Picking the Best ACA Health Plan in Georgia for 2023

Open enrollment spans the months of November 1, 2022 - January 31, 2023. Georgia operates on the federally mandated health insurance exchange, the Affordable Care Act (ACA). This article will highlight the most affordable ACA Health Plans in Georgia, using the persona of a 30-year-old female who does not smoke, has no disability, and makes $70,000 annually.

What are the best ACA Health Plans in Georgia?

We’ve highlighted 15 health insurance plans offered by Georgia healthcare insurers based on the lowest deductibles and monthly premiums for 2023. For this article, we used the persona of a 30-year-old female who does not smoke, has no disability, and makes $70,000 to gather our data. Additionally, we used the zipcode 30044 to account for the highest population in Georgia based on U.S. Census Bureau Estimates.

15 Best Health Insurance Plans based on Lowest Deductibles, Monthly Premiums, and Easy Pricing

Source: healthcare.gov

*Easy pricing refers to the healthcare.gov tool to filter plans that have the same out-of-pocket costs and care before deductibles for some services.

Defining HMOs, PPOs, and EPOs 

Health insurance terms can be confusing. To save you several google searches, visit the Mira article to familiarize yourself with the most common terms you’ll come across when navigating your insurance process. 

Health Maintenance Organizations (HMOs)

HMOs usually limit coverage to care among doctors working for or in contract with the HMO. Out-of-network coverage is generally not covered except in cases of emergency. Coverage may also depend on whether you live or work within the area they service. 

Features of HMOs include: 

• Typically have lower insurance premiums and out-of-pocket costs
• Lots of flexibility in choosing providers
• Requires a primary care physician (PCP) referral before seeking specialty care
• If out-of-network providers are used, expect to pay entirely out-of-pocket

Preferred Provider Organization (PPO)

PPOs allow you to choose your preferred physician or healthcare provider, whether in-network or out-of-network. This means you don’t need a referral from a primary care physician to visit other providers.

Features of PPOs include:

• Typically have higher premiums than HMOs or POS plans
• Those enrolled can freely seek specialists and out-of-network physicians without a referral
• A great option for those requiring frequent and various care and who can afford higher premiums

Exclusive Provider Organization (EPO)

EPOs are a budget-friendly managed care option. They are typically more restricted in their coverage and only cover in-network services. 

Features of EPOs include: 

• Usually have a more extensive network than HMOs
• May not require a referral from a primary care physician.
• Premiums are higher than HMOs but lower than PPOs

What Should I Consider When Picking a Health Plan?  

When looking for a health plan, you should consider a few things. First, you must consider your health needs, finances, and how much you can afford. These things will likely change as time goes on, but understanding before selecting will help you make the best decision. 

Consider Plans with Easy Pricing

As you navigate through the healthcare.gov site, many filters are available to help you learn more about your chosen plan. Consider marketplace plans marked with easy pricing. These plans are easier to compare because their out-of-pocket costs are the same within their health plan category. These prices include deductibles, out-of-pocket maximums, and copayments/co-insurance. Additionally, these plans will include benefits you can use with a copayment before you reach the deductible amount. Benefits include:

• Doctor and specialist visits, including mental health
• Urgent care
• Physical, speech, and occupational therapy
• Generic and most preferred drugs

What are your health needs?

When picking a health plan, you want to consider your health needs. This includes what medications you currently take, chronic conditions like diabetes, and how often you need to see your medical provider. If you frequently visit specialists, needing a referral from your PCP can be more difficult than helpful. Finally, consider whether you plan on making any major life changes soon.

Life changes can include:

• Having a child
• Getting married
• Retiring early
• Moving
• Switching careers

Once you’ve figured out your health needs, you can move on to the next step of deciding which health plan is best for you. Some health plans also provide you with dental and vision care.

If you’re looking for a health plan to cover you and your family, you can still consider the above to help rank your options. If you’re married, your spouse may receive health insurance through their job; check to see if their plan offers more benefits.

What’s your financial situation?

After you’ve thought about your health needs, take the time to calculate your budget moving forward. Including things like housing, transportation, and even entertainment costs is important. Then you can see how much of your budget can go toward health insurance. 

Your financial situation depends on how much you can pay out of pocket. The following are the basic categories of plans by metal tier that you can select within the health exchange. These plans vary based on monthly premiums and are suited to various living situations.

ACA Plan Breakdown & Cost Sharing

Source: healthcare.gov

If you’re someone with an income that fluctuates, such as a freelancer or short-term contracted employee, you should think about how this will impact your budget at its highest and lowest. For people who live in cities with a high cost of living, you will find that the average cost of health insurance for one person varies compared to cities with a low cost of living. 

You’ve done your budget and understand how much your current lifestyle affects your finances. Be mindful not to spend all your money on health insurance, as you still need a savings account. We’ve even figured out a few things to consider when lowering your expenses.

How much can you afford?

