Affordable health insurance plans in Georgia are available for individuals, families, Seniors, and small businesses. Pre-existing conditions are covered without any waiting periods or surcharges, and Marketplace large federal subsidies can drastically reduce premiums. View and compare free online quotes for Ga. consumers and help simplify the enrollment process. Compare the best policies in minutes. The 11 companies offering 2024 private plan coverage are Alliant, Ambetter, BCBS of Georgia, Kaiser, Oscar, CareSource, Aetna, UnitedHealthcare, and Cigna.
Humana stopped offering coverage four years ago, and previously, UnitedHealthcare, Aetna, Cigna, and Harken Health exited the state. UHC, Aetna, and Cigna returned two years ago. The counties that have the most participating insurers are Cherokee, Forsyth, Fulton, Cobb, Gwinnett, Cobb, Dekalb, Douglas, Henry, and Fayette. Ambetter is the sole carrier that offers plans in all 16 regions. Currently, more than 200,000 persons in the state are covered by Ambetter. Oscar had the fewest policyholders with less than 300. However, Oscar and Cigna jointly offer small business coverage. The five carriers decreasing rates two years ago were Alliant, BCBS of Georgia, Kaiser, Oscar, and CareSource.
Seniors can shop for the best Medicare Supplement/Medigap plans and lower out-of-pocket expenses. Advantage contracts are also available as an alternative to original Medicare coverage. Many of these plans include prescription drug benefits. Part D plans are also offered with many copay options. When you reach age 65, typically there is a seven-month enrollment window that allows you to review and apply for coverage without medically qualifying. The least expensive Part D plan is SilverScript SmartSaver for $7.30 per month and a total of 24 plans are available. Also, many $0 premium MA plans are also offered.
Note: Beginning in the fall of 2024 (2025 effective dates) Georgia will control its own state Exchange. Approved rate increases for this year are listed below:
Aetna – 18.02%
Alliant – 19.51%
Ambetter – 9.08%
Anthem BCBS – 12.86%
CareSource – 12.31%
Cigna – 39.87%
Kaiser – 11.60%
Oscar – 8.51%
UnitedHealthcare – 6.35%
The Obamacare Impact
Whether you live in Atlanta, Macon, Augusta, Athens, Savannah or any other city in the state, you may be eligible for a substantial federal subsidy to help pay your private healthcare Exchange premium. Courtesy of the ACA (Affordable Care Act) legislation, if your household income is under 400% of the Federal Poverty Level (FPL), you get free money. And if it’s under 250%, you qualify for special “cost sharing,” which can drastically reduce your deductible on Silver-tier plans. Copays and maximum out-of-pocket maximums also reduce.
In Georgia, and all other states, it is no longer mandated law that you must purchase coverage. During Open Enrollment (November 1st-December 15th), you can easily apply for a qualified policy from BCBS and many other carriers. If OE is missed, a “Special Enrollment Period” is available for many specific situations (divorce, baby, reaching age 26, moving to a different service area, losing job etc…). You can also buy a “temporary” plan, which will be discussed later. The OE period is different for persons that have reached age 65. We provide specific information on Senior Medigap and Advantage plans later.
Although the existing US healthcare system can always change with each new Administration, it’s not expected that new laws and regulations will be fully implemented until 2024. Premium increases are expected to slowly decrease, while additional flexibility may offer additional low-cost plan options. It’s also likely that each state will be given more control over the plans they approve and issue. “Medicare For All” is not likely to become a reality, regardless of which political party controls Congress.
The Georgia Health Marketplace (Exchange)
Georgia Marketplace Plans Cover Pre-Existing Conditions
Cheap! Perhaps that best describes rates for individuals and families, since the average monthly cost of healthcare to consumers in the state is abut $70 per month for Exchange plans. This includes any applicable federal subsidies, which are instantly deducted from the premium as a tax credit.
Last year, more than 450,000 persons were able to purchase Exchange coverage, and most applicants qualified for a subsidy. Also, more than 200,000 additional persons previously became eligible for PeachCare or Medicaid , which provides low-income families with quality coverage at a minimal or no cost. Benefits are very comprehensive, and include maternity, mental illness, and major medical coverage.
Our state’s average price is the second lowest in the nation, with almost 90% of applicants qualifying for some type of financial assistance. Although there has not been an expansion of Medicaid like more than 30 other states, almost 100,000 persons were able to sign up for CHIP or Medicaid during the first year of the Exchange. It is expected that the eligibility requirements will be loosened sometime in the next five years.
Additional new counties within Anthem’s network include Banks, Bartow, Chatooga, Cherokee, Cobb, Coweta, Dawson, Dekalb, Douglas, Fannin, Fayette, Floyt, Forsyth, Franklin, Fulton, Gilmer, Gwinnett, Habersham, Hall, Hart, Henry, Lamar, Lumpkin, Pickens, Pike, Polk, Rabun, Stephens, Towns, Union, and White.
Pre-Existing Conditions Are Covered
Pre-existing conditions are no longer excluded or considered when determining the premium of your policy. A prior lapse in coverage will also not impact your cost, although several restrictions and tax consequences apply if you miss Open Enrollment. “Special Enrollment Periods” (SEP) continue to be available if you lose existing qualified coverage through an employer, by moving to a different area, from a divorce, having a baby, and several other scenarios. If you do not qualify, an Off-Exchange short-term policy can purchased (more information below).
NOTE: If your employment situation changes, and your wages substantially increase (or decrease), a re-calculation of your subsidy is highly recommended. This can avoid a possible unexpected reduction in your tax refund, or a higher tax liability for the following calendar year. Remember – the federal subsidy is based on your projected household income the following year, not your income from the prior year. Also, if your household income substantially changes, adjusting your current subsidy may be needed to avoid paying a large tax bill, or unnecessarily overpaying each month for your policy.
Secondary policies can also be purchased privately. The best supplemental health insurance plans can help you pay for deductibles and other expected (or unexpected) expenses. These contracts are not subsidized, and are not designed to be primary coverage or replace a policy that provides primary benefits. They will simply assist you when you have high out-of-pocket costs from a covered claim on your Marketplace plan. Specific plans provide income for critical illnesses and diseases.
NOTE: Medicare supplement plans help Seniors reduce out-of-pocket expenses, but they are not eligible for federal subsidies, and are not impacted by the vast majority of the Affordable Care Act. The Open Enrollment period is also different as it runs between October 15th and December 7th. Many major carriers offer these plans.
Sample Subsidy Calculations
There’s also a good chance that you qualify for a federal subsidy that could drastically reduce your premium…or possibly pay all of it. This financial aid is solely based on your household income (modified adjusted gross income) and the number of dependents you declare on your tax return.
We can easily calculate your subsidy and we also included some examples below. Although amounts can vary, depending on your county of residence, for our examples, we used Fulton, Gwinnett, DeKalb, and Cobb counties. The amounts listed below are the monthly dollars that are provided to reduce the cost of your health insurance. In several situations, the total premium you pay will be $0.
$375 – 25 year-old with $20,000 income
$521 – 45 year-old with $25,000 income
$776 – 55 year-old with $30,000 income
$481 – 30 year-old couple with $65,000 income
$1,159 – 50 year-old couple with $50,000 income
$1,132 – 30 year-old couple with two children and $80,000 income
$1,515 – 50 year-old couple with two children and $85,000 income
$1,359 – 50 year-old couple with two children and $100,000 income
$1,421 – 60 year-old couple with $85,000 income
$1,787 – 60 year-old couple with $55,000 income
$2,078 – 62 year-old couple with one child and $80,000 income
How Do You View And Compare Rates?
That’s the easy part. The “Get Free Quotes” box at the top of the page allows you to view the most affordable medical plans in your area from the top-rated companies. It only takes a few moments and of course, at your request, we’ll help explain the differences in plans and which policies best suit your needs. If you wish to apply for a policy, the process is quick and easy.
Many Affordable Student Medical Plans Are Available
Comprehensive, catastrophic, short-term, HSA, high-deductible, self-employed and single-parent options are available. If you are eligible for Medicaid or Medicare, we’ll also show you the best choices from each of the major companies. A wide selection of low-cost GA student medical plans are available, regardless if you are considered full-time or part-time.
