The Peach State has a lot of redeeming qualities, but according to a study by US News, health care isn't one of them. Georgia ranks as having the 42nd best health insurance in the country considering health care access, quality, and good public health.
Health insurance options in Georgia
According to Georgia's Office of Insurance, residents can get health care several ways:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do Georgians get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 49% | ||
| Individual or family | 6% | ||
| Medicaid | 17% | ||
| Medicare | 12% | ||
| Military | 2% | ||
| Uninsured | 14% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
14 percent of Georgia residents are uninsured, a few percent above the national average. That doesn’t bode well for policyholders, as the more uninsured people there are, the higher rates are for insured people.
Georgia health insurance companies
There aren't many health care provider options in Georgia, but here are the best providers in the state:
- Alliant
- Ambetter
- BlueCross BlueShield
- Caresource
- Kaiser Permanente
- Oscar
These companies offer both individual and family plans. Check out provider websites to find out more about rates and specific location factors.
Georgia health insurance costs and rate factors
Georgia residents spend an average of $6,587 per year on health care expenditures, less than the national average. Health care prices vary person to person, here are a few of the main factors insurers will use to price your policy:
Plan type
The more health care coverage you want, the more money it will cost. Marketplace plans are organized into metal tiers: bronze, silver, gold, and platinum.
How much should you expect to pay as a Georgia resident? These are the average prices for a 40-year-old Georgia resident in 2019:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $347 | $430 | $491 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
In Georgia, a gold plan costs about 43 percent more than a bronze plan. Why the massive price increase? Because bronze plans only cover 60 percent of medical costs and gold plans cover 80 percent. If you use your insurance often, a gold plan may be a better investment.
The lowest level of coverage you may qualify for is a catastrophic plan. These types of plans offer low monthly premiums, but a high deductible. For 2020, the deductible for catastrophic plans is $8,150. Purchasing a bronze or silver plan may save you money when you need to use your insurance.
Body mass index
According to the CDC, a high body mass makes you statistically more likely to suffer from numerous health conditions. Health insurance companies often analyze your BMI to determine your risk-level and price your policy. Often, a higher BMI leads to higher insurance rates.
In 2018, Georgia had a 32.5 percent obesity rate, the 21st highest in the country. 31 percent of Georgians who used QuoteWizard to compare health insurance plans have a BMI in the obese range.
Tobacco use
If you smoke, your rates could skyrocket. There are several substantial risks that come from smoking, and insurers know that. 17.5 percent of Georgians are smokers, the 20th highest rate in the country.
Age
According to HealthCare.gov, older people can pay up to three times more for health care than younger people. GA residents who used QuoteWizard to shop for health insurance are, on average, 40 years old.
Location
Each state has different rules and laws surrounding the health care marketplace. Your location plays a big role in how much you'll pay.
Also, health care providers base your costs on your community rating. This means if a neighbor files a high number of claims, your premiums will spike.
How health-conscious your state is therefore plays a role in your premiums. According to America's Health Rankings, Georgia is the 41st healthiest state in the US.
Georgia health insurance laws
The Affordable Care Act makes it so insurance companies can't use certain factors when pricing your policy.
- Pre-existing conditions: Insurance companies can't charge you higher rates because of pre-existing conditions. Before this rule, providers would charge people with pre-existing conditions far more than those without.
- Gender: According to a study by Health Services Research, women tend to pay up to a third more on health care. With the ACA, insurance companies cannot charge women and men different prices for the same plan.
- Insurance and medical history: Providers also used to check your medical history and lapses in past insurance coverage. If they could even get coverage to begin with, people used to pay significantly more if they had previous medical problems or lapses in insurance.
Marketplace plans have maximum limits you can pay out-of-pocket. For 2018, the out-of-pocket maximum is $8,150 for individual plans and $16,300 for family plans.
Georgia requires that insurance companies offer some coverage for these services:
- Mastectomy
- Maternity
- Treatment of mental disorders
- Birth control
- Cancer screenings
- Diabetic supplies
- Bone marrow transplant
- Heart transplant
There are more services that providers need to offer some coverage for. Find the entire list here.
Medicare and Medicaid in Georgia
Government-funded health care programs Medicare and Medicaid help two different groups. Medicaid helps residents 65 and over with health care costs. Medicaid aids low income families and children.
Medicare
Those over 65 qualify for Medicare, a federally-funded health care program. You may also qualify for one of these four Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Here are Georgia's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $31,518 |
| 2 | $42,583 |
| 3 | $53,649 |
| 4 | $64,715 |
| 5 | $75,780 |
| 6 | $86,846 |
| 7 | $97,911 |
| 8 | $108,977 |
Georgia Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Ralph T. Hudgens
- Insurance Hotline:
- (800) 656 – 2298
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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