You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. If you find that you will have a high deductible, you can offset that with a service like Mira that offers a significant discount on lab tests and prescriptions.

Average Marketplace Premium for Georgia by Metal Tier, 2018-2023

Source: KFF

If you decide to select a high deductible health plan (HDHP), you will find that you will have a lower monthly premium. These plans are typically helpful to relatively healthy people who don’t plan to have significant medical expenses. You can pair an HDHP with a Health Savings Account (HSA), which allows you to use your pre-taxed funds towards medical expenses like copays and deductibles. However, you cannot use this to pay for your monthly premium.

What if you frequently travel?

If you travel a lot and need coverage during this time, look at PPO plans. Preferred Provider Organization plans will give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium.

What happens if you can’t afford any plan on the exchange? 

Some states have a tax penalty if you are not enrolled in health insurance. As of 2018, Georgia does not apply the tax penalty for not having health coverage. Depending on your income, the marketplace may offer you a premium tax credit that helps to lower your monthly insurance payment. Use the cost estimate tool to preview plans and prices based on your income to see if you qualify for financial assistance.

Medicaid

Medicaid is the state and federally-funded program that can provide you with affordable health coverage if you can’t afford any plan on the marketplace. To be eligible in Georgia, you must meet the income limit based on the Federal Poverty Level (FPL) estimates. You are likely eligible if your household income is at or below the current 133 percent FPL

Financial Assistance At Hospitals

It’s a good idea to ask about financial assistance options upon visiting a hospital. Some hospitals around Georgia offer financial assistance for low-income, uninsured, and underinsured individuals. The Indigent Care Trust Fund (ICTF) is an example of a program in Georgia that pays hospitals to offer healthcare for free or on a sliding scale for low-income individuals. 

To find out if your hospital participates in this program, contact your billing office or the Georgia Department of Community Health at 1-800-436-7442. Additionally, if you find yourself in a position with a costly hospital bill after your visit, contact your hospital’s billing department to see if they offer options for financial help. Click here for Georgia’s consumer guide for medical bills and debt.

How to enroll in an ACA plan?

Step 1:

Start by heading to healthcare.gov to begin your health insurance application. Click on the ‘Take the first step to apply’ button. 

Step 2:

You’ll be asked to create an account through healthcare.gov. Make sure to have your basic personal information handy, such as your name, birth date, social security number, federal tax information, immigration documents, and employer and income information.

Step 3:

After creating an account, you’ll be able to browse plans based on your income level and additional needs. The site will help you narrow down plan comparisons that best fit your budget. If you find yourself confused during this process, have this article handy to refer back to. For more information on navigating the healthcare marketplace during this current open enrollment period (November 1, 2022-January 31, 2023), check out our in-depth article to guide you through the enrollment process.

ACA Health Plans in Georgia Frequently Asked Questions (FAQs)

Below are some frequently asked questions about health insurance in Georgia we gathered for you.

What health insurance terms should I understand during this enrollment period?

We’ve gone over PPO, HDHP, and HSA. You should also know what a Flexible Spending Account (FSA), Self-Pay Pricing (SPP), and Special Enrollment Period (SEP) are. We have a list with a few more insurance terms to help you during this enrollment period.

What requirements do I need to meet to qualify for health insurance in Georgia?

To be eligible to enroll for health insurance in Georgia, you:

• Must live in Georgia
• Must be a U.S. citizen or national (or be lawfully present). Click here to learn more about eligible immigration statuses.
• Cannot be currently incarcerated.

You cannot use the Marketplace to buy a health or dental plan if you have Medicare coverage.

What are the benefits that my plan is required to provide? 

Your plan must provide the following 10 essential health benefits:

1. Ambulatory patient services (outpatient care you get without being admitted to a hospital).
2. Emergency services.
3. Hospitalization (like surgery and overnight stays).
4. Pregnancy, maternity, and newborn care (both before and after birth).
5. Mental health and substance use disorder services include behavioral health treatment (including counseling and psychotherapy).
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills).
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits).

When is the special enrollment period?

If you miss open enrollment and you’ve had a qualifying life event such as having a baby, a change in income, or health insurance loss, you may be able to apply 60 days prior or 60 days after the event to enroll in a health plan. To see if you qualify, go to healthcare.gov and fill out a few questions. The site will direct you to either answer more questions to assess your eligibility.

Bottom Line 

Open enrollment begins November 1st, 2022-January 31, 2023. Now’s the time to familiarize yourself with the best health insurance option you can afford. Plans will vary in what they offer and how much they cost based on their metal tier, coverage types, and premium and deductible amounts. Health insurance options will vary for everyone, so it’s best to use resources like the cost estimator tool on healthcare.gov to help assess and personalize your options.  

If you’re looking for a more affordable alternative to health insurance, memberships such as Mira exist and might be a better fit. For just an average of $45 per month, members get access to low-cost urgent care visits, affordable lab testing, and discounted prescriptions at up to 80% off. Sign up today and start saving on healthcare!