It makes financial sense to compare student Exchange policies to the University medical coverage that is offered. Typically, there are often huge differences in student pricing om plans purchased directly from the school. For example, although Kennesaw State and Emory have somewhat similar plans, Valdosta State and the University of Georgia student medical plans are much different.
Companies That Offer Health Insurance Coverage In Georgia
Exchange plans are offered by Ambetter (Peach State Health Plan), Blue Cross Blue Shield of Georgia, Kaiser Permanente, Oscar, Alliant, Aetna, UnitedHealthcare, Cigna, and CareSource. Since the first year of the Exchanges, many carriers have exited the Marketplace. Several of the larger companies that no longer offer coverage are Assurant, Harken, and Humana. However, off-Exchange and Group plan options are available through Aetna, Federated Mutual, Freedom Life, National Foundation Life, and many of the companies previously mentioned that offer on-Exchange coverage.
The variety of available carriers has helped to stabilize premiums by providing more competition. All carriers must be approved by the Georgia Department of Insurance. The Regulatory Services Division oversees the licensing of companies, and ensures they are following all regulations and legislation. All life and health contracts are reviewed. By July of each year, proposed rate increases of more than 10% must be submitted to the DOI for review and accountability. Consumers can review the reasons provided that justify the requested increase, along with the final increase that was granted.
However, all companies do not offer policies in every county. Although Blue Cross Blue Shield is represented in all parts of the state, there are pockets (especially in the southwestern portion) where the number of participating carriers has been very small. Some of these counties include Berrien, Brooks, Clinch, Cook Decatur, Early, Grady, Irwin, Lanier, Miller Seminole, Thomas and Turner. Prices for coverage in these counties (and others in the area) are the highest in the state. Anthem also offers medically-underwritten coverage to small groups and self-employed persons that work in the agriculture industry.
Network Availability
Although Anthem offers policies in all counties, their entire network that covers more than 95% of hospitals, is not necessarily available. The passage of the Affordable Care Act (ACA) legislation forced many carriers to offer thinner network coverage to help pay for guarantee-issue plans. Often, there are multiple networks, with a separate option for unsubsidized plans that are issued “off-Exchange.”
In Georgia, Anthem BCBS utilizes about half of its network capability. For example, Piedmont and Emory hospitals are considered “outside of the network,” and therefore will result in higher out-of-pocket costs for consumers. Also not available for network usage are these hospitals: Redmond Regional, Hamilton Medical, Fannin Regional, and Hutcheson Medical Center.
Last Year’s Marketplace Rate Change Requests
Aetna – 18.02% increase
Alliant Health Plans – 19.51% increase
Ambetter – 9.08% increase
Anthem BCBS – 17.69% increase
Bright Health – 5.86% increase
CareSource – 15.94% increase
Cigna – 1.10% increase
Kaiser – 6.51% increase
Oscar – 10.32% increase
UnitedHealthcare – 23.89% increase
Most Affordable Individual Georgia Health Insurance Plans (Under Age 65)
Catastrophic Tier
Kaiser Permanante KP GA Signature Catastrophic 9450 – $9,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. First three pcp and outpatient mental health care office visits are covered at 100%. Thereafter, the deductible applies.
Anthem Catastrophic Pathway X Guided Access HMO 9450 – $9,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $40 copay for first three pcp office visits, and then deductible applies.
Oscar Secure – $9,450 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. $0 copay for first three pcp office visits, and then deductible applies. Oscar Virtual Care visits covered with no charge.
Bronze Tier
CareSource Marketplace Bronze First – $7,500 deductible with maximum out-of-pocket expenses of $9,400 and 50% coinsurance. $50 and $100 copays on office visits. $25 generic drug copay ($62.50 mail order). $75 Urgent Care copay.
CareSource Marketplace HSA Eligible Bronze – HSA-eligible plan. $6,000 deductible with maximum out-of-pocket expenses of $7,200 and 60% coinsurance.
Ambetter Standard Expanded Bronze – $7,500 deductible with maximum out-of-pocket expenses of $9,400 and 50% coinsurance. $50 and $100 office visit copays with $75 Urgent Care copay. $25 Generic drug copays ($62.50 mail order). Diagnostic tests subject to coinsurance and deductible.
Ambetter Clear Bronze – 9,000 deductible with maximum out-of-pocket expenses of $9,000 and 0% coinsurance. Preferred generic and generic drug copays are $3 and $25 ($7.50 and $62.50 mail order).
Ambetter Everyday Bronze – $8,450 deductible with maximum out-of-pocket expenses of $9,250 and 50% coinsurance. $40 and $90 office visit copays with $50 Urgent Care copay. $3 preferred generic drug and $30 generic drug copays ($7.50 and $90 mail order). $50 copay for lab tests.
BCBSHP Anthem Bronze Pathway X Guided Access HMO 8000 – $8,000 deductible with maximum out-of-pocket expenses of $9,450 and 50% coinsurance. $85 Urgent Care copay. All non-preventive office visits and prescriptions must meet deductible.
BCBSHP Anthem Bronze Pathway X Guided Access HMO 7500/50% Standard – $7,500 deductible with maximum out-of-pocket expenses of $9,400 and 50% coinsurance. $50 and $100 office visit copays and $75 Urgent Care copay. $25 generic drug copay ($75 mail order).
BCBSHP Anthem Bronze Pathway X Guided Access HMO 5000 – $5,000 deductible with maximum out-of-pocket expenses of $9,450 and 30% coinsurance. $45 pcp office visit copay and $85 Urgent Care copay. $30 generic drug copay ($90 mail order).
BCBSHP Bronze Pathway X Guided Access HMO 0 For HSA – HSA-eligible plan with $7,450 deductible and maximum out-of-pocket expenses of $7,450 and 0% coinsurance.
Oscar Bronze Simple 2 – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Oscar Bronze Classic – PCP Saver Plus – $8,000 deductible with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $0 pcp office visit copay. $100 Urgent Care copay. Generic drug copays are $3 and $30 (Tiers 1A and 1B). Lab work copays are $25 and $75 (preferred and non-preferred).
Oscar Bronze Classic Standard – $7,500 deductible with maximum out-of-pocket expenses of $9,400 and 50% coinsurance. $50 and $100 office visit copays. $75 Urgent Care copay. Generic and preferred brand drug copays are $25 and $50. Non-preferred brand drug copay is $100.
Oscar Bronze Classic 4700 Plan – $4,700 deductible with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $70 and $125 office visit copays. $125 Urgent Care copay. Generic drug copays are $3 and $30 (Tiers 1A and 1B). Lab work copays are $25 and $70 (preferred and non-preferred).
Kaiser Permanente KP GA Signature Bronze 6500/40%/HSA – HSA-eligible plan with $6,500 deductible and maximum out-of-pocket expenses of $6,900 and 40% coinsurance.
Kaiser KP GA Signature Bronze Virtual Complete 5500/60 – $5,500 deductible with maximum out-of-pocket expenses of $9,100 and 30% coinsurance. $60 pcp office visit copay for first three visits. $30 generic drug copay ($60 mail order). $100 Urgent Care copay.
Kaiser KP GA Signature Standard Bronze 7500/50 – $7,500 deductible with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $50 and $100 office visit copays. $25 generic drug copay ($50 mail order). $75 Urgent Care copay.
Friday Health Plans Bronze Copay X – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance. $0 and $150 office visit copays and $175 Urgent Care copay. Generic and preferred brand drug copays are up to $30 and $160.
Friday Health Plans Standard Expanded Bronze X – $7,500 deductible with maximum out-of-pocket expenses of $9,000 and 50% coinsurance. $50 and $100 office visit copays and $75 Urgent Care copay. Generic and preferred brand drug copays are up to $25 and $50.
Friday Health Plans Bronze Basic – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Aetna CVS Bronze – $7,500 deductible with maximum out-of-pocket expenses of $9,000 and 50% coinsurance. $50 and $100 office visit copays and $75 Urgent Care copay. Generic drug copays are up to $25 and $62.50 (Mail order).
