IRS Form 1095A includes the applicable cost of what is referred to as the “benchmark” rate. The benchmark rate is the 2nd lowest cost silver plan was available during the prior year’s health insurance marketplace enrollment. Unless a Georgia resident resides in a Georgia county with only one private company participating in the health insurance marketplace, that 2nd lowest silver plan for one year may well not be the 2nd lowest silver plan for the next year. This phenomenon is most evident in the Atlanta metropolitan area.
If this scenario isn’t complicated enough to you already, consider the fact that you may enroll in a marketplace plan during a prior year and never notice that the same plan has higher co-pays and deductibles the following year. Even though all plans on the federal health insurance exchange must offer (by federal law) the same 10 essential health benefits (whether bronze, silver or gold), they are not required to offer the same co-pays and deductibles. These are the other moving parts that change every year as well.
All we do is Affordable Care Act health insurance enrollment. It is therefore incumbent upon us to remain laser focused on all of the significant changes that occur each and every year inside the federal health insurance exchange. When Georgia residents click the “Get a Quote & Enroll / Re-Enroll” icon, they are assured of being able to choose among all of the updated marketplace insurance plans available. More importantly, each plan on the menu includes all plan details, benefits, updated co-pays and deductible options.
When Georgia residents enroll in the marketplace and then enroll in a marketplace plan, they are provided with every decision-making tool available. Because this is what we do and it’s all we do, the details available to Georgia residents are designed to help Georgia residents qualify for maximum allowable federal financial assistance for a plan that’s affordable and makes sense for you and your family. The federal health insurance marketplace offers valuable benefits not available in short term plans. Your enrollment and re-enrollment deserve your special attention. It should be one of the most important decisions you make each and every year.
(14) Our primary focus has always been to educate Georgia residents on ACA quoting and enrollment.
Georgia Health Insurance Marketplace educates Georgia residents on enrollment criteria. The state of Georgia has always been aware that collectively, Georgia residents have one of the very lowest participation rates for health insurance. On a percentage basis, there are more uninsured Georgia residents than almost all of the 50 states. The state of Georgia has recently made efforts to help solve this unfortunate situation and when it does, we will be at the forefront of helping even more Georgia residents to enroll in the health insurance marketplace.
Affordable Care Act health insurance enrollment is not without its unintended consequences. The state of Georgia does not yet have expanded Medicaid for Georgia families below 100% of the federal poverty level for their family size. When the Affordable Care Act was enacted, many of Georgia’s poorest citizens were excited that they would finally have access to affordable health insurance.
Because Georgia does not have expanded Medicaid, Georgia is therefore a federally facilitated marketplace state. This means that once a very low-income Georgia family (below 100% of the poverty level for their family size) completes their application for marketplace plan, they soon discover that their federal eligibility notice does not include monthly financial assistance. Hopefully, this situation will change soon.
The federal Department of Health & Human Services allocated considerable funding for educating the public on the life changing benefits of marketplace insurance plans. This was understandable. It was a paradigm shift in health insurance. The elimination of medical underwriting meant that any and all pre-existing conditions would have to be honored without penalty for all marketplace plans (also referred to as Qualified Health Plans).
Moreover, there could no longer be any limitations on hospital coverage and prior insurance claims by one individual meant that they could not be “rate punished” for their medical claim history. While the federal awareness campaign emphasized the inherent health benefits of the Affordable Care Act, less emphasis was placed on how to actually apply for marketplace plan and how to successfully qualify for marketplace plan enrollment with monthly federal financial assistance.
This lack of emphasis on the actual enrollment qualifications affected affordable care act health insurance enrollment for both lower, middle and upper-income Georgia households. There were far too many unanswered questions about the rules and regulations surrounding the actual enrollment process itself. Since 2013, we have endeavored to fill in the vital information gaps for all Georgia residents, regardless of their socio-economic circumstances.
