What We Do

Georgia Health Insurance Marketplace was established on July 10, 2011 (shortly after passage of the Affordable Care Act) in preparation for the full implementation of the federal health insurance marketplace and the anticipated coordination with state health exchanges. We began as a privately funded organization and we are devoted only to enrolling Georgia residents into Affordable Care Act plans.

We provide all Georgia residents (with or without subsidy qualification) the ability to get real-time marketplace quotes (set to exact federal quoting algorithms) and then to enroll or re-enroll in Georgia state exchange health plans offered through the federally facilitated marketplace. Our goal is to make it easier for any Georgia resident to (1) get an accurate quote based on the information provided (2) enroll in the marketplace through the marketplace’s Enhanced Direct Enrollment platform (3) enroll in a marketplace plan with full confirmation from the marketplace and the chosen insurance company. (4) receive almost 365-day access and accountable follow – through. The state of Georgia has one of the highest uninsured rates (for health insurance) in the nation. Georgia also has one of the highest average hospital costs in the nation as well. Our goal is to improve health insurance access for all Georgia residents.

Since 2013, we have helped thousands of Georgia household residents (both with and without monthly federal subsidies) to “Get a Quote & Enroll / Re-Enroll” in the federal health insurance marketplace. We make every attempt to simplify the process while at the same time understanding that the process may not seem simple.

We exclusively enroll Georgia residents with private insurance companies participating in Georgia state exchange health plans in the health insurance marketplace. All of the plans available through Georgia Health Insurance Marketplace are mandated to include (by federal law) the following: (1) All pre-existing conditions approved with no medical underwriting whatsoever; (2) No rate increases due to claims history; (3) No coverage ceiling on costly hospitalization and surgery; (4) Inclusion of the 10 essential health benefits in all marketplace insurance plans including: hospitalization, emergency services, laboratory services, prescription drugs, preventive and wellness services, chronic disease management, ambulatory out-patient services, pediatric services, pregnancy / maternity / prenatal / postnatal services / newborn care, rehabilitative & habilitative services and devices, mental health and substance use disorder services, and more.

The initial awareness program by the Department of Health & Human Services placed an emphasis on the benefits but less emphasis on actually qualifying and enrolling. The unintended consequence was that the de-emphasis created unfounded marketplace insurance myths:

Household income estimating mistakes made by Georgia residents during health insurance marketplace enrollment are hair-trigger sensitive to the actual amount the Georgia resident will be paying. These mistakes affect Georgia residents from all socio-economic levels.

Educating Georgia consumers has been an important part of our original 2013 SEED Mission Statement: Simplify-Educate-Enroll-Document. We have made it easier to enroll in the health insurance marketplace and do everything possible to educate Georgia residents on some of the basic facts about Affordable care Act plans.

MYTH: “Obamacare (Affordable Care Act marketplace insurance) is only good for Georgia’s poor people.”

FACT: Since Georgia doesn’t have expanded Medicaid, many poor folks don’t qualify for any financial help. Family sizes of 1-2-3-4-5-6 earning LESS than $12k / $16k / $21k / $25k / $30k / $34k do NOT qualify.

MYTH: “Our household income is too high to qualify for monthly federal assistance to help pay for the plan.”

FACT: Family sizes of 1-2-3-4-5-6 earning LESS than $48k-$64k-$82k-$100k-$120k- $135k DO qualify

MYTH: “Lower middle-class and middle-class households don’t qualify for lower deductible silver plans.”

FACT: Family sizes of 1-2-3-4-5-6 earning (13-31k) (17-42k) (22-52k) (26-62k) (31-75k) (35-85k) DO qualify.

MYTH: “PPO primary care physicians/specialists are better than HMO primary care physicians/specialists”

FACT: Go into a physician’s waiting room. There’ll be patients with PPO plans & patients with HMO plans. Georgia physicians treat patients equally, whether the patient is in the physician’s PPO plan or HMO plan.

MYTH: “We did our application for a marketplace plan years ago and enrolled in the lowest priced silver plan.”

FACT: The “lowest priced silver plan” changes every year. You might be paying more than you need to be.

MYTH: “We did a marketplace application years ago, so we don’t need to update our yearly income.”

FACT: Updated household income is by far the most important factor affecting your monthly payment.