Cigna Connect 9100 – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Cigna Simple Choice – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Cigna Connect 7800 – $7,800 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance. $50 pcp office visit copay. Preferred generic drug copay is $3 ($9 mail order).
Cigna Connect 6500 – $6,500 deductible with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $50 and $100 office visit copays. Preferred generic drug copay is $3 ($9 mail order).
Cigna Simple Choice 7500 – $6,500 deductible with maximum out-of-pocket expenses of $9,100 and 50% coinsurance. $50 and $100 office visit copays. $75 Urgent Care copay. Generic drug copay is $25 ($75 mail order).
UnitedHealthcare Bronze Standard $9,100 Deductible – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Alliant SoloCare HMO Bronze Standardized – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance.
Alliant SoloCare HMO Bronze Standardized 110027-01 – $9,100 deductible with maximum out-of-pocket expenses of $9,100 and 0% coinsurance. $50 and $100 office visit copays. $75 Urgent Care copay. Generic drug copay is $25.
Silver Tier
Ambetter Clear Wellstar Select Silver – $5,400 deductible with maximum out-of-pocket expenses of $5,400 and 0% coinsurance.
Ambetter CMS Standard Select – $5,800 deductible with maximum out-of-pocket expenses of $8,900 and 40% coinsurance. $40 and $80 copays on office visits with $60 Urgent Care copay. $20 and $40 copays on generic and preferred brand drugs ($50 and $100 mail order copays).
Ambetter Focused Wellstar Select Silver – $6,100 deductible with maximum out-of-pocket expenses of $7,500 and 50% coinsurance. $45 and $100 copays on office visits with $60 Urgent Care copay. $50 copay for diagnostic tests. $5 and $25 copays on generic and preferred generic drugs ($12.50 and $62.50 mail order copays). Preferred brand drug copays are $75 and $187.50 (mail order).
Kaiser KP GA Signature Silver Virtual Complete 4800/40 – $4,800 deductible with maximum out-of-pocket expenses of $8,500 and 30% coinsurance. Pcp office visit copay of $40 for first three visits, with $80 copay for Urgent Care. Generic drug copays are $15 and $30 (mail-order). No charge for lab tests.
Kaiser KP GA Signature Silver 5800/40 – $5,800 deductible with maximum out-of-pocket expenses of $8,900 and 40% coinsurance. $40 and $80 office visit copays with $60 copay for Urgent Care. Generic drug copays are $20 and $40 (mail-order). Preferred brand drug copays are $40 and $80 (mail order).
Kaiser GA Signature Silver 3500/20%/HSA – HSA-eligible with $3,500 deductible, $6,500 maximum out-of-pocket expenses, and 20% coinsurance.
Kaiser KP GA Signature Silver 4500/35 – $4,500 deductible with maximum out-of-pocket expenses of $8,150 and 35% coinsurance. Office visit copays are $35 and $65, with $65 copay for Urgent Care. Generic drug copays are $15 and $30 (mail-order). Preferred brand drug copays are $50 and $100 (mail order).
BCBSHP Silver Pathway X Guided Access HMO 6500 – $6,500 deductible with maximum out-of-pocket expenses of $9,100 and 20% coinsurance. $25 and $75 office visit copays. $3 copay for generic drugs, and a $40 copay for preferred brand drugs ($9 and $120 mail-order copays). $75 Urgent Care copay.
BCBSHP Silver Pathway X Guided Access HMO 3000 – $3,000 deductible with maximum out-of-pocket expenses of $9,100 and 25% coinsurance. $20 pcp office visit copay and $50 Urgent Care copay. Deductible and coinsurance applies to prescription drugs. $50 Urgent Care copay.
BCBSHP Silver Pathway X Guided Access HMO 5500 – $5,500 deductible with maximum out-of-pocket expenses of $9,100 and 25% coinsurance. $20 and $80 office visit copays. $3 copay for generic drugs, and a $40 copay for preferred brand drugs ($9 and $120 mail-order copays). $50 Urgent Care copay.
BCBSHP Silver Pathway X Guided Access HMO 5800/40% Standard – $5,800 deductible with maximum out-of-pocket expenses of $8,900 and 40% coinsurance. $40 and $80 office visit copays. $20 copay for generic drugs, and a $40 copay for preferred brand drugs ($60 and $120 mail-order copays). $60 Urgent Care copay.
BCBSHP Silver Pathway X Guided Access HMO 4950 – $4,950 deductible with maximum out-of-pocket expenses of $9,100 and 25% coinsurance. $20 and $80 office visit copays. $3 copay for generic drugs, and a $40 copay for preferred brand drugs ($9 and $120 mail-order copays). $50 Urgent Care copay.
BCBSHP Silver Pathway X Guided Access HMO 2600 – $2,600 deductible with maximum out-of-pocket expenses of $9,100 and 30% coinsurance. $0 pcp office visit copay and $50 Urgent Care copay. $20 copay for generic drugs, and a $50 copay for preferred brand and non-preferred generic drugs ($60 and $150 mail-order copays).
Alliant Solocare Silver No Referral HMO – $7,000 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. Office visit copays of $85 and $120 with $75 Urgent Care copay. No charge for first three pcp visits. The generic, preferred brand and non-preferred brand prescription drug copays are $20, $65, and $165.
Alliant Solocare Silver No Referral HMO – $6,000 deductible with maximum out-of-pocket expenses of $8,550 and 40% coinsurance. Office visit copays of $30 and $60 with $75 Urgent Care copay. No charge for first three pcp visits. The generic, preferred brand and non-preferred brand prescription drug copays are $20, $55, and $150.
CareSource Marketplace Low Premium Silver – $6,500 deductible with maximum out-of-pocket expenses of $8,700 and 30% coinsurance. Office visit copays of $30 and $70 with $75 Urgent Care copay. The low-cost and preferred brand prescription drug copays are $20 and $50 ($50 and $125 mail order). $200 copay (after deductible) for x-rays.
CareSource Marketplace Standard Silver – $5,800 deductible with maximum out-of-pocket expenses of $7,900 and 20% coinsurance. Office visit copays of $25 and $60 with $75 Urgent Care copay. The low-cost and preferred brand prescription drug copays are $20 and $50 ($50 and $125 mail order). $200 copay (after deductible) for x-rays.
Oscar Silver Simple – PCP Saver – $5,000 deductible with maximum out-of-pocket expenses of $8,375 and 40% coinsurance. Pcp office visit copay of $20 with $75 Urgent Care copay. The generic prescription drug copays are $3 and $20 (1A and 1B). $10 copay for lab work.
Oscar Silver Simple – $4,200 deductible with maximum out-of-pocket expenses of $8,700 and 50% coinsurance. Pcp office visit copay of $25 with $75 Urgent Care copay. The generic prescription drug copays are $3 and $20 (1A and 1B). $10 copay for lab work.
Aetna Silver $25 copay 6000 – $6,000 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. $25 and $75 copays on office visits with $75 Urgent Care copay. $15 and $50 copays on preferred generic and preferred brand drugs ($45 and $150 mail order copays). Preferred generic drug copays are $5 and $12.50 (mail order).
Bright Health – $4,000 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. Pcp office visit copay of $35 with $50 Urgent Care copay. The preferred generic drug copay is $15.
Cigna Connect 6000 – $6,000 deductible with maximum out-of-pocket expenses of $8,700 and 40% coinsurance. $30 and $80 copays on office visits with $50 Urgent Care copay. $2 and $25 copays on preferred generic and generic drugs ($9 and $75 mail order copays). Preferred brand drug copays are $50 and $150 (mail order).
Friday Health Plans Silver – $5,500 deductible with maximum out-of-pocket expenses of $8,700 and 20% coinsurance. $0 generic drug copay.
Gold Tier
Ambetter Secure Care 5 – $1,450 deductible with maximum out-of-pocket expenses of $6,300 and 30% coinsurance. $15 and $35 office visit copays. The Urgent Care copay is $35. $15 copay for test for lab and outpatient professional services. Generic and preferred brand drug copays are $15 and $30. The 90-day mail-order copays are $37.50 and $75.
Kaiser KP GA Gold 1700/25 – $1,700 deductible with maximum out-of-pocket expenses of $8,500 and 30% coinsurance. Office visit copays are $25 and $55, with $75 copay for Urgent Care. Generic drug copays are $15 and $30 (mail-order).
