Georgia Health Insurance Consumer Guide

To enroll in private health coverage through the Marketplace in Georgia, you must:⁵

• Be a resident of Georgia
• Be lawfully present in the United States
• Not be incarcerated
• Not have Medicare coverage 

Those are the only qualifications you need to meet in order to enroll in a Marketplace plan, but qualifying for financial assistance (premium subsidies and cost-sharing reductions) is a little different, and does have some additional parameters. 

Eligibility for Marketplace financial assistance depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. In addition, to qualify for Marketplace financial assistance you must:

• Not have access to affordable employer-sponsored health coverage. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or PeachCare for Kids (Georgia CHIP).

You can sign up for an ACA-compliant individual or family health plan in Georgia between November 1 and January 15. This is the annual open enrollment period. 

For coverage to start on January 1, you must make your plan selection by December 15. If you apply between December 16 and January 15, your coverage will take effect on February 1.⁶ 

After the annual open enrollment period ends, your opportunity to enroll or make a plan change will be limited. It’s generally only available if you experience a qualifying life event, such as giving birth or losing other health. But some people can enroll year-round even without a specific qualifying life event.⁷

Enrollment in Georgia Medicaid and PeachCare for Kids (CHIP) is available year-round, so if you’re eligible for either of these programs, you can enroll anytime.

To enroll in an ACA Marketplace plan in Georgia, you can: 

• Visit HealthCare.gov, which is Georgia’s health insurance Marketplace. HealthCare.gov provides an online platform where you can compare the available plans, determine your eligibility for financial assistance, and enroll in the coverage that best meets your needs. (Starting in the fall of 2024, Georgia will no longer use HealthCare.gov and will instead have a state-run Marketplace platform.) 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁸

You can reach HealthCare.gov’s call center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

You may find affordable health insurance options in Georgia by enrolling in a plan through HealthCare.gov – especially if you’re eligible for financial assistance. 

Income-based subsidies called Advance Premium Tax Credits (APTC) are available as a result of the Affordable Care Act. APTCs can help lower your premium payments each month, and most enrollees are eligible for these subsidies.

As of 2023, 94% of Marketplace enrollees in Georgia were receiving premium subsidies that saved them an average of nearly $487 /month. After subsidies were applied, the average enrollee’s monthly cost was about $66 /month.⁹ 

Source: CMS.gov¹⁰

If your household income isn’t more than 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR), which are another type of ACA subsidy. These subsidies can lower your deductibles and out-of-pocket expenses as long as you select a Silver-level plan. Sixty-three percent of Georgia’s Marketplace enrollees were receiving CSR benefits as of 2023.¹¹

Depending on your income and circumstances, you may find that you’re eligible for free or low cost health coverage through Medicaid or PeachCare for Kids. Learn more about whether you might meet the criteria for Medicaid in Georgia.

Nine private insurers offer health coverage through the Georgia exchange in 2023, with varying coverage areas. All nine plan to continue to offer coverage in 2024:¹² 

• Alliant
• Ambetter from Peach State Health Plan (Centene)
• Blue Cross Blue Shield Healthcare Plan of Georgia
• Kaiser
• Oscar
• CareSource
• Aetna/CVS 
• UnitedHealthcare 
• Cigna 

There were eleven insurers in Georgia’s exchange in 2022, but Bright Health stopped offering coverage after the end of 2022. Friday Health Plans stopped offering coverage in the spring of 2023 and their existing policies terminated on July 31, 2023.¹³

For 2024, Georgia’s insurers have proposed the following average rate changes:¹² 

These proposed average rate increases are for full-price plans, but 94% of Georgia Marketplace enrollees are receiving premium tax credits that help reduce their monthly payments.¹⁴

Subsidy amounts change each year to keep pace with changes in the benchmark plan (the second-lowest-cost Silver plan) in each area. As a result of the American Rescue Plan, the subsidies are larger than they used to be, and available to more people. And this will continue to be the case through 2025, due to the Inflation Reduction Act.

If the cost of your current plan increases, you can explore other plans in the exchange that may be less expensive and offer similar benefits.

During the open enrollment period for 2023 coverage, 879,084 people enrolled in private plans through the Georgia Marketplace.¹⁵

Effectuated enrollment is always lower than the number of people who sign up during open enrollment. As of early 2023, there were 842,201 people with effectuated coverage through the Marketplace in Georgia.¹⁴ 

Source: 2014,¹⁶ 2015, ¹⁷ 2016,¹⁸ 2017,¹⁹ 2018,²⁰ 2019,²¹ 2020,²² 2021,²³ 2022,²⁴ 2023,¹⁵  2024²⁵

HealthCare.gov: The Marketplace in Georgia, where residents can enroll in individual/family health coverage and receive income-based subsidies. You can reach HealthCare.gov at 800-318-2596. (Note that Georgia will no longer use HealthCare.gov as of the 2025 plan year, so when open enrollment begins in November 2024, Georgia residents will be using a new enrollment platform.)

Georgia Department of Community Health (DCH) – Administers Georgia Medicaid and PeachCare for Kids.

Georgia Office of Insurance and Safety Fire Commissioner – Regulates and licenses health insurance products sold in the state, as well as the brokers and agents who sell them.

Georgia’s three federally funded Navigator organizations help people enroll in coverage (private health plans or Medicaid) in the exchange:²⁶

• Georgia Association for Primary Health Care, Inc. (GAPHC) 
• Georgia Legal Services Program
• St. Joseph’s Mercy Care Services

Georgia Cares State Health Insurance Assistance Program – A resource for Medicare beneficiaries and their caregivers, providing counseling and assistance with various Medicare issues.