Georgia Health Insurance

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Facts and Figures

Place in State
Health Report Card 37^th
Insured 7,735,095
Uninsured 1,843,900
Insurance
Carriers 8
Number of
Primary Care Physicians 14240
Number of
Hospitals 152
Average Cost of
Health Insurance* $167

Breakdown of Insureds

Employer-sponsored health insurance 65%
Private plans 5%
Medicaid 16%
Medicare 11%
Others 3%

Insurance Carriers

AARP-branded plans, insured by Aetna
Blue Cross Blue Shield of Georgia
Celtic Ins. Co.
Cigna
Coventry Health Care of Georgia, Inc.
Humana
Kaiser Permanente GA
UnitedHealthcare

State Health Report Card

While smoking has decreased from 22.1 percent to 17.6 percent of the adult population in the past five years, nearly 1.3 million adults still smoke in Georgia. Almost 2.2 million adults in Georgia are obese, 894,000 more adults than 10 years ago. In the past five years, the violent crime rate decreased from 446 to 403 offenses per 100,000 population. In the past ten years, diabetes increased from 6.8 percent to 9.7 percent of the adult population, increasing the number of adults with diabetes in the state to 698,000. In the past ten years, the percentage of children in poverty increased from 16.4 percent to 24.7 percent of persons under age 18. While smoking has decreased from 22.1 percent to 17.6 percent of the adult population in the past five years, nearly 1.3 million adults still smoke in Georgia. Almost 2.2 million adults in Georgia are obese, 894,000 more adults than 10 years ago. In the past five years, the violent crime rate decreased from 446 to 403 offenses per 100,000 population. In the past ten years, diabetes increased from 6.8 percent to 9.7 percent of the adult population, increasing the number of adults with diabetes in the state to 698,000. In the past ten years, the percentage of children in poverty increased from 16.4 percent to 24.7 percent of persons under age 18.

Georgia Health Insurance Laws and Regulations

Georgia health insurance providers are prohibited by law to refuse anyone from renewing their coverage (Unless the coverage lapsed due to non-payment). Georgia health insurance plans are required to be sold with a guaranteed renewability clause. Insurers are also prohibited from cancelling a member’s coverage despite your medical condition. When writing new Georgia health insurance plans, insurers can exclude coverage for a pre-existing condition. This means that the coverage will not apply to treatment or medical attention in relation to the pre-existing condition. The exclusion period may range from 6 months to 2 years. Carriers are free to decide on their Georgia health insurance quotes and plan benefits. Approval of application and premium rates are influenced by factors like a person’s age, health condition or location. Small businesses are guaranteed access to group health insurance plans. Georgia health insurance quotes for group coverage can vary according to the risk factors of its members. COBRA and HIPAA laws apply.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Georgia health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Georgia, 85,090 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 106,922 Medicare policyholders in Georgia to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 102,366 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $573 per person or a total of $58,632,728 was saved in Georgia.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 1,476 individuals in Georgia have benefited from this new law.

When looking at Georgia health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. All 2,318,000 private policyholders in Georgia will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Georgia health insurance with no deductibles or co-pays. In 2011, 851,076 Medicare subscribers and 1,713,000 individuals with private policies received such services in Georgia.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit-a cap on the yearly spending for your benefits, or a lifetime dollar limit-a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 3,317,000 Georgia residents have benefited from this law.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Georgia, 160 community health centers received a total of $33.6 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Georgia has
already received a total of $18.2 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

Medicaid in Georgia

404-656-6060

Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits for this program include physician services, medical and dental check-ups, diagnostics, prescriptions, hospital services, hospice, dental care, family planning, maternity, prenatal, newborn care, drug and alcohol treatment, mental health services and many more. Eligibility: 1. Must be U.S. citizens or legal residents living in Connecticut. 2. Must not exceed income limits: Pregnant women: 200% FPL. Children aged 0-1: 185% FPL. Children aged 1-5 : 133% FPL. Children aged 6-19: 100% FPL. Families with dependents: up to 30% FPL. Medically-needy: Singles earning 35% FPL with resource limit of $2,000; couples earning 30% FPL with resource limit of $4,000. Add $100 for additional member. Aged, blind, or disabled receiving SSI: Singles earning 74% FPL with asset limit of $2,000; couples earning 83% FPL with asset limit of $3,000.

PeachCare for Kids

877-427-3224

Georgia PeachCare for Kids aims to provide coverage for children in low-income families who are not eligible for Medicaid. This program is available for children up to 18 years. Benefits of the program include: physician care for sick child, specialist care, prescription medications, immunizations and regular check-ups, dental care, vision care, mental health care, hospitalization, and emergency room services. Eligibility: 1. Must be U.S. citizens qualified residents living in Georgia. 2. Must be below 19 years. 3. Uninsured. 4. Must meet income requirements: Income must not exceed 235% of the FPL.

Georgia Long Term Care Partnership

1-800-669-8387 (toll-free)

This public-private partnership creates an innovative program offering individuals quality, affordable long-term care insurance and a way to receive needed care without depleting all their assets.

Health Insurance Continuation Program

ADAP/HICP Coordinator, (404) 657-3127

Health Insurance Continuation Program (HICP) is a special program designed to help eligible individuals who cannot keep up with their premium payments. The HICP assists subscribers by paying a maximum of $1100 in monthly health insurance premiums, which may include other members on a family health plan. Eligibility: Only applicants whose insurance plans include coverage for both outpatient primary care and prescription without an annual cap will be considered. Other qualifications for HICP include: 1. Having a diagnosis of HIV or AIDS. 2. Having a gross household income not exceeding 300% of the Federal Poverty Level. 3. Having cash assets not exceeding $4500 if single or $5500 if married. 4. Not being covered by or ineligible for Medicaid.

Medicare

800-633-4227

This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

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