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Georgia Health Insurance

Georgia Medical Insurance Overview

Despite the many health insurance options to people living in the state of Georgia, the percentage of those who are uninsured is relatively high.  There are program options available for working residents to obtain group insurance coverage, low income families and individuals can obtain insurance through a state-funded plan or individuals who are not working or self-employed can obtain an individual policy.
Because of the changes to health care due to the Affordable Care Act, it is hoped that it will improve the percentage of uninsured people living in the state.
Below is a breakdown of the state of health insurance coverage and plans that are offered in the state of Georgia.

Georgia’s Health Care Issues
The United Health Foundation has ranked Georgia in 40th place when it comes to its overall health as compared to the other 49 states.  Georgia’s ranking has fallen from 36th place in 2011, but the state has its strengths and challenges.
Among its strengths, Georgia has a low incidence of Pertussis, a low percentage of people who have died as a result of drug abuse and a high rate of immunizations against HPV in the state’s adolescent female population.  Challenges for the state’s health include the percentage of people without insurance coverage, a high prevalence of babies born with low birth weights and a low amount of kids that graduate from high school.

Understanding Georgia’s Uninsured Population
Studies have shown that since the state of Georgia was hit hard by the 2008 recession, there were many residents who are currently without insurance coverage.  As of 2014, 16 percent of the residents of Georgia are uninsured.  During the recession, insurance coverage through the workplace declined, leaving many of the working population without health benefits.  Thirty-one percent of residents in George take advantage of the state-sponsored programs available, which is just over the national average.

Below you can see a list of statistics regarding Georgia’s population of uninsured residents:

  • 16 percent of the state’s residents do not have insurance coverage of any kind.
  • The population of uninsured people is high, but poor and low-income children are equal to the percentages of these age and income groups in the country as a whole.
  • Poor individuals make up 52 percent of the number of uninsured people in the state, with low income earners comprising 46 percent of the number of those uninsured.

Group Health Plans
As with any other state, if you work in the state of Georgia, you should first ask your employer if they offer group health insurance.  In this state, 47 percent of companies offer group plans to their employees.  To find out more information about the pre-selected plans offered, you should speak with a Human Resources representative or Manager.  Before you make a decision on what plan is best for you and your situation, ensure that you have studied each option carefully.  In most cases, you will probably be asked to provide a certain portion of the costs associated with coverage under the group plan.

The Office of Insurance and Safety Fire regulates health insurance companies in the state of Georgia.

Signing Up
Prior to applying for coverage under your employer’s group plan, read up on the different options available to you.  You should have more than two options to choose from and you can choose whichever you feel is more suited to your future potential medical needs.

When signing up, ask your H.R. rep when the open enrollment period is for coverage so that you can apply at the proper time.  New enrollees can typically apply for group coverage upon being hired into the company, but you should verify this information with Human Resources.  Always remember to do the proper amount of due diligence and keep the following questions at the forefront of your mind when going through the application process:

  • Do you need to cover any dependents under your insurance policy?
  • Will you need to cover your spouse under your plan?
  • Are you suffering from any health conditions?
  • Do you know what’s covered under the group plan?
  • What is excluded under the plan?
  • Will your budget allow the cost of the monthly premiums?

Pre-Existing Condition Exclusion Periods
An exclusion period may be enforced if you enroll into a health plan but have a pre-existing condition.  Exclusion periods are time frames in which you cannot use the benefits under your insurance plan.

The HIPAA law states that private insurance companies in the state of Georgia may exclude you from coverage for a period of one year before your insurance coverage is active.  In addition, the law allows for insurance providers to look back into your medical history for a period of up to six months in order to determine whether or not you have a pre-existing condition.

Exclusion periods are not enforced on dependents that are 19 and younger.  If you enroll a child under the age requirements, the presence of pre-existing conditions will not delay his or her insurance benefits.

Affiliation or Waiting Periods
You can also be made to wait out a length of time referred to as an affiliation period.  This period of time also prevents the usage of benefits but cannot exceed two months in total.

Individual Health Plans
Six percent of residents living in the state of Georgia are covered under individual insurance policies; despite the many difficulties having this sort of coverage imposes.  For those who are unemployed, self-employed or employed by a company that doesn’t offer insurance coverage, if you don’t qualify for a state-funded program, you will have to find individual insurance coverage.  When applying for an individual insurance plan, you can be turned down for insurance coverage if you have a pre-existing condition.  You are also at the mercy of the insurance provider with regard to the underwriting done on the plan itself, so it may prove to be costly to receive coverage.

Despite the expensive options for this type of insurance benefits, it is estimated that a healthy person living in Georgia can be covered under an individual policy for roughly $41 per month.

