Full of peaches and Southern charm, Georgia is a beautiful state with deep roots and history. The capital and largest city, Atlanta, remains one of the greatest cities in the nation for the arts, culture, professional sports, and world-class attractions. Other towns throughout the state may not quite as bustling, but the Georgia character and attitude (and notable accent) remains in tact regardless of location. Georgia residents have a variety of national health insurance companies to choose from, including Aetna, Blue Cross Blue Shield of Georgia, Cigna, Kaiser Permanente, and UnitedHealth. For an accurate listing of the plans and pricing in your specific area, enter your zip code in the appropriate space below.
Georgia’s overall health is gaining momentum as time progresses. Though it has been and still remains one of the least healthy states in the U.S., at least there are improvements being made. Some of the contributing factors to the positive upswing of the state’s health are a large number of people getting immunizations, a low presence of binge drinking, and a decrease in the population of adult smokers. Although the quantity of smoking adults is dwindling, there are still 1.3 million people over age 19 smoking in Georgia.
A few down sides of the most recent health evaluation for the state include an increase in diabetes among adult Georgians, as well as obesity – which affects nearly 2.2 million adult residents. There are also high levels of air pollution in Georgia, and the number of people without medical insurance is also elevated. Despite the poor air quality, the people of Georgia should take initiative to improve their health, which can occur in many ways: by purchasing health insurance coverage or using a public health program, eating nutritious foods and participating in physical activity, or quitting smoking.
Health Insurance Plans
- Managed Choice Open Access Value plans are PPOs with a basic level of coverage and several deductibles to choose from. These plans offer unlimited non-specialist and specialist office visits for a copay on the first five visits, and covered at 100% from the sixth visit onward. When using an in-network provider, there is no charge for preventive care, which includes an annual GYN exam, routine physicals, and check-ups for children. After you have met your deductible, services such as hospitalization, lab work, and physical therapy are available for a payment of coinsurance.
- Managed Choice Open Access PPO plans have a more comprehensive level of benefits than the Value plan, with a higher deductible and lower premiums. These plans offer prescription drugs coverage for a copay, as well as doctor’s office visits before meeting your deductible. Once the deductible has been reached, your plan will cover much of the cost for many services such as hospital care. Immunizations, well-child care, routine physicals and other preventive care are all covered at 100% in-network. Some of these plans are available with unlimited primary care visits, in addition to dental and/or prescription coverage.
- Managed Choice Open Access High Deductible plans are qualified for use with a health savings account (HSA), and offer a wide cross-section of coverage. From the day your plan starts, you can receive in-network preventive care at no cost. When you have met your deductible, a number of services including doctor’s office visits, prescription drugs, outpatient surgery, inpatient hospital care, and home health care are covered at 100% by your plan. You can use the funds from the HSA to meet your deductible, pay coinsurance, or save for retirement, as long as you are spending on qualified medical expenses.
Blue Cross Blue Shield of Georgia
- PPO plans have a basic (SmartSense) or comprehensive (Premier) set of benefits for an affordable rate. These plans can be either POS or PPO, which connect you to the Blue Choice Open Access Network or preferred network of providers for a discounted rate. If you decide you want to see a provider who is not in the network, you may do so for a slightly higher cost. Preventive care services can be sought once your plan becomes effective at 100% when using in-network providers. SmartSense PPO plans offer the convenience of being able to pay coinsurance for major medical care before your deductible has been met. These plans also are available with several prescription drug coverage options.
- ForwardFocus HSA POS plans are Point-of-Service plans with the capability of opening a health savings account to pay for medical costs. After you have paid your deductible, you have a wide variety of benefits including coverage on doctor’s office visits, inpatient and outpatient hospital care, prescription drugs, chiropractic care and more. You can either choose to pay 20% or 0% coinsurance, and deductibles of $1,750, $2,500, $3,500, or $5,550. Through HSA POS plans, you can use the Blue Open Access Network of providers for your medical care.
