Georgia Health Insurance Marketplace (GHIM)

1.) VITALLY IMPORTANT INFORMATION ON HOW YOUR FAMILY GROSS HOUSEHOLD INCOME IS CALCULATED • Household Income is NOT calculated by take home pay. It is based on your gross income before taxes/withholding. • Eligibility is based on the consumer’s “projected” gross 2015 household income. Having a new 2014 job is okay. • Self-employed/1099 workers multiply average monthly net x 12 months. (Social security/disability also multiply x 12 months) • With logical arithmetic calculations, GHIM helps Georgia residents to calculate “projected” 2015 household income. • Not all family members must show income. Multiple family members may contribute to the total household income. • These are gross hourly pay thresholds that may be helpful in showing minimum family gross household income.

(Gross weekly projected paycheck $ (NOT take-home pay) x 52 wks should equal/exceed appropriate Family Size Min Household Income)

2.)  Who are the major private health insurance companies that provide Qualified Health Plans (QHPs) in Georgia? During last year’s (the 1st and extended) Open Enrollment Period, Georgia’s major Qualified Health Plan (QHP) participants were BlueCross/Blue Shield of Georgia, Humana and Kaiser. During this year’s (the 2nd and much shorter) Open Enrollment Period, Georgia’s major Qualified Health Plan (QHP) participants are Assurant, Blue Cross/Blue Shield of Georgia, Cigna, Coventry, Humana, Kaiser and United Health Care.

3.)  Are Qualified Health Plan (QHP) private insurance rates the same throughout Georgia? Georgia has the 2nd highest number of counties (159) of any state in the union (only behind Texas with 254). Clusters of geographically adjacent counties (whether urban or rural) will generally have very similar “after subsidy rates” (based on household income/family size/ age/county). Since there are so many counties in Georgia, there are also as many as15 different geographic rate/rating areas in Georgia and rates can vary widely. Georgia’s highest “after subsidy rates” (after the appropriately calculated monthly federal subsidies) are in Southwest Georgia. Georgia’s lowest “after subsidy rates” (after the appropriately calculated monthly federal subsidies) are in Southeast Georgia.

4.)  Do all of the Qualified Health Plan (QHP) private health insurance companies compete throughout Georgia? Those competing for the “subsidy eligible 100%-400% of the poverty level” may vary widely from geographic county region to geographic region. While some of the major Qualified Health Plan (QHP) private health insurance companies may have the most affordable “after subsidy rates” in one particular geographic county region, that same company may be relatively overpriced in others. (NOTE: Georgia Health Insurance Marketplace (GHIM) is provided 24/7 real time access to health insurance rates in Georgia and constructed a comprehensive study of all of Georgia’s 159 counties and all of Georgia’s different contiguous geographic county rates and rating areas.)

5.)  Who will I pay (if I have a payment) once my Qualified Health Plan enrollment application has been finalized? After GHIM has successfully enrolled the Georgia consumer into a Qualified Health Plan (QHP), the consumer will receive immediate confirmation both from FFM as well as the Qualified Health Plan (QHP) private health insurance company. The Qualified Health Plan (QHP) private health insurance company will contact you prior to the QHP policy effective date to let you know when the first payment (if any) will be due. You do NOT pay Georgia Health Insurance marketplace (GHIM). Our service is free to all Georgia residents.

6.) When do the automatic monthly federal subsidies (that lower my monthly payment) begin? Monthly federal subsidies (APTCs or Advance Premium Tax Credits) are paid immediately each and every month from the very start of your Qualified Health Plan (QHP) policy effective date. 

7.)  When will my Qualified Health Plan become effective and when will my first monthly payment (if any) be due?

8.)  Since Qualified Health Plan (QHP) rates are not based on medical underwriting and healthy people receive the same rates as unhealthy people, what is a general overview of how rates are determined within any one given geographic region of Georgia? To oversimplify the answer to that question, younger consumers with relatively higher household incomes will receive lower monthly subsidies and will therefore pay relatively higher “after subsidy monthly rates” . Older consumers with relatively lower household incomes will receive higher monthly subsidies and will therefore pay relatively lower “after subsidy monthly rates”.