Continuation Coverage
Insurance coverage under COBRA is available to people who have lost their insurance for any reason.  In the event that you get divorced or lose your job and it results in you becoming uninsured, you may be able to obtain COBRA coverage for up to 18 months or the time it takes you to secure other coverage, whichever comes first.  COBRA will pick up where your insurance coverage left off if the company that originally issued the policy has over 20 employees.  You can obtain HIPAA coverage in the event that you have exhausted your options under COBRA.  You can also obtain a conversion plan which is basically an individual plan that is based on your original insurance policy with the same provider.

Georgia Health Benefits Exchange
When the Affordable Care Act mandated health insurance marketplaces, Georgia opted for a federally-facilitated exchange.  The Governor of the state felt that a marketplace run by the state government would exercise little control overall and said that the federal government would have real control over the entire marketplace.  Now the marketplace has been active for a while, many residents wish for the state to be in charge of the options offered on the exchange.

Georgia State Insurance Programs
Along with the option to choose from group or individual health insurance coverage in the state of Georgia, there are many programs available for lower-income adults, children and families.  Below is a detailed breakdown of each of the state programs including information on eligibility requirements and associated costs, if any.

Pre-Existing Condition Insurance Plan (PCIP)
This plan offers coverage to those who have proof that they were denied health insurance coverage because of a pre-existing condition.  Benefits of PCIP include specialty care, prescription medications, hospitalizations and more.  You may be charged between $147 and $633 for insurance under this program.

Medicaid
For low wage earners in Georgia and nationwide, the Medicaid program offers coverage options.  Doctor’s visits, tests, medications, labs, immunizations and more are covered under the Medicaid program.  The state bases your eligibility for coverage on your income level.  Retroactive benefits for three months prior to approval can be received for certain eligible participants.

PeachCare for Kids
For children of lower income families, there is the PeachCare for Kids program.  Under PeachCare, kids can get checkups, shots and many more medical services.  If your dependent is under the age of six, there are no monthly premiums charged for this program.  Otherwise, you may have to pay $70 as a maximum monthly premium.

Women-Infants-Children (WIC)
WIC offers a great deal of nutritional services, food options and breastfeeding resources to women who are pregnant, mothers of infants, infants and children under the age of five.

Children 1st
For children under six-years-old who are determined at risk for health conditions or delayed development, this program offers medical services.

Babies Can’t Wait
If a child is suffering from a physical ailment or mental condition that affects their development, coverage is available under the Babies Can’t Wait program.  Conditions covered include spina bifida, blindness and Down syndrome.  For families who have trouble paying, there is a sliding scale to determine the premiums required for coverage.

Breast & Cervical Cancer Program (BCCP)
Through BCCP, women can obtain breast examinations, mammograms, pelvic exams and pap tests.  In order to qualify, you must meet income requirements and be of the appropriate age.

Cancer State Aid Program (CSA)
Under CSA, you can receive chemotherapy, pharmacy services, in-patient and outpatient services, and home health assistance.  To enroll, you must not have insurance coverage and must earn an income that is less than 300 percent of the Federal Poverty Level.

Women’s Health Medicaid Program
Women can receive treatment for cervical and breast cancer under this program if they are uninsured and earn under 200 percent of the FPL.  In the case of those under 65, coverage is guaranteed in the event the woman has been given a pre-cancer diagnosis of the breast or cervix.

Medicare, the Medicare Prescription Drug Program, and Georgia Cares
Medicare and the various parts it contains are available to disabled people and seniors living in the state of Georgia.  If you are over 65 and have worked in a Medicare-covered job for at least ten years, you are eligible for coverage under Medicare.  Also guaranteed coverage are people suffering from end-stage renal disease.  Georgia Cares is a counseling service offered to those residents in the state who are looking into Medicare as an insurance option.

VA Medical Benefits Package
Veterans who have served out their amount of active duty or have been in the military for 24 consecutive months can receive coverage under this program.  As long as you have received an honorable discharge from the military, you can be covered under this plan.

Partnership for Prescription Assistance
The PPA is a referral service that connects you with 475 public options so that you can receive assistance in covering the costs associated with your prescription medications.

Immunization Program
This program offers vaccines to protect consumers in Georgia against preventable diseases like the flu, Hepatitis B and pneumococcal disease.

National Association of Mental Illness (NAMI) Helpline
This is a resource offered to the mentally ill in the state of Georgia.  The NAMI helpline is staffed by a team of volunteers who offer informational resources to people who suffer from mental illness.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA provides protections with regard to the use and dissemination of your health information along with how insurance companies are governed.  Under HIPAA employers cannot deny you insurance coverage because of a pre-existing condition and it guarantees the ability for people to renew insurance coverage under an individual policy.  HIPAA also limits the amount of time you can face with regard to exclusion periods along with governing COBRA coverage extensions for those who have lost their insurance coverage.

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