Kaiser KP GA Gold 1500/20 – $1,500 deductible with maximum out-of-pocket expenses of $6,500 and 30% coinsurance. Office visit copays are $20 and $40, with $75 copay for Urgent Care. Generic drug copays are $10 and $20 (mail-order).
BCBSHP Gold Pathway X Guided Access HMO 1850 – $1,850 deductible with maximum out-of-pocket expenses of $8,550 and 10% coinsurance. Office visit copays are $30 and $60. $50 Urgent Care copay. Also, $10 copay for generic drugs and $40 copay for preferred brand and non-preferred generic drugs. Mail-order copays are $30 (generic) and $120 (preferred and non-preferred brand).
CareSource Marketplace Gold – $2,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Office visit copays of $10 and $45 with $75 Urgent Care copay. The low-cost and preferred brand prescription drug copays are $15 and $50 ($37.50 and $125 mail order).
Alliant Solocare Gold PPO 40002 – $2,300 deductible with maximum out-of-pocket expenses of $8,550 and 20% coinsurance. Office visit copays of $20 and $40 with $75 Urgent Care copay. The generic, preferred brand, and non-preferred generic prescription drug copays are $15, $50, and $150.
Oscar Gold Classic Plan – $2,500 deductible with maximum out-of-pocket expenses of $6,000 and 30% coinsurance. Office visit copays of $30 and $55 with $75 Urgent Care copay. The generic and preferred brand prescription drug copays are $3 and $55 ($7.50 and $138.50 mail order).
Sample Georgia Health Insurance Rates (Monthly Rates)
30-Year-Old Fulton County $34,000 Household Income
$44 – Kaiser GA Signature Bronze 5000/50
$44 – Kaiser GA Signature Bronze 6500/40%/HSA
$51 – Ambetter Essential Care 1
$53 – CareSource Marketplace Bronze
$126 – Anthem Silver Pathway X Guided Access HMO 6750
30-Year-Old Married Couple Fulton County $52,000 Household Income
$85 – Kaiser GA Signature Bronze 5000/50
$85 – Kaiser GA Signature Bronze 6500/40%/HSA
$100 – Ambetter Essential Care 1
$104 – CareSource Marketplace Bronze
$249 – Anthem Silver Pathway X Guided Access HMO 6750
40-Year-Old Gwinnett County $38,000 Household Income
$88 – Kaiser GA Signature Bronze 5000/50
$88 – Kaiser GA Signature Bronze 6500/40%/HSA
$96 – Ambetter Essential Care 1
$98 – CareSource Marketplace Bronze
$180 – Anthem Silver Pathway X Guided Access HMO 6750
40-Year-Old Married Couple With One Child Gwinnett County $70,000 Household Income
$124 – Kaiser GA Signature Bronze 5000/50
$124 – Kaiser GA Signature Bronze 6500/40%/HSA
$146 – Ambetter Essential Care 1
$152 – CareSource Marketplace Bronze
$364 – Anthem Silver Pathway X Guided Access HMO 6750
50-Year-Old Cobb County $44,000 Household Income
$122 – Kaiser GA Signature Bronze 5000/50
$122 – Kaiser GA Signature Bronze 6500/40%/HSA
$134 – Ambetter Essential Care 1
$137 – CareSource Marketplace Bronze
$251 – Anthem Silver Pathway X Guided Access HMO 6750
50-Year-Old Married Couple With Two Children Cobb County $87,000 Household Income
$96 – Kaiser GA Signature Bronze 5000/50
$96 – Kaiser GA Signature Bronze 6500/40%/HSA
$129 – Ambetter Essential Care 1
$139 – CareSource Marketplace Bronze
$465 – Anthem Silver Pathway X Guided Access HMO 6750
60-Year-Old DeKalb County $50,000 Household Income
$134 – Kaiser GA Signature Bronze 5000/50
$134 – Kaiser GA Signature Bronze 6500/40%/HSA
$152 – Ambetter Essential Care 1
$157 – CareSource Marketplace Bronze
$197 – Anthem Silver Pathway X Guided Access HMO 6750
60-Year-Old Married Couple DeKalb County $75,000 Household Income
$108 – Kaiser GA Signature Bronze 5000/50
$108 – Kaiser GA Signature Bronze 6500/40%/HSA
$144 – Ambetter Essential Care 1
$154 – CareSource Marketplace Bronze
$234 – Anthem Silver Pathway X Guided Access HMO 6750
What About PeachCare?
In 1999, PeachCare for Kids began offering quality medical coverage to children under the age of 18 that did not qualify for Medicaid benefits. If household income is below 247% of the Federal Poverty Level, typically, a child is eligible, although a full determination must be made. Income will be verified before coverage is offered. A CMO (see below) is offered for assistance. The four available company options are CareSource, Amerigroup Community Care, WellCare, and Peach State Health Plan.
Comprehensive benefits include office visits, prescriptions, preventive (including annual physicals and immunizations), mental healthcare, emergency-room treatment, visits to specialists, along with dental and vision benefits. There is a wide selection of primary care providers available and the Georgia Department of Community Health will help as a liaison.
Coverage is free for anyone under age six. The monthly rate increases to $0-36 for children age 6 or older. For households with two or more children, the monthly rate is dependent on household income, and will be no more than $72 per month. Copays are extremely low, typically either $2 or $3. The maximum copay is $12.50. Preventive and emergency treatment, immunizations, and routine and preventative diagnostic dental services do not require any copay or coinsurance. The maximum out-of-pocket expense in a year is 5% of your household income. If reached, your premium payments, along with copays, are waived. Children in foster care also do not have to pay copays.
If a premium payment is not received by the due date, benefits will continue for up to two months. You can apply for reinstatement the following month. You can also cancel your policy by the 15th of the month the bill is due to be paid.
All applicants must be US citizens and legal residents of the state of Georgia. There also must not be any current coverage in force (including Medicaid). Maximum household income limits are shown below:
1-Person Household – $33,568
2-Person Household – $45,226
3-Person Household – $56,885
4-Person Household – $68,543
5-Person Household – $80,201
6-Person Household – $91,960
What Is The SHBP?
The “SHBP” is the Georgia State Health Benefit Plan, which provides healthcare benefits to more than 600,000 retired and active state teachers and other employees. There are actually three separate contract plans and they are “Public School Employees,” “Teachers,” and “State Employees.” Since it is self-funded and also self-insured, companies and members pay premiums that are used to disperse benefits. Eligible applicants include annuitants, general assembly, public school employees, teachers, state employees, former employees, and eligible dependents. Note:
Working employees that are not Medicare-eligible can consider Health Reimbursement Arrangement contracts in Gold, Silver, or Bronze tiers. Initially, when the account is opened, some “spending dollars” will be transferred to the account. Popular low-cost Medicare Advantage options are also offered to former employees that have reached age 65. Rates are typically less than conventional Medigap Supplement plans, and often, Part D prescription coverage is included. The three HMO options are Kaiser Regional HMO, UnitedHealthcare Statewide HMO, and BCBS Statewide HMO.
The three major companies that offer coverage are Blue Cross and Blue Shield of Georgia, UnitedHealthcare and Kaiser Permanente.
Blue Cross and UnitedHealthcare also offer Medicare Advantage plans to anyone who is retired. “Standard” and “Premium” plans are available. Of course, you must be enrolled in Medicare to be eligible for Advantage benefits. UnitedHealthcare offers an HDHP option. The available plans are UHC Standard, UHC Premium, BCBS Standard, and BCBS Premium. Under age-65 plan options include BCBS Gold, BCBS Silver, and BCBS Bronze, which are HRA plans. The three available HMO plans are BCBS Statewide, UHC Statewide, and Kaiser Regional. The only HDHP plan offered is from UHC.
Georgia SHBP Provides Quality Healthcare To Teachers
Open Enrollment is offered to eligible employees, former employees, applicants eligible for COBRA, and workers that are on an approved leave without pay. Retired persons must be enrolled in a specific plan immediately before they terminate work. Retirees not participating in a plan must choose coverage the year before they retire during an OE period. Dependents and spouses of retirees can not enroll during these periods. Also, if retired benefits terminate, reinstatement of the policy is not possible unless they return to work for the employer.