9.)  What are the specific personnel advantages of a direct enrollment through Georgia Health Insurance Marketplace (GHIM) vs. Federally Facilitated Health Insurance Marketplace (FFM)? Both GHIM and FFM personnel share a common goal: To enroll consumers in Qualified Health Plans (QHPs) provided by the Affordable Care Act (also known as Obama Care). Both GHIM and FFM are free services. Both GHIM and FFM utilize However, Georgia residents may find these 3 differences to be important:

*NOTE: In fairness, whether it’s big government or big corporations, the difficulties of a massive enrollment program within a very short period of time are unavoidable (no matter who’s in charge). That’s why FFM has to use temporary independent contractors, not permanent government employees (except for supervisors). Once the Open Enrollment Period (OEP) ends, most of these temporary independent contractors go on to another job seeking new employment elsewhere. GHIM personnel are year round full time and we’re always available for you after your enrollment as well. GHIM certified personnel are trained, tested, certified and authorized by the Department of Health & Human Services (HHS), the Centers for Medicare & Medicaid Studies (CMS) and the Center for Consumer Information and Insurance Oversight (CCIO) and we’re dedicated to getting your enrollment done correctly and successfully for you.

10.)  What are the specific “technological advantages “of a direct enrollment through Georgia Health Insurance Marketplace (GHIM) vs. Federally Facilitated Health Insurance Marketplace (FFM)?

** NOTE: The above 5 FFM issues reported to GHIM during last year’s Open Enrollment Period were reported directly to GHIM by Georgia enrollees who had experienced these problems when initially trying to enroll themselves with FFM (either via or with the help of one of the FFM part time independent contractor representatives) . The frequency with which these issues were reported continued to increase throughout last year’s much longer Open Enrollment Period ended. Those Georgia residents who ended up migrating from FFM to GHIM due to the above issues represented almost 20% of GHIM’s first Open Enrollment Period enrollees. 

11.)  Whether I have Georgia Health Insurance Marketplace (GHIM) directly enroll me OR I do it myself through the Federally Facilitated Health Insurance Marketplace (FFM), what specific personal information  is required to be provided in order for me and my family to become qualified for the monthly federal subsidy for a Qualified Health Plan?  The  specific personal information that is required in order to receive a monthly federal subsidy (APTC) is as follows: (1) names of enrolling family members, (2) family size, (3) email address and phone number (4) gender and marital status, (5) dates of birth,  (6) tobacco use, (7) address, city, state, (8) county of residence,  (9) household income including projected 2015 income, (10) social security numbers and (l1) income source information. (NOTE: GHIM’s Pre-Enrollment Application does not include (10) social security numbers and (11) income source information. The reason for this exclusion is that GHIM deems it more appropriate if this particular personal information is shared instead through the private follow-up phone conversation between you and GHIM during your requested best days and times for GHIM to call you)

12.)  Those questions seem very simple and direct. Shouldn’t I be able to answer them myself? The answer to that is yes, you should.  If that was all there was to it, then the federal monthly subsidy enrollment process for a Qualified Health Plan would be fairly easy for everyone. Unfortunately, it’s much more complicated than that. Here’s why: (a) The verbal communication issues between enrollee and FFM independent contractor representatives can easily be misinterpreted (see FAQ #8). (b) The technical issues of have been well publicized and even the most tech savvy have wrestled with these ongoing issues (see FAQ #9). (c) GHIM directly assists you in determining the mathematical calculations of “anticipated “2014 end of year household income. (d) GHIM directly assists  you in determining the requirement of submitting “anticipated “ 2015 household income as well (this calculation is required as well) (e) GHIM  carefully navigates the federal matrix of household income, monthly federal subsidy, most affordable QHP monthly rate, and lowest possible annual deductible. (f) GHIM has a documented history of performing these functions with maximum success. GHIM’s purpose is to provide you with your lowest monthly rate (if any) with your highest monthly federal subsidy.