Unfortunately, there is still state-wide confusion about federal health insurance exchange plans in general and Georgia state exchange health plan enrollment in particular. In spite of the initial efforts by federal health insurance marketplace navigators in Georgia, there are still qualifying regulations that are misunderstood by many Georgia residents from all socio-economic backgrounds and circumstances. This confusion has led to some Georgia residents being rejected when they were actually qualified. It has also led to other Georgia residents never bothering to apply because they thought they couldn’t afford it. There are still many Georgia residents who are unaware that marketplace plans accept all pre-exiting conditions, without exception. Underwriting for medical conditions for marketplace plans is against federal law. That’s a direct opposite of short-term plans or alternative cost-sharing plans. Only marketplace plans are qualified Health Plans.

Since 2011, we’ve been at the forefront helping Georgia residents with health insurance marketplace enrollment. To re-enroll or enroll in the marketplace and then re-enroll or enroll in a marketplace plan should be a process that every Georgia resident should be able to do. These are 2 different processes. The federal government application and the enrollment into a chosen plan are very different. Even though one comes after the other, the process is such that Georgia residents first choose a plan based on their initial quote and then enroll to determine a confirmed amount of federal assistance and then enroll in a plan with the federal assistance becoming built into the plan on a confirmed basis.

The process of federal health insurance exchange enrollment is explained in detail on our homepage and in the Know More section of our website and it is a helpful learning tool that is generally easily understood. To apply for marketplace plan, and then re-enroll or enroll in the marketplace, all Georgia residents may start the process by clicking the “Get a Quote & Enroll / Re-Enroll” icon on our home page. By far the most important aspect is the initial quote. If a Georgia resident miscalculates household income or inputs family size incorrectly, then the initial quote can be an amount that is not a true indication of the amount of monthly financial federal assistance available. If on the initial quote, the applicant put in 3 different household incomes, there would in turn of course be 3 different quotes. All too often, Georgia residents are far too cavalier when it comes to diligently estimating household income for the calendar year in which they will be insured.

The new Enhanced Direct Enrollment platform introduced by the Health Insurance Marketplace has made it even easier for us to continue to help any Georgia resident to complete their application for marketplace plan on the federal health insurance exchange. The Enhanced Direct Enrollment system integrates the initial quote, the federal application, the federal eligibility notice, the federal confirmation, the confirmation of the plan selection, notification of the need for the Georgia resident to supply (upload) verification documents and the ability for Georgia residents to create their own Dashboard.

Every Georgia resident getting a quote and applying and enrolling receives documented confirmations from three sources: (1) the federal marketplace; (2) the Enhanced Direct Enrollment platform (HealthSherpa) and (3) the marketplace insurance company participating in Georgia state exchange health plans. The Enhanced Direct Enrollment platform is a fully integrated enrollment and confirmation system that allows Georgia residents easy access to their entire application, enrollment, confirmation, documentation history including the inclusion of their IRS Form 1095A (sent to each resident for use to coordinate with their federal tax return for the year in which they were most recently enrolled.

All marketplace insurance plans, including quoting, initial plan selection, enrollment application, plan confirmation, and enrollment confirmation documentation are administered through HealthSherpa, the only federally certified Enhanced Direct Enrollment system allowing Georgia residents the ability to directly enroll in the federal health insurance marketplace. We are fully integrated with the federal marketplace quoting and enrollment algorithms and all enrollments and confirmations are done in real time.

To enroll in a marketplace plan, the process is now easier and more seamless for Georgia consumers. The federal health insurance marketplace created the Enhanced Direct Enrollment platform for greatly improved enrollment. Many states participate in the federally facilitated marketplace. The state of Georgia is one of those states. A federally facilitated marketplace state is often a state that does not have what is called “expanded Medicaid.” This means that adults in Georgia households who have upcoming (2020) estimated household income projected to be below 100% of the federal poverty level, will not qualify for monthly federal financial assistance.