Rates have been fairly stable in recent years, with no major price increases. Most SHBP members are quite satisfied with the increase in carriers that are offering plans, compared to only one company (BCBS) four years ago.
Off-Exchange Plans (Under Age 65)
Purchasing a policy “off-Exchange” means that the government website is completely bypassed and no federal subsidy will be paid. Naturally, if your household income is less than 250% of the Federal Poverty Level (FPL), this concept may not be very cost-effective. Although you are not required to accept a federal subsidy (if eligible), there is no advantage to not utilizing the funds.
However, if your income is high enough that a subsidy is not available, these types of plans are occasionally slightly less expensive than the “on-Marketplace” policies that they mirror. Also, the provider network may be larger and more robust, giving you more facilities to choose from. Since each situation is unique, comparing both options is most prudent, especially if you’re not familiar with contract benefits. Also, if expensive out-of-state treatment is required, these options should be studied.
Health Insurance Section 1332 Waiver Suspended
Two years ago, CMS (Centers for Medicare and Medicaid Services) suspended a portion of the state’s approved waiver. The Georgia Access Model (second part of waiver) was suspended while the first portion (state-based reinsurance program) is not impacted. It is possible that for plan years 2025 through 2026, the waiver could be reinstated, depending on the state’s response to recommended changes. Another option for the state is to sue the federal government.
Georgia Senior Health Insurance – Medicare Supplement, Prescription Drug (Part D), And Medicare Advantage Plans
Medicare Supplement plans are offered by many major companies. Ten policy options are available, with Plan F offering the most comprehensive coverage. An alternative “High Deductible” Plan F (G-HD for new enrollments) is also available. You must be enrolled in Parts A and B to qualify for a Medigap (Supplement) policy. If you are buying a policy after Open Enrollment ends, medical underwriting may apply. Shown below are current estimated monthly rates for popular plans in the largest counties in Georgia. Prices are based on a non-smoking 65 year-old male.
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan A
$106 – Accendo
$114 – Aetna
$114 – AARP-UnitedHealthcare
$114 – Anthem BCBS
$123 – Mutual Of Omaha
$126 – Elips Life
$126 – Medico
$131 – Philadelphia Life
$135 – Manhattan Life
$135 – United States Fire
$138 – Great Southern Life
$140 – Capitol Life
$142 – Humana
$145 – National Health
$146 – Union Security
$155 – GPM Health
$156 – Central States
$166 – United American
$203 – Cigna
$266 – Assured Life
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan C
$159 – Philadelphia American
$210 – AARP-UnitedHealthcare
$302 – United American
$379 – Assured Life
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan F (High Deductible)
$43 – Medico
$48 – United American
$50 – Bankers Fidelity
$53 – Great Southern Life
$53 – Cigna
$54 – Philadelphia American
$58 – National Health
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan F
$143 – Medico
$151 – Accendo
$152 – Elips Life
$160 – Central States
$161 – Aetna
$164 – United States Fire
$165 – Humana
$166 – Manhattan Life
$169 – Great Southern Life
$169 – Capitol Life
$174 – Union Security
$180 – Mutual Of Omaha
$185 – National Health
$197 – Philadelphia American
$205 – Anthem BCBS
$211 – AARP-UnitedHealthcare
$219 – Guarantee Trust Life
$223 – GPM Health
$245 – Cigna
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan G (High Deductible)
$41 – Medico
$48 – United American
$48 – Aetna
$49 – Philadelphia American
$50 – United States Fire
$51 – Elips Life
$52 – Humana
$53 – Mutual Of Omaha
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan G
$118 – Medico
$127 – Elips Life
$128 – AARP-UnitedHealthcare
$129 – Anthem BCBS
$132 – Mutual Of Omaha
$134 – Accendo
$135 – United State Fire
$141 – Humana
$141 – Capitol Life
$142 – Union Security
$143 – Manhattan Life
$143 – Aetna
$143 – Great Southern Life
$145 – Philadelphia American
$152 – National Health
$152 – Bankers Fidelity
$155 – GPM Health
$194 – Cigna
$281 – United American
$292 – Assured Life
Fulton, Lamar, Clayton, Meriwether, Fayette, and Pike Counties Plan N
$107 – CSI Life
$109 – Aetna
$110 – Union Security
$111 – Assured Life
$111 – Anthem BCBS
$115 – Western United Life
$115 – Guarantee Trust Life
$117 – Lumico Life
$118 – Mutual Of Omaha
$120 – Humana
$121 – Thrivent
$123 – AARP-UnitedHealthcare
$127 – Greek Catholic Union
$129 – Great Southern Life
$139 – New Era Life
$141 – Cigna
Gwinnett, Barrow, Rockdale, Newton, Walton, and Cobb Counties Plan C
$172 – Western United Life
$200 – AARP-UnitedHealthcare
$348 – Assured Life
Gwinnett, Barrow, Rockdale, Newton, and Cobb Counties Plan F (High Deductible)
$57 – Philadelphia American
$57 – Cigna
$60 – Great Southern Life
$55 – Humana
$64 – American Continental Life
Gwinnett, Barrow, Rockdale, Newton, and Cobb Counties Plan F
$160 – Aetna
$167 – Humana
$171 – Western United Life
$174 – Lumico Life
$177 – Anthem BCBS
$179 – Philadelphia American
$180 – Union Security
$183 – Thrivent
$186 – Great Southern Life
$189 – Mutual Of Omaha
$210 – CSI Life
$235 – Cigna
$239 – Oxford Life
$292 – United American
$357 – Gerber
Gwinnett, Barrow, Rockdale, Newton, and Cobb Counties Plan G
$120 – Anthem BCBS
$122 – AARP-UnitedHealthcare
$132 – Western United Life
$136 – Lumico Life
$142 – Aetna
$142 – Humana
$144 – Mutual Of Omaha
$146 – CSI Life
$147 – Union Security
$148 – Thrivent
$150 – Great Southern Life
$154 – Philadelphia American
$177 – Oxford Life
Gwinnett, Barrow, Rockdale, Newton, and Cobb Counties Plan N
$89 – Accendo
$89 – Union Security
$89 – Aetna
$98 – Thrivent
$99 – Lumico Life
$100 – Great Southern Life
$104 – Mutual Of Omaha
$106 – Humana
$107 – Western United Life
$108 – CSI Life
$108 – AARP-UnitedHealthcare
$110 – Philadelphia American
$111 – Assured Life
$111 – Anthem BCBS
$189 – Oxford Life
Chatham, McIntosh, Effingham, and Liberty Counties Plan B
$109 – Aetna
$167 – AARP-UnitedHealthcare
$279 – Assured Life
Chatham, McIntosh, Effingham, and Liberty Counties Plan C
$160 – Western United Life
$200 – AARP-UnitedHealthcare
$348 – Assured Life
Chatham, McIntosh, Effingham, and Liberty Counties Plan F (High Deductible)
$44 – Cigna
$47 – Great Southern Life
$54 – Philadelphia American
Chatham, McIntosh, Effingham, and Liberty Counties Plan F
$131 – Accendo
$132 – Aetna
$144 – Great Southern Life
$145 – Union Security
$147 – Humana
$152 – Lumico Life
$159 – Western United Life
$162 – Thrivent
$166 – Mutual Of Omaha
$177 – Anthem BCBS
$181 – Philadelphia American
$181 – Cigna
$196 – Guarantee Trust Life
$279 – Oxford Life
Chatham, McIntosh, Effingham, and Liberty Counties Plan G (High Deductible)
$43 – Aetna
$45 – United States Fire
$49 – Humana
$49 – Philadelphia American
$51 – Mutual Of Omaha
Chatham, McIntosh, Effingham, and Liberty Counties Plan G
$116 – Accendo
$117 – Great Southern Life
$117 – Aetna
$119 – Union Security
$120 – Anthem BCBS
$122 – AARP-UnitedHealthcare
$123 – Western United Life
$125 – Humana
$127 – Mutual Of Omaha
$127 – Lumico Life
$131 – Thrivent
$143 – Cigna
$145 – Philadelphia American
$177 – Oxford Life
Chatham, McIntosh, Effingham, and Liberty Counties Plan N
$89 – Capitol Life
$89 – Accendo
$89 – Union Security
$89 – Aetna
$95 – Lumico Life
$96 – Great Southern Life
$96 – United States Fire
$98 – Thrivent
$104 – Mutual Of Omaha
$108 – AARP-UnitedHealthcare
$110 – Philadelphia American
$111 – Assured Life
$111 – Anthem BCBS
$112 – Humana
$118 – Cigna