- POS plans from Blue Cross Blue Shield of Georgia are also available in either SmartSense or Premier Plus. Premier Plus offers broad prescription drug coverage and preventive care covered at 100% before the deductible. With Premier Plus plans, you have many deductibles to choose from, ranging from $750 to $10,000 for individuals and $1,500 – $20,000 for families. There is a maternity coverage option with Premier Plus plans, as well as dental and life insurance. Hospital care such as inpatient stays, surgeries, diagnostic lab work, and emergency services are covered at 80 or 100% after meeting the deductible.
- Tonik plans are designed for young adults with three types to choose from: Thrill seeker, Part-time Daredevil, and Calculated Risk-Taker. All three offer office visits, emergency room services, and prescription drugs immediately for a copay when your plan becomes effective. Preventive services are also available immediately for no cost, including well-child care, PSA screenings, mammograms, immunizations and more. After the deductible has been met, you may receive hospital care such as X-rays, blood tests, surgery, inpatient and outpatient services for no cost. Dental and vision coverage are also included for no charge in Tonik plans.
- Open Access PPO plans are available as either Value plans or more comprehensive PPO plans. These plans come in a variety of deductible and coinsurance options and give you the ability to either use Cigna’s preferred network of providers in Georgia or seek out-of-network care. In-network preventive care is available as soon as your plan begins for no cost, and select medical services such as outpatient surgery will cost a percentage of coinsurance before you meet the deductible. Office visits and prescription drugs are also available immediately for a copay.
- Health Savings plans from Cigna are high deductible plans compatible with health savings accounts (HSAs). These plans allow for much flexibility and control over your health care, by either saving HSA funds for the future or applying them towards medical expenses like your deductible. Once you have met your deductible, doctor’s office visits, prescription drugs, and most inpatient and outpatient hospital care is covered entirely by your plan. Preventive care, such as immunizations, routine physicals and well-child care are covered at 100% before your deductible when using in-network services. Some of these plans have a dental coverage option.
- Copay plans from HumanaOne are available in several coinsurance (70, 80, or 100%) and deductible options. These are PPO plans with convenient copays on doctor’s office visits, prescription drugs, and emergency room care. All other covered services will be covered at a percentage of coinsurance when using in-network providers. These plans are convenient and simple to use, and typically very cost-effective. In-network preventive treatment is also included in copay plans for no cost, such as immunizations, annual physical and GYN exams and more.
- Value plans are PPOs, with a range of deductibles and additional benefit options, like dental and prescription drug coverage. Preventive care is available in-network for no charge from the day your plan starts. These plans offer a variety of benefits, including emergency room care, outpatient surgery, inpatient treatment, home health care, non-specialist and specialist visits for a level of coinsurance (or no cost) once you have met your deductible. You may also see out-of-network providers for a lesser degree of coverage.
- HSA plans have many advantages, including the ability to control your health care costs. When you open a health savings account with one of these high deductible plans, you can either use the tax-advantaged funds to meet your deductible, pay coinsurance, or reserve money for future emergency use. There is no charge after deductible for doctor’s office visits, diagnostic services, as well as hospitalization and surgery. As with other plans, you are able to receive preventive care immediately for no cost.
- Advantage plans give members access to Kaiser Permanente’s HMO network in the state of Georgia, with a basic set of covered services available from the first day of coverage. Care available immediately includes emergency room, urgent care, prescriptions, and primary care physician visits. Preventive care is covered at 100%, which includes routine physical and GYN exams, well-child care, mammograms and more. More services are available after deductible, such as outpatient surgery and mental health care.
- Classic plans are also HMOs, as are all Kaiser Permanente plans in Georgia. These plans have multiple deductibles to choose from: $1,500, $2,500, $3,500, or $5,000 for individuals and $3,000, $5,000, $7,000, or $10,000 for families. Doctor’s office visits, prescription drugs, emergency care, and urgent care can be used for a copay immediately when your plan starts. Classic plans also give you the ability to use mental health services for a percentage of coinsurance after deductible.