Through our Enhanced Direct Enrollment platform provided by HealthSherpa (the only Enhanced Direct Enrollment platform working with the federal health insurance marketplace), we streamline all quoting, applications and enrollments. Any Georgia resident who wants to re-enroll or enroll in the health insurance marketplace should understand the vital importance of making every attempt to accurately estimate your household income for the calendar year for which you are to be covered. 2019 coverage means 2019 household income estimate and 2020 coverage means 2020 household income estimate. Georgia residents will find our homepage tutorial to be extremely helpful in understanding the importance of estimating household income in preparation for your actual enrollment.

If you enroll in the federal health insurance marketplace during 2019 Special Enrollment Period (SEP 12/16/2018 through 10/31/2019) you are therefore seeking insurance for 2019 coverage. This means that your estimated household income must be based on your estimated 2019 calendar year household income final. That would be because you are requesting to be covered during the remainder of the calendar year 2019 and you will be filing your 2019 tax return in 2020.

If you apply for marketplace plan during the 2020 Open Enrollment Period (OEP 11/1/2019 through 12/15/2019) or during 2020 Special Enrollment Period (SEP 12/16/2019 through 10/31/2020) you are therefore seeking marketplace insurance for 2020 coverage and your household income estimate is to be based on your 2020 income (for the tax return filed in 2021). This means that your estimated household income must be based on your estimated 2020 calendar year household income final. That would be because you are requesting to be covered during the remainder of the calendar year 2020.

Our Enhanced Direct Enrollment quoting system mirrors the exact federal health insurance exchange quoting algorithms for all Georgia plans. If you put in an accurate household income estimate, then your monthly payment for your marketplace plan enrollment will be completely accurate. If a Georgia household submits the exact same household income and tax household size on their initial quote after clicking the “Get a Quote & Enroll / Re-Enroll” icon, that same quote will appear after the Georgia resident has completed their application for marketplace plan in the Health Insurance Marketplace’s Enhanced Direct Enrollment platform.

When you enroll in the marketplace, if there is any difference in the final quote, it would only mean that the initial 2020 yearly household income estimate (from all tax household family member’s income) was different than what was submitted immediately prior to receiving the initial quote. During the initial quote, a Georgia household could theoretically fill in 3 separate estimates for 2020 household income and the applicant would end up viewing 3 different quotes each time for all plans. Applications for can now be completed faster and documentation is also more comprehensive since enrollment includes comprehensive documented confirmations both from the health insurance marketplace as well as the Enhanced Direct Enrollment platform (HealthSherpa) and from the chosen insurance company.

Georgia Health Insurance Marketplace provides fully documented confirmations both from the health insurance marketplace and from the marketplace’s certified enhanced direct enrollment platform. The easy and logical steps to receiving fully documented federal health insurance exchange enrollment confirmations are fairly simple and intuitive. They summarize the income data input in the application and announce the monthly financial help and this allows the Georgia resident to go ahead and enroll in the plan they had originally chosen.

1.To apply for marketplace plan (or to re-enroll and choose a new plan) or (renew your existing plan), the Georgia resident must first click the “Get a Quote & Enroll / Re-Enroll” red icon on the website. This begins the process for you to enroll in the marketplace. It is a fairly easy and seamless process and many Georgia residents finish the process within 15 minutes depending on family size. Always have accurate dates of birth and social security numbers ready for all tax household family members, whether they are seeking coverage or not. Tax household family size can be verified by submitting complete information for all family members only.

2. Answer the initial for questions: (zip code) (who needs coverage) (how many members are in your tax household) and (estimated yearly household income for the calendar year of your upcoming coverage)

3. Choose health insurance from the menu of plans available to you through the federal health insurance marketplace. Look at the plan details and pay attention to the copays and deductible. The deductible is the main criteria that determines cost unless a Georgia resident qualifies for medical cost reduction.

4. Click “add to cart” once you have chosen either a bronze, silver or gold plan from the menu of federal health insurance exchange plans available. Once this is done, you will be directed to the beginning of the application, where you will first attest to the privacy statement and then verify your identity.

5 Start application for marketplace plan in order to enroll in the federal health insurance marketplace. At this point you are not applying to the private insurance company but rather the federal government in order to verify your qualifications for monthly financial federal assistance, or the advanced premium Tax Credit (APTC).