$120 – Guarantee Trust Life
$189 – Oxford Life
Cherokee, Cobb, Douglas, Paulding, Polk, and Carroll Counties Plan C
$192 – AARP-UnitedHealthcare
$199 – New Era Life
$221 – Central States
$235 – Humana
$285 – United American
Cherokee, Cobb, Douglas, Paulding, Polk, and Carroll Counties Plan F (High Deductible)
$48 – United American
$57 – Philadelphia American
$57 – Cigna
$59 – Mutual Of Omaha
$59 – Humana
$72 – Aetna
Cherokee, Cobb, Douglas, Paulding, Polk, and Carroll Counties Plan F
$170 – Philadelphia American
$178 – Humana
$179 – Pekin Life
$180 – Manhattan Life
$183 – Shenandoah Life
$186 – Combined Insurance
$187 – Greek Catholic Union
$191 – Cigna
$193 – AARP-UnitedHealthcare
$193 – Companion Life
$199 – Aetna
$202 – Combined Insurance
$203 – Mutual Of Omaha
$211 – Equitable
$218 – CSI Life
$229 – Central States
$251 – American Retirement Life
$295 – United American
$358 – Gerber
Cherokee, Cobb, Douglas, Paulding, Polk, and Carroll Counties Plan G
$125 – AARP-UnitedHealthcare
$126 – Western United Life
$134 – Shenandoah Life
$134 – Guarantee Trust Life
$136 – Philadelphia American Life
$139 – Thrivent
$143 – American Continental
$144 – Humana
$147 – Pekin Life
$149 – Liberty Bankers Life
$151 – Mutual Of Omaha
$153 – Companion Life
$155 – Combined Insurance
$156 – Greek Catholic Union
$156 – Transamerica
$157 – Cigna
$160 -CSI Life
$171 – Equitable Life
$174 – Central States
$195 – American Retirement Life
$270 – United American
$299 – Gerber
Cherokee, Cobb, Douglas, Paulding, Polk, and Carroll Counties Plan N
$109 – Western United Life
$111 – Shenandoah Life
$112 – Guarantee Trust Life
$116 – Humana
$118 – American Continental
$118 – Thrivent
$119 – Mutual Of Omaha
$122 – Pekin Life
$122 – AARP-UnitedHealthcare
$127 – Greek Catholic Union
$128 – CSI Life
$128 – Liberty Bankers Life
$129 – New Era Life
$134 – Cigna
$134 – Transamerica
$142 – Central States
$146 – Equitable life
$149 – American Retirement Life
$150 – Combined Insurance
$212 – United American
Georgia Medicare Advantage Plans
Medicare Advantage contracts typically are less expensive than Supplement plans. A private insurer provides basic Medicare coverage, along with several additional benefits. Many plans include prescription drug coverage. We have listed below policy options (with Rx benefits) from major carriers. Not all plans are offered in each county. Rates will also vary, depending upon your county of residence.
The counties that offer the most 2024 plan options are:
94 – DeKalb County
94 – Henry County
94 – Fulton County
93 – Clayton County
92 – Gwinnett County
91 – Forsyth County
89 – Fayette County
89 – Rockdale County
88 – Walton County
86 – Douglas County
86 – Cobb County
86 – Barrow County
AARP Medicare Advantage Walgreens From UHC (HMO) – $0 deductible with maximum out-of-pocket expenses of $6,300. Office visit copays are $0 and $0-$35, and the urgent care and ER copays are $0-$40 and $120. Diagnostic tests and procedures are subject to a $45 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $335 copay for 6 days, and outpatient hospital coverage is subject to a $0-$335 copay. The rehabilitation services copay is $0-$30. Ground ambulance copay is $275.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3) $95 (Tier 4), and 33% (Tier 5). Monthly premium is $0.
AARP Medicare Advantage From UHC GA-004 (PPO) – $395 deductible with maximum out-of-pocket expenses of $7,550. Office visit copays are $0 and $0-$45, and the urgent care and ER copays are $0-$40 and $100. Diagnostic tests and procedures are subject to a $40 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $395 copay for 5 days, and outpatient hospital coverage is subject to a $0-$395 copay. The rehabilitation services copay is $0-$25. Monthly premium is $0. Ground ambulance copay is $290.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $14 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 27% (Tier 5). Monthly premium is $0.
AARP Medicare Advantage Plus Plan 1 (HMO-POS) – $0 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $45, and the urgent care and ER copays are $30-$40 and $90. Diagnostic tests and procedures are subject to a $20 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $370 copay for 5 days, and outpatient hospital coverage is subject to a $0-$370 copay. The rehabilitation services copay is $40. Monthly premium is $0.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $14 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 33% (Tier 5).
AARP Medicare Advantage Plus Plan 2 (HMO-POS) – $0 deductible with maximum out-of-pocket expenses of $4,900. Office visit copays are $0 and $30, and the urgent care and ER copays are $40 and $90. Diagnostic tests and procedures are subject to a $20 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $265 copay for 7 days, and outpatient hospital coverage is subject to a $0-$265 copay. The rehabilitation services copay is $30.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 33% (Tier 5). Monthly premium is $32.
Aetna Medicare Essential Plan (PPO) – $0 deductible with maximum out-of-pocket expenses of $6,900. Office visit copays are $0 and $40, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$95 copay and lab services are subject to a $0-$15 copay. Inpatient hospital coverage has a $298 copay for 7 days, and outpatient hospital coverage is subject to a $0-$298 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 29% (Tier 5).
Aetna Medicare Plus Plan (PPO) – $0 deductible with maximum out-of-pocket expenses of $7,550. Office visit copays are $10 and $45, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$50 copay and lab services are subject to a $0-$25 copay. Inpatient hospital coverage has a $450 copay for 4 days, and outpatient hospital coverage is subject to a $0-$275 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 26% (Tier 5).
Aetna Medicare Freedom Plan (PPO) – $150 deductible with maximum out-of-pocket expenses of $7,000. Office visit copays are $5 and $35, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$95 copay and lab services are subject to a $0-$20 copay. Inpatient hospital coverage has a $375 copay for 5 days, and outpatient hospital coverage is subject to a $0-$295 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 30% (Tier 5).
Aetna Medicare Advantra Preferred (PPO) – $195 deductible with maximum out-of-pocket expenses of $7,550. Office visit copays are $5 and $45, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$95 copay and lab services are subject to a $0-$20 copay. Inpatient hospital coverage has a $298 copay for 7 days, and outpatient hospital coverage is subject to a $0-$225 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 29% (Tier 5).
Allwell Medicare – $0 deductible with maximum out-of-pocket expenses of $5,900. Office visit copays are $0 and $40, and the urgent care and ER copays are $40 and $90. Diagnostic tests and procedures are subject to a $40 copay and lab services are subject to a $0-$30 copay. Inpatient hospital coverage has a $295 copay for 6 days, and outpatient hospital coverage is subject to a $295 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $7 (Tier 2), $37 (Tier 3) $100 (Tier 4), and 27% (Tier 5).
Allwell Medicare Premier – $0 deductible with maximum out-of-pocket expenses of $6,500. Office visit copays are $10 and $40, and the urgent care and ER copays are $40 and $90. Diagnostic tests and procedures are subject to a $40 copay and lab services are subject to a $0-$20 copay. Inpatient hospital coverage has a $350 copay for 5 days, and outpatient hospital coverage is subject to a $350 copay.
Preferred pharmacy cost-sharing copays are $5 (Tier 1), $15 (Tier 2), $37 (Tier 3) $86 (Tier 4), and 33% (Tier 5).