13.)  When should I submit my Qualified Health Plan (QHP) Pre-Enrollment Application? GHIM invites you to allow us to enroll you now. We can’t begin working for you until we’ve received your Pre-Enrollment Application Form for an Affordable Care Act (Obama Care) Qualified Health Plan (QHP) Please submit it now because we process Pre-Enrollment Applications on a first-come-first-served-basis. GHIM’s free service was buried during last year’s enrollment and this year’s is much shorter than last. Please submit your Pre-Enrollment Application Form immediately to be sure that your enrollment will be completed on time.

14.)  Will Georgia Health insurance Marketplace (GHIM) be able to handle the heavy influx of pre-enrollment applications and final enrollment applications during this year’s Open Enrollment Period? This year’s Open Enrollment Period will be much shorter than last year’s (the number of months has been cut in half) For this reason, GHIM has been proactive by initiating 2 new measures:

  1. Due to this year’s very short open enrollment period,GHIM is accepting ONLY pre-enrollment applications (either per our paper form or submitted online via our secure website), not verbal telephone applications.  GHIM is hopeful that this will reduce the amount of inbound calls during this very busy period. The majority of the time, we will be making outbound calls ourselves to follow-up with those who have submitted their pre-enrollment applications.
  2. Upon receiving the pre-enrollment application form that includes your preferred “Best time for GHIM to call in order to complete your final enrollment information”, GHIM will be contacting you by phone and at that time and will verbally verify your information from your pre-enrollment application form and ask you additional questions in order to finalize the enrollment application.

15.)  What is the difference between a Qualified Health Plan (QHP) Platinum Plan vs. a Qualified Health Plan (QHP) Silver Plan? To those at 100%-200% of the federal poverty level, a Silver Plan may be superior to a Platinum Plan because the Silver Plan’s annual deductible (through federally subsidized medical cost sharing reductions) is substantially reduced for those consumers at 100%-200% of the federal poverty level. However, regardless of the household income, a Platinum Plan may provide substantially lower co-pays (for Doctor Visits) than a Silver Plan. All of the plans (Platinum, Gold, Silver and Bronze) provide for free comprehensive annual physicals which are completely free and do not require any co-pay whatsoever.

16.)  Will my Qualified Health Plan rate ever go up due to changes in my health or because the plan had to pay a large medical bill for me? No. Thanks to the Affordable Care Act (Obama Care), that practice is now against the law. Individual and family rate increases will not happen due to changes in your health or because you had a large medical expense. "Overall" rate Increases for Qualified Health Plans are submitted, processed and administered based on federal guidelines in cooperation with the individual state. Generally speaking, the participating Qualified Health Plan private insurance company provider will submit an annual request for a rate increase (or sometimes even a rate decrease) which will be pending approval by a cooperating agreement with both the federal and individual state government. The outcome of the request (either for an increase or a decrease) becomes public on 11/15/2014. Although the following may not always be the case,  for lower-income and low-moderate income families, an increased monthly federal subsidy may be enough to absorb any rate increase and this cannot be confirmed until the latest rate submission approval has been made public.

17.)  What is the Special Enrollment Period (SEP) that happens AFTER this year’s short Open Enrollment Period (OEP)? The Special Enrollment Period (SEP) doesn’t begin until February 15, 2015 and it will end November 14, 2015. Unlike this year’s Open Enrollment Period (OEP), the SEP is limited ONLY to those who have had certain “life events”.  Enrollment is extremely limited during this time (but GHIM performs this function as well). These special “life events” allow you to enroll anytime within 60 days after the occurrence of the special life event. These life events are:

  1. Getting married.
  2. Having, adopting, or placement of a child.
  3. Permanently moving to a new area that offers different health plan options.
  4. Losing other health coverage (for example due to a job loss, divorce,  expiration of COBRA coverage, or a health plan being decertified). NOTE: Voluntarily quitting other health coverage or being terminated for not paying your premiums are  not considered loss of coverage. Losing coverage that is non-compliant is also not considered loss of coverage.)
  5. For people already enrolled in a Qualified Health Plan, having a change in income or household status that affects eligibility for APTC (monthly federal subsidies) or CSR (cost-sharing reductions).
  6. An individual, who was not previously a citizen, national, or lawfully present individual gains such status.
  7. An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. We must permit individuals whose existing coverage through a compliant and eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan.
  8. An Indian, as defined by section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month.