6. Agree to privacy statement from HealthSherpa. Health Sherpa works exclusively with the health insurance marketplace to help you qualify Georgia residents for coverage and is the federal marketplace’s only certified and approved Enhanced Direct Enrollment platform available. The privacy statement affirms that your information will be used only to qualify you to enroll in the health insurance marketplace. Information is used for that purpose and that purpose only. However, your information will be shared with other federal departments as needed to validate your qualifications to enroll and receive assistance. It is much less intimidating than it sounds.

7 Answer identity verification questions to verify that it is you (and/or family members) who is requesting health insurance marketplace enrollment. These are questions that you will know and are derived from a database of information with answers that Georgia residents should be able to answer. If two spouses are applying, it’s best if both look at the questions together.

8.Complete the application for marketplace plan. You will not be eligible to enroll in one of the federal health insurance exchange plans until you have completed the application. It is advised that you have all social security numbers and all correct dates of birth ready in advance for all family members (including those not applying for coverage) before you begin the application. Make a mistake on a date of birth or a social security number sometimes results in a citizen having to actually prove their citizenship. Exactitude is important.

9. Click “Download Letter” (*****and please read it). This is your federal eligibility notice which allows you to enroll in a marketplace plan and will be addressed to you. I will be from the Department of Health & Human Services and the health insurance marketplace. This is your initial confirmation prior to your completion of your marketplace plan enrollment and tells you that your next step is to choose a plan. Affordable Care Act health insurance enrollment is not considered complete until you choose a plan. *****NOTE: Full content overview of the federal eligibility letter is shown below. Be sure to read the federal eligibility notice (letter) carefully because there may be due dates involved and it’s vitally important that those due dates are not missed. Missing a due date can mean loss of monthly financial federal assistance, which can mean you may end up being without health insurance until the next year’s Open Enrollment Period (OEP11/1-12/15)

10. Click “Enroll in this plan”. This will be the same initial marketplace insurance you chose when you clicked “add to cart”. Once you enroll in a marketplace plan, you begin receiving further confirmation emails from the federal marketplace, from HealthSherpa and later on from the private insurance company and plan you chose. These emails are important. If you elected to receive communication via regular mail, you will receive that as well from both the marketplace (in London, Kentucky) and from the private insurance company you chose.

11. View the confirmation screen also inviting you to create your own Marketplace Dashboard (This is optional but you will find your own Marketplace Dashboard to be extremely helpful and useful). Your Dashboard enables you to see your application for marketplace plan, view plan details, change marketplace insurance plans, view monthly financial assistance amount (APTC, federal subsidy amount), make changes to your application, download your IRS Form 1095A and so much more. Your pre-populated username is the email address used in your application for marketplace plan. You’ll need to create your own 6+ digit password. Please remember your password. You will find your own Dashboard to be extremely helpful.

12. Receive further confirmation emails from the health insurance marketplace and receive further emailed confirmation from the marketplace’s Enhanced Direct Enrollment (HealthSherpa). Receive emailed confirmation of plan name, initial premium and applicable phone number to call to make your initial payment. Receive email and/or mail from your chosen marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) letting you know that you must make your initial payment in order for your coverage to begin. You will have the choice of making your initial payment via the phone number provided on your confirmation or you may a make your initial payment through your Dashboard.

***** Eligibility Notice (letter) from health insurance marketplace. When a Georgia resident completes their online application for marketplace plan and before they choose one of the state exchange health plans, they will first download (and/or view) their own confirmed eligibility notice (letter) online. The eligibility notice (letter) will confirm the following:

1) Whether or not you qualified for Open Enrollment (11/1-12/15) or Special Enrollment (12/16-10/31).

(2) Whether or not you qualified for financial assistance (APTC) and exactly how much you qualified for.

(3) Whether or not you qualified for cost sharing reductions (CSR) that lower co-pays and deductible.

(4) The yearly household income that was reflected in your application.

(5) The next step you need to make (choosing a marketplace plan / generally the original one chosen).

(6) Another next step you need to make (“possibly” requested document verification)** due in 60-90 days.

** During Open Enrollment Period (11/1-12/15) and Special Enrollment Period (12/16-10/31), all Georgia residents who have been requested to send/upload documentation verification by a certain date (usually income verification such as a copy of latest online pay statement), MUST make sure that the marketplace actually receives it by that requested deadline. If not, the marketplace will stop making monthly financial assistance payments (on your behalf) to your chosen marketplace insurance company. Generally, this results in a cancellation from the insurance company itself after they have sent you a new invoice for the unsubsidized monthly payment.