Anthem MediBlue Access Basic – $0 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $10 and $40, and the urgent care and ER copays are $35 and $90. Diagnostic tests and procedures are subject to a $0-$140 copay and lab services are subject to a $0-$20 copay. Inpatient hospital coverage has a $393 copay for 5 days, and outpatient hospital coverage is subject to a $0-$285 copay.
Preferred pharmacy cost-sharing copays are $4 (Tier 1), $13 (Tier 2), $42 (Tier 3) $95 (Tier 4), and 30% (Tier 5).
Anthem MediBlue Access Plus – $150 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $45, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$175 copay and lab services are subject to a $0-$25 copay. Inpatient hospital coverage has a $295 copay for 7 days, and outpatient hospital coverage is subject to a $0 or 20% copay.
Preferred pharmacy cost-sharing copays are $4 (Tier 1), $11 (Tier 2), $42 (Tier 3) $95 (Tier 4), and 30% (Tier 5).
Anthem MediBlue Plus – $150 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $45, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$175 copay and lab services are subject to a $0-$25 copay. Inpatient hospital coverage has a $295 copay for 7 days, and outpatient hospital coverage is subject to a $0 or 20% copay.
Preferred pharmacy cost-sharing copays are $4 (Tier 1), $11 (Tier 2), $42 (Tier 3) $95 (Tier 4), and 30% (Tier 5).
Cigna HealthSpring Preferred – $0 deductible with maximum out-of-pocket expenses of $5,900. Office visit copays are $0 and $30, and the urgent care and ER copays are $30 and $90. Diagnostic tests and procedures are subject to a $0-$95 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $275 copay for 6 days, and outpatient hospital coverage is subject to a $0-$250 copay.
Preferred pharmacy cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $42 (Tier 3) $95 (Tier 4), and 33% (Tier 5).
Cigna HealthSpring Preferred GA – $0 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $35, and the urgent care and ER copays are $50 and $90. Diagnostic tests and procedures are subject to a $0-$225 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $330 copay for 5 days, and outpatient hospital coverage is subject to a $0-$325 copay.
Preferred pharmacy cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $42 (Tier 3) 50% (Tier 4), and 27% (Tier 5).
Cigna HealthSpring True Choice – $300 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $35, and the urgent care and ER copays are $55 and $90. Diagnostic tests and procedures are subject to a $0-$95 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $290 copay for 6 days, and outpatient hospital coverage is subject to a $0-$275 copay.
Preferred pharmacy cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $42 (Tier 3) 50% (Tier 4), and 27% (Tier 5).
HumanaChoice (PPO) – $400 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $20 and $50, and the urgent care and ER copays are $20-$50 and $90. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $0-$50 copay. Inpatient hospital coverage has a $450 copay for 4 days, and outpatient hospital coverage is subject to a $50-$450 copay.
Preferred pharmacy cost-sharing copays are $5 (Tier 1), $15 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 25% (Tier 5).
Humana Gold Plus – $0 deductible with maximum out-of-pocket expenses of $5,900. Office visit copays are $0 and $10-$40, and the urgent care and ER copays are $0-$40 and $90. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $0-$45 copay. Inpatient hospital coverage has a $298 copay for 7 days, and outpatient hospital coverage is subject to a $40-$345 copay.
Preferred pharmacy cost-sharing copays are $4 (Tier 1), $12 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 33% (Tier 5).
Humana Gold Choice – $340 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $15 and $50, and the urgent care and ER copays are $15-$50 and $90. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $0-$50 copay. Inpatient hospital coverage has a $390 copay for 5 days, and outpatient hospital coverage is subject to a $50-$395 copay.
Preferred pharmacy cost-sharing copays are $7 (Tier 1), $17 (Tier 2), $47 (Tier 3) $100 (Tier 4), and 26% (Tier 5).
WellCare Dividend – $0 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $50, and the urgent care and ER copays are $40 and $90. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $475 copay for 4 days, and outpatient hospital coverage is subject to a $350 copay.
Preferred pharmacy cost-sharing copays are $4 (Tier 1), $15 (Tier 2), $47 (Tier 3) 45% (Tier 4), and 29% (Tier 5).
WellCare Value – $0 deductible with maximum out-of-pocket expenses of $3,400. Office visit copays are $0 and $40, and the urgent care and ER copays are $25 and $120. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $20 copay. Inpatient hospital coverage has a $340 copay for 8 days, and outpatient hospital coverage is subject to a $225- $300 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $10 (Tier 2), 44% (Tier 3) 45% (Tier 4), and 33% (Tier 5).
WellCare Premier – $75 deductible with maximum out-of-pocket expenses of $5,500. Office visit copays are $5 and $40, and the urgent care and ER copays are $30 and $90. Diagnostic tests and procedures are subject to a $0-$100 copay and lab services are subject to a $0 copay. Inpatient hospital coverage has a $300 copay for 5 days, and outpatient hospital coverage is subject to a $300-$325 copay.
Preferred pharmacy cost-sharing copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3) 45% (Tier 4), and 31% (Tier 5).
Georgia Part D Prescription Drug Plans
A total of 21 plans are available in 2024 (three less than last year) including 5 plans with monthly premiums less than $25. The average weighted rate on all plans is $53.36 and 3 options are offered with a $0 deductible. Thirteen enhanced plans and eight basic (BA, DS, and AE) are available. Monthly premiums range from $.50 to $130.90 per month. 18 plans increased their rate from last year while 3 plans decreased their rate.
SilverScript Choice – $52.60 monthly premium with $545 deductible. 30-day cost-sharing copays are $2 (Tier 1), $7 (Tier 2), 16% (Tier 3), 42% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $6 (Tier 1), $21 (Tier 2), 16% (Tier 3), 42% (Tier 4), and n/a (Tier 5). 3,505 formulary drugs are available. 3.0 Summary Star Rating.
SilverScript Plus – $100.30 monthly premium with $200 deductible. 30-day cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 30% (Tier 5). 90-day cost-sharing copays are $15 (Tier 1), $30 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,585 formulary drugs are available. 3.0 Summary Star Rating.
SilverScript SmartSaver – $15.70 monthly premium with $280 deductible. 30-day cost-sharing copays are $0 (Tier 1), $5 (Tier 2), 24% (Tier 3), 50% (Tier 4), and 29% (Tier 5). 90-day cost-sharing copays are $24 (Tier 1), $36 (Tier 2), 24% (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,643 formulary drugs are available. 3.0 Summary Star Rating.
Humana Walmart Value Rx Plan – $22.70 monthly premium with $480 deductible (does not apply to Tiers 1 and 2). 30-day cost-sharing copays are $1 (Tier 1), $4 (Tier 2), 16% (Tier 3), 38% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $12 (Tier 2), 16% (Tier 3), 38% (Tier 4), and n/a (Tier 5). 3,184 formulary drugs are available.
Humana Premier Rx Plan – $81.50 monthly premium with $480 deductible. 30-day cost-sharing copays are $1 (Tier 1), $4 (Tier 2), $45 (Tier 3), 49% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $135 (Tier 3), 49% (Tier 4), and n/a (Tier 5). 3,242 formulary drugs are available.
Humana Basic Rx Plan – $30.90 monthly premium with $480 deductible. 30-day cost-sharing copays are 7% (Tier 1), 11% (Tier 2), 20% (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are 7% (Tier 1), 11% (Tier 2), 20% (Tier 3), 35% (Tier 4), and n/a (Tier 5). 3,060 formulary drugs are available.
AARP MedicareRx WalGreens – $29.30 monthly premium with $310 deductible (does not apply to Tiers 1 and 2). 30-day cost-sharing copays are $0 (Tier 1), $10 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 27% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $30 (Tier 2), $120 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3,166 formulary drugs are available.
AARP MedicareRx Saver Plus – $45.00 monthly premium with $480 deductible. 30-day cost-sharing copays are $1 (Tier 1), $10 (Tier 2), $42 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $30 (Tier 2), $126 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3,165 formulary drugs are available.
AARP MedicareRx Preferred – $104.20 monthly premium with $0 deductible. 30-day cost-sharing copays are $5 (Tier 1), $10 (Tier 2), $45 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day cost-sharing copays are $15 (Tier 1), $30 (Tier 2), $135 (Tier 3), 40% (Tier 4), and n/a (Tier 5). 3,583 formulary drugs are available.
