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Insurance Carriers

State Government Insurance Programs Offered

Medicaid in Georgia


Ambulance, Ambulatory surgical, Nurse anesthetists, Diagnostic, screening and preventive services, Dental, Dialysis, Durable medical equipment, Family planning, Early and periodic screening, diagnosis and treatment (EPSDT), Health insurance premium purchase program, Home health, Hospice, Inpatient and outpatient hospital, Care for the developmentally- challenged, Laboratory and radiology, Medicare crossovers, Mental health, Non-emergency transportation, Maternity, nurses and nursing facility, Oral surgery, Orthotic and prosthetic, Pharmacy, Physician, Podiatric services, Pre- admission screening/annual resident review, Rural health clinic/community health center, and Vision care. Pre-Existing Health Conditions Covered GUARANTEED COVERAGE Must be U.S. citizen or lawful alien living in Georgia. Income limits for the following: Pregnant women: 200% FPL. Children ages 0-1: 185% FPL. Children ages 1-5 : 133% FPL. Children ages 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


PeachCare for Kids: Must be low- income children under age 19, with family incomes up to 235% FPL, and must be uninsured, ineligible for Medicaid, and be U.S. citizens, certain qualified legal residents, refugees or asylees who reside in Georgia.

Georgia Long Term Care Partnership


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


The Health Insurance Continuation Program (HICP) assists eligible persons who are unable to pay their health insurance premiums. This special program pays a maximum monthly health insurance premium of $1100.00, which may include a spouse and children on a family health insurance plan, as well as dental and vision. Upon the ending of the client’s COBRA coverage (including extended coverage), all enrolling sites are encouraged to verify their client’s Conversion or Individual policy eligibility, prior to submitting an application for ADAP enrollment. The HICP will pay Individual Policy premiums. Eligibility Criteria The HICP will only accept new clients for the Program who have insurance plans that include both outpatient primary care coverage and prescription coverage without a yearly cap. Premium payments will be limited to $1100.00 per month total. Additionally, individuals are eligible for HICP if they: Have a diagnosis of HIV infection or AIDSHave a gross household income equal to or less than 300% of the Federal Poverty LevelHave cash assets equal to or less than $4500 if single or $5500 if marriedAre not covered by or eligible for Medicaid

Medicare


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Heath Care Reform

Small business tax credits.  123,000 small businesses in Georgia could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 97,800 Medicare beneficiaries in Georgia hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Georgia who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 145,000 people from Georgia retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 5 million Georgia residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 387,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Georgia peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 4.6 million residents of Georgia with health insurance from their employer, along with anyone who signs up with a new insurance plan in Georgia.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 43,500 individuals in Georgia who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $177 million federal dollars are available to Georgia starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 163 Community Health Centers in Georgia but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 15% of Georgia’s population who live in an underserved area.

New Medicaid options for states. For the first time, Georgia has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

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