Georgia Health Insurance Marketplace is required by federal and state laws to protect the personally identifiable information (PII) of any Georgia resident making application for marketplace plan.

To apply for marketplace plan and complete federal health insurance exchange enrollment in Georgia state exchange health plans, Georgia residents are required to share personally identifiable information (PII) in order to qualify for monthly federal financial assistance. By their very nature, enrollment means that your personally identifiable information will have to be communicated to multiple federal agencies including the Internal Revenue Service (IRS) due to the taxpayer funded nature of the enrollment itself.

This is unavoidable. In order for your application process to go faster, it is highly advisable that before you start your application, you have all of the correct dates of birth and social security number of all family members handy. This includes family members in your tax household who are and who are not applying for coverage.

Also, make absolutely sure that the name(s) on the application is an exact match of the name on the social security card. However, it is not necessary to include the middle name. This is particularly important for married females who may or may not have changed their name on their social security card when they got married.

An application with an incorrect date of birth or an incorrect social security number may end up triggering a request for “documentation of immigration status” because the applicable date(s) of birth and social security number(s) were input incorrectly by you in the application marketplace.

Another required item to have handy will be the phone number for a company employer. This information is necessary for every employed family member (with job income) even of they are not applying for coverage. Neither the marketplace nor the insurance company will actually be calling your employer. However, it is required information nonetheless if there is any income originating from a job. Any request for employer address is totally optional and therefore unnecessary.

Every marketplace insurance company able to accept Georgia state exchange plan enrollment actually receives 2 payments every month. The health insurance marketplace (through the Department of Health & Human Services) makes 1 payment each month (on your behalf) to your chosen private insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar).

That 1 payment (monthly financial assistance) each and every month represents what is called your advance premium tax credit (APTC). The other payment is made by you, the Georgia resident, and sometimes your payment may only represent a relatively small percentage of the actual cost of the federal health insurance exchange plan. (Real cost of marketplace insurance plan) minus (APTC) equals (Consumer payment).

Many Georgia consumers who enroll in the federal health insurance marketplace are benefitting by having substantial amounts of monthly federal assistance (paid each month on their behalf) by the federal health insurance marketplace.

Generally speaking, it is not unusual for lower and lower-middle income Georgia married couples (100%-250% of the federal poverty level) between the ages of 55-64 to receive anywhere from $12,000-$20,000+ in annual financial federal assistance. It becomes understandable that when Georgia resident household(s) complete marketplace plan enrollment and choose marketplace insurance plans, they are required to submit personally identifiable information (PII) in order to qualify for monthly federal financial assistance

PII such as names of all tax household family members, street address, email address, dates of birth of all tax household members, social security numbers of all tax household members, all household income sources and much more. The reason why Affordable Care Act health insurance enrollment requires all of this PII is to make certain that the Georgia household actually qualifies for the financial help in the first place. The Enhanced Direct Enrollment platform used by Georgia Health Insurance Marketplace is the only secure health insurance marketplace enrollment platform certified and approved by the marketplace. Protecting the personally identifiable information of a Georgia household completing a Georgia state exchange health plan enrollment is our top priority.

Georgia residents who enroll in the health insurance marketplace and choose federal health insurance exchange plans need to feel comfortable knowing their personally identifiable information is protected. It should be important for Georgia residents to know that the Georgia Health Insurance Marketplace secure website is a consumer-friendly public site that honors the strict privacy of Georgia residents. If you’ve ever gone online in the past looking for health insurance and suddenly your phone becomes bombarded with unwanted phone-calls from unknown phone numbers from unknown private health insurance agents all over the country, you can take comfort in knowing that it is impossible for this to ever happen as a result of visiting Georgia Health Insurance Marketplace. We guard your privacy and we respect your privacy. We enable Georgia residents to apply for marketplace plan through the federal health insurance marketplace and enroll in a marketplace plan through online enrollment and fat the same time be assured that your personally identifiable information (PII) has been thoroughly protected.

Finally, it’s important for Georgia residents to know that the Georgia Health Insurance Marketplace secure website is a consumer-