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Georgia Health Insurance
There are multiple health insurance options open to those in the state of Georgia who are uninsured or underinsured, but there are several questions to keep in mind. If your employer does not offer health insurance, are you healthy enough to obtain health insurance on the individual market? If so, Health Plan One can help by quoting plans appropriate for your needs and price range. Do you own your own business? Health Plan One can also assist sole proprietors and small business owners in obtaining small group coverage. Do you have any pre-existing conditions, disabilities, or are you below an income level which could qualify you for free or low-cost health care programs offered by the government? You may be eligible in Georgia for Medicaid, PeachCare for Kids, the Long Term Care Partnership, HICP, Children's Medical Services, or GVHCP. Information on any of these options is available on this page.
What Every Georgian Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.
Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through Health Plan One. Simply visit our Short-Term information page for your free quotes.
It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important. Notably, if you have had group health coverage in Georgia for one year (18 months for late enrollees), and you switch jobs and go to another plan, the new health plan cannot impose another pre-existing condition exclusion period, provided there is no break in your coverage for more than 63 days.
What If I'm Between Jobs?
Because it is important not to have a break in coverage, if you've recently lost your job look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs, to invest in an individual/family insurance policy through Health Plan One.
With individual coverage you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in Georgia so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through Health Plan One could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Georgia each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.
If you're healthy and are unhappy with the health insurance offered by your employer, are between jobs, or are not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.
Small Group Plans
If you are self-employed, you could qualify for a small group plan in Georgia. You must have 2 or more eligible employees who each work at least 25-30 hours per week. No minimum amount of time in business is required to apply, but you must be able to provide tax forms and other business documentation requested by the carrier to which you're applying. All carriers in Georgia do medically underwrite for small group plans. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. Health Plan One can help you by quoting plans for small groups. Simply call us at (877) 567-5267.
If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.
To view small group plans in Georgia, visit our Georgia Small Group page.
Medicaid in Georgia
The Medicaid program, administered within the GA Department of Community Health by the Medical Assistance Plans division, provides basic health care coverage for children, pregnant women, and those who are elderly, blind, or disabled. In order to be eligible residents of Georgia must make below a certain income ceiling. These income requirements are available here: http://dch.georgia.gov/00/channel_title/0,2094,31446711_31945377,00.html You must also provide proof of citizenship for Medicaid. In order to determine your eligibility visit your local county Department of Family and Children Services Office. As you can see from looking at the income requirements page, there are several different levels of coverage through Medicaid and several different categories applicants fall into. For a more detailed explanation of these categories, visit the GA Medicaid page at http://dch.georgia.gov/00/channel_title/0,2094,31446711_31944826,00.html
The managed care aspect of GA Medicaid is referred to as Georgia Families. Almost everyone who is in enrolled in Medicaid or PeachCare for Kids (information below) must enroll in Georgia Families to choose a health plan and primary care physician. For more information on managed care programs and Georgia Families, click around on their website at http://www.georgia-families.com/GASelfService/en_US/home.htm
Under the Medicaid umbrella, more than 1.4 million Georgians receive prescription benefits. To learn more about prescription coverage through the Medicaid programs, visit http://dch.georgia.gov/00/channel_title/0,2094,31446711_32040242,00.html
To learn more about long term care through Medicaid, click here http://dch.georgia.gov/00/channel_title/0,2094,31446711_131673936,00.html
Those looking for Georgia Medicare Advantage plans, should visit MedicareSolutions.com
PeachCare for Kids
PeachCare for Kids is Georgia's version of the State Children's Health Insurance Programs available in most states. The program is meant to cover uninsured children whose parents' income is too high to apply for Medicaid but is too low to allow them to buy health insurance on the individual market. To be eligible, the child must be age 18 and under, a US citizen (or a qualified legal resident/refugee/asylee) who resides in Georgia, uninsured, and have a family income less than or equal to 235% of the federal poverty level. For more information on eligibility, click here http://www.peachcare.org/FaqView.aspx?displayFaqId=104 Thankfully, the program is available at little or no cost to children whose families qualify. The benefits include sick visits to the doctor, dental care, mental health care, prescription medications, and much more. Click around the PeachCare website at http://www.peachcare.org/Default.aspx for more information on benefits and how to apply.
Georgia Long Term Care Partnership
This program is a public-private partnership which creates an innovative program offering participants quality affordable long-term care insurance and access to medical care without breaking the bank. The partnership is administered by the DCH and provides an alternative to "spend down" options or transferring assets by establishing a partnership between Medicaid and private long-term care carriers. The eligibility requirements and specific benefits of the program are highly detailed and should be carefully considered at http://dch.georgia.gov/00/channel_title/0,2094,31446711_121970353,00.html
Health Insurance Continuation Program
The HICP assists those who are unable to pay their health insurance premiums when an enrollee's COBRA coverage ends. The Eligibility requirements for this program are also quite detailed. HICP will only accept new enrollees with insurance plans that include both outpatient primary care coverage and prescription coverage without a yearly cap. Premium payments are limited to $1100 per month. Individuals are eligible if:
- Have a positive HIV/AIDS diagnosis
- Have a gross household income of 300% of the FPL or less
- Have cash assets of $4500 if single or $5500 if married or less
- Aren't covered by or eligible for Medicaid
For more information, please visit the program website at http://health.state.ga.us/programs/stdhiv/hicp.asp
Children's Medical Services and the Georgia Volunteer Health Care Program
The CMS program pays for children from birth to age 21 with qualifying conditions to receive comprehensive, coordinated specialty care. CMS is the state and federally funded Title V Children with Special Health Care Needs Program. Families with incomes over 150% of the Federal Poverty Level through 236% of the FPL will be required to contribute a certain amount toward the care of their child. Additionally, children who are Medicaid/PeachCare enrolled, receive SSI, or are in foster care are eligible for CMS services. For more information, please see http://health.state.ga.us/programs/cms/index.asp
The Georgia Volunteer Health Care Program
The Georgia Volunteer Health Care Program (GVHCP) allows physicians in Georgia to donate their time toward treating uninsured individuals at or below 200% of the federal poverty level. If you are such an individual, check out the GVHCP website http://dch.georgia.gov/00/channel_title/0,2094,31446711_84263925,00.html to learn more about the program and to see whether a free clinic staffed by these doctor's is available in your area. The state provides these doctor's with state-sponsored liability protection.
To visit the Georgia Department of Community Health website, click here http://dch.georgia.gov/02/dch/home/0,2467,31446711,00.html
The state of Georgia has established an extraordinarily helpful website to connect Georgians with health care providers and to educate them on the healthcare and insurance industries. This website is http://georgiahealthinfo.gov/cms/
For information on HIPAA plans available in Georgia to those residents who are for medical reasons uninsurable on the private market, check out our HIPAA Insurance page.