Since the state of Georgia (along with other state health exchanges) does not participate in what is called “Expanded Medicaid”, this means that for any Georgia household to complete an application for marketplace plan and receive monthly federal financial assistance when they enroll in the federal health insurance marketplace, the Georgia household must have estimated household income (for the year of coverage) of “more” than 100% of the federal poverty level and less than 400% of the poverty level (for their “family size.”) Family size means the # of family members included on the “upcoming” tax return for the “year in which they are applying for coverage”, (regardless of the number of family members applying).
When Georgia residents first get a quote and then apply for marketplace plan, they may lose sight of the vital importance of the 2 things that have the greatest effect on their initial quote and their final rate once they enroll in the federal health insurance marketplace. These 2 subjects are explained thoroughly both on our Home Page, Know More Page and FAQ: Family size meaning all family members who will be in your upcoming tax return, including those not needing coverage. Household income for the calendar year of coverage including income from all family members, even those not applying.
For a successful 2020 application for marketplace plan (to include monthly federal financial assistance) for open enrollment period (2020 OEP 11/1/2019-12/15/2019) and special enrollment period (2020 SEP 12/16/2019-10/31/2020) and using “approximate” yearly household income thresholds, a Georgia family’s “estimated” 2020 yearly household income based on their estimated 2020 tax return (to be filed in 2021) must be more than 100% and less than 400% of the poverty level. (For simplicity, $ amounts are rounded up).
Family Size of 1: Estimated 2020 yearly household income MORE than $12,500 and LESS than $50,000
Family Size of 2: Estimated 2020 yearly household income MORE than $17,000 and LESS than $68,000
Family Size of 3: Estimated 2020 yearly household income MORE than $21,500 and LESS than $86,000
Family Size of 4: Estimated 2020 yearly household income MORE than $26,000 and LESS than $103,000
Family Size of 5: Estimated 2020 yearly household income MORE than $30,500 and LESS than $120,000
Family Size of 6: Estimated 2020 yearly household income MORE than $35,000 and LESS than $138,500
Since 2013, Georgia Health Insurance Marketplace has made every effort to make it easier for Georgia residents in all 159 Georgia counties and from all socio-economic circumstances to get a quote for Georgia state exchange health plans and to successfully finalize Georgia state exchange health plan enrollment. Since 2013, we’ve helped enroll and re-enroll tens of thousands of Georgia residents. This is what we do and this is all we do.
(15) Our secondary priority is to educate Georgia residents on qualifying for cost sharing reductions (CSR).
Georgia Health Insurance Marketplace educates Georgia residents on Cost Sharing Reduction. Thoughtful and reasonably accurate yearly household income estimates (based on current income) are not only important in determining monthly federal financial assistance (advance premium tax credits) but are also important in determining Cost Sharing Reduction (CSR).
CSR is available only on silver marketplace insurance plans. Cost Sharing Reduction means Georgia household family sizes in certain income categories also qualify for lower co-pays and lower deductibles: This means lower hospital bills and lower co-pays for doctor bills and prescription drugs.
(For simplicity, amounts are rounded up)
Family Size of 1: Estimated 2020 yearly household income MORE than $12,500 and LESS than $31,000
Family Size of 2: Estimated 2020 yearly household income MORE than $17,000 and LESS than $42,000
Family Size of 3: Estimated 2020 yearly household income MORE than $21,500 and LESS than $53,000
Family Size of 4: Estimated 2020 yearly household income MORE than $26,000 and LESS than $64,000
Family Size of 5: Estimated 2020 yearly household income MORE than $30,500 and LESS than $75,000
Family Size of 6: Estimated 2020 yearly household income MORE than $35,000 and LESS than $86,000
When you apply for marketplace plan and successfully complete your marketplace plan enrollment, both the Georgia Health Insurance Marketplace quoting algorithm system and Enhanced Direct Enrollment platform will confirm your eligibility for both monthly financial assistance as well as cost sharing reduction.
There are distinct multiple advantages for lower and middle-income Georgia residents who enroll in the health insurance marketplace and in one of the state exchange health plans. Three different CSR levels (explained more fully on the homepage and in the KNOW MORE section of our website) are based on three different income levels: 100%-149%, 150-199% and 200%-249% of the federal poverty level.