- Essential plans provide you with preventive care services for no cost before deductible, in addition to visits to your primary care doctor for a $75 copay (non-preventive). These plans offer a comprehensive level of care, with most medical services (ambulance, specialist office visits, inpatient hospitalization) covered in full after meeting the deductible. Many other services are available for a copay before you meet your deductible, including emergency room care, prescription drugs, and urgent care.
- HSA plans in Georgia have a deductible of $5,000 for individuals and $10,000 for families, and 100% coverage on virtually every type of medical care after deductible. HSA plans are also qualified for use with a health savings account, with which you can grow tax-free funds for specified medical expenses (deductibles and coinsurance before deductible). Preventive care is covered entirely from the day your plan starts, such as physical exams, mammograms, and immunizations.
- Copay plans from UnitedHealthOne come with a variety of coinsurance options (75/25, 80/20, or 100) and deductible choices ranging from $1,000 to $10,000 for individuals. These are PPO plans that allow you to choose in-network providers for discounted, high-quality health care, or the out-of-network doctor or facility of your preference. There are predictable, convenient copayments for primary care or specialist office visits ($35), and prescription drugs ($15 generics). The rest of your medical care will be covered by your chosen coinsurance level after your deductible is met. Preventive care is always covered in full as soon as your plan becomes effective.
Public Health Options
In Georgia, Medicaid is the umbrella program providing a number of important state-funded health services. Other programs are also available through the state, for specific groups of people and illnesses afflicting the population. The most crucial and well-funded assistance and health programs are associated with Medicaid, such as Long Term Care, Planning for Healthy Babies, Health Insurance Premium Payment (HIPP), and Georgia Families. There is an extensive list of specialized programs for Georgia residents with cancer, asthma, HIV/AIDS, diabetes, those who wish to quit smoking and more. For the full list of public health services offered by the state of Georgia, visit the Georgia Department of Health. A selection of options is listed below, and you can find resources and links to more programs through the Medicaid site and the Department of Health.
- Georgia Medicaid: health care coverage for low-income families, children, pregnant women, disabled, elderly, blind and many other individuals in need of medical assistance
- PeachCare for Kids: state-funded health care for children without insurance, including vision, dental, preventive, primary and specialist services
- Georgia Families: a CMO (care managed organization) for members of Medicaid and PeachCare for Kids
- Planning For Healthy Babies: a program intended to prevent low birth weight and very low birth weight infants
Health Insurance Laws
In the state of Georgia, health insurance laws allow health insurance companies the ability to define a pre-existing condition however the underwriter sees fit. There is no law restricting Georgia insurers from rejecting individuals with pre-existing conditions for a health plan (yet), or increasing premiums based on their risk level. Insurance companies are also legally permitted to attach an elimination rider if they decide to provide a high-risk individual with a plan, which means they will never cover any care related to the pre-existing condition. There is also the chance they could issue an exclusion period for a maximum of 24 months.
For individuals who have been denied coverage or overcharged on the basis of having a pre-existing condition, there is an option called the Pre-Existing Condition Insurance Plan, which is operated by the U.S. Department of Health and Human Services. PCIP plans work like a regular private insurance plan, with varying monthly premiums depending on age, to give Georgia residents with pre-existing conditions the health care coverage they need. This is a temporary solution until 2014, when the Affordable Care Act will make it illegal for insurers to reject adults with pre-existing conditions for a policy. The use of elimination riders and exclusion periods will also be prohibited in order to make care more available and equal. Children with pre-existing conditions already have this right, according to the ACA.
Insurance companies in Georgia are required to follow the guaranteed renewability provision of HIPAA (Health Insurance Portability and Accountability Act of 1996) with all policy-holders. This means that an insured Georgia resident cannot have their plan canceled by their insurer due to becoming ill after their plan starts. It also ensures that at the end of an individual’s annual term, the health insurance company will offer to renew the same policy. These rules remain true under the condition that the policy-holder has not violated their plan by neglecting to pay premiums and claims, committing fraud, or moving outside of the service area.