WellCare Classic – $29.10 monthly premium with $480 deductible. 30-day cost-sharing copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $6 (Tier 2), $96 (Tier 3), 33% (Tier 4), and n/a (Tier 5). 3,110 formulary drugs are available.
WellCare Value Script – $12.90 monthly premium with $480 deductible. 30-day cost-sharing copays are $0 (Tier 1), $4 (Tier 2), $42 (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $12 (Tier 2), $126 (Tier 3), 47% (Tier 4), and n/a (Tier 5). 3,450 formulary drugs are available.
WellCare Medicare Rx Value Plus – $69.00 monthly premium with $0 deductible. 30-day cost-sharing copays are $0 (Tier 1), $4 (Tier 2), $47(Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $12 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,464 formulary drugs are available.
Cigna Extra Rx – $65.00 monthly premium with $100 deductible. 30-day cost-sharing copays are $4 (Tier 1), $10 (Tier 2), $42 (Tier 3), 50% (Tier 4), and 31% (Tier 5). 90-day cost-sharing copays are $12 (Tier 1), $30 (Tier 2), $126 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,271 formulary drugs are available.
Cigna Secure Rx – $32.40 monthly premium with $480 deductible. 30-day cost-sharing copays are $1 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $6 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,190 formulary drugs are available.
Cigna Essential Rx – $36.20 monthly premium with $480 deductible. 30-day cost-sharing copays are $0 (Tier 1), $6 (Tier 2), 18% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $18 (Tier 2), 18% (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,170 formulary drugs are available.
Anthem Blue MedicareRx Standard – $81.90 monthly premium with $375 deductible. 30-day cost-sharing copays are $1 (Tier 1), $4 (Tier 2), $46 (Tier 3), 35% (Tier 4), and 26% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $12 (Tier 2), $138 (Tier 3), 35% (Tier 4), and n/a (Tier 5). 2,946 formulary drugs are available.
Anthem Blue MedicareRx Plus – $78.90 monthly premium with $0 deductible. 30-day cost-sharing copays are $1 (Tier 1), $3 (Tier 2), $43 (Tier 3), 45% (Tier 4), and 33% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $9 (Tier 2), $129 (Tier 3), 45% (Tier 4), and n/a (Tier 5). 3,155 formulary drugs are available.
Anthem Blue MedicareRx Enhanced – $23.60 monthly premium with $310 deductible. 30-day cost-sharing copays are $0 (Tier 1), $2 (Tier 2), 20% (Tier 3), 39% (Tier 4), and 26% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $6 (Tier 2), 20% (Tier 3), 39% (Tier 4), and n/a (Tier 5). 3,140 formulary drugs are available.
Clear Spring Health Premier Rx – $14.40 monthly premium with $445 deductible. 30-day cost-sharing copays are $1 (Tier 1), $3 (Tier 2), $40 (Tier 3), 43% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $9 (Tier 2), $120 (Tier 3), 43% (Tier 4), and n/a (Tier 5). 3,276 formulary drugs are available.
Clear Spring Health Value Rx – $23.80 monthly premium with $445 deductible. 30-day cost-sharing copays are $1 (Tier 1), $3 (Tier 2), $42 (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $9 (Tier 2), $126 (Tier 3), 33% (Tier 4), and n/a (Tier 5). 3,251 formulary drugs are available.
Elixir RxPlus – $14.30 monthly premium with $445 deductible. 30-day cost-sharing copays are $1 (Tier 1), $6 (Tier 2), $43 (Tier 3), 45% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $18 (Tier 2), $129 (Tier 3), 45% (Tier 4), and n/a (Tier 5). 3,254 formulary drugs are available.
Elixir RxSecure – $26.00 monthly premium with $445 deductible. 30-day cost-sharing copays are $1 (Tier 1), $7 (Tier 2), 15% (Tier 3), 45% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $3 (Tier 1), $21 (Tier 2), 15% (Tier 3), 29% (Tier 4), and n/a (Tier 5). 3,188 formulary drugs are available.
Indy Health EliteRx – $47.00 monthly premium with $0 deductible. 30-day cost-sharing copays are $3 (Tier 1), $5 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day cost-sharing copays are $9 (Tier 1), $15 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,578 formulary drugs are available.
Indy Health SaverRx – $26.20 monthly premium with $445 deductible. 30-day cost-sharing copays are $0 (Tier 1), $10 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day cost-sharing copays are $0 (Tier 1), $30 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5). 3,219 formulary drugs are available.
Temporary Ga Policies – They’re Cheap!
Non-compliant short-term plans are often purchased because of the extremely low premiums and same-day approval feature that many carriers offer. Although they are underwritten (not guaranteed-approval) and many pre-existing conditions are not covered, these contracts are popular if existing or prior coverage lapsed and you need to obtain benefits ASAP.
In less than 24 hours, an application can be approved and coverage (depending on the policy and carrier) can be kept for as long as 12 months. Although major medical benefits are fairly robust, often, there are out-of-pocket expenses for prescriptions, office visits and therapy. Also, depending on the length of time you don’t have qualified Exchange coverage a pro-rated penalty may be charged based on household income.
We listed below several examples of available short-term rates. Applicants are assumed to be in good health and are non-smokers.
30 Year-Old Male Residing In Fulton County
$51 – $7,500 deductible and 20% coinsurance from The IHC Group.
$60 – $5,000 deductible and 20% coinsurance from The IHC Group.
$66 – $2,500 deductible and 20% coinsurance from The IHC Group.
$90 – $1,000 deductible and 20% coinsurance from The IHC Group.
$113 – $5,000 deductible and 20% coinsurance from National General.
$124 – $5,000 deductible and 20% coinsurance from UnitedHealthcare.
$198 – $1,000 deductible and 30% coinsurance from UnitedHealthcare.
45 Year-Old Female Residing In Gwinnett County
$82 – $7,500 deductible and 20% coinsurance from The IHC Group.
$98 – $5,000 deductible and 20% coinsurance from The IHC Group.
$109 – $2,500 deductible and 20% coinsurance from The IHC Group.
$154 – $1,000 deductible and 20% coinsurance from The IHC Group.
$173 – $5,000 deductible and 20% coinsurance from Companion Life.
$212 – $5,000 deductible and 20% coinsurance from UnitedHealthcare.
$219 – $1,000 deductible and 30% coinsurance from UnitedHealthcare.
50 Year-Old Married Couple (2 Persons) Residing In Cobb County
$224 – $7,500 deductible and 20% coinsurance from The IHC Group.
$271 – $5,000 deductible and 20% coinsurance from The IHC Group.
$304 – $2,500 deductible and 20% coinsurance from The IHC Group.
$445 – $1,000 deductible and 20% coinsurance from The IHC Group.
$448 – $5,000 deductible and 20% coinsurance from UnitedHealthcare.
$465 – $2,500 deductible and 30% coinsurance from UnitedHealthcare.
$521 – $5,000 deductible and 20% coinsurance from Companion Life.
40 Year-Old Married Couple With Two Children (4 Persons) Residing In Dekalb County
$172 – $7,500 deductible and 20% coinsurance from The IHC Group.
$207 – $5,000 deductible and 20% coinsurance from The IHC Group.
$232 – $2,500 deductible and 20% coinsurance from The IHC Group.
$317 – $5,000 deductible and 20% coinsurance from UnitedHealthcare.
$338 – $1,000 deductible and 20% coinsurance from The IHC Group.
$396 – $2,500 deductible and 30% coinsurance from UnitedHealthcare.
$503 – $5,000 deductible and 20% coinsurance from National General.
NOTE: Temporary policies can often be renewed one time. This means that after the first renewal, although your existing carrier may not offer coverage, another carry will, assuming you meet their underwriting criteria. And ironically, after a year, you can return to the original company and re-apply for another policy.
Affordable health insurance rates in Georgia. With the help of federal subsidies, guarantee-approval underwriting, and comparing multiple plans, we’ll help you find those low-cost plans that provide the benefits you need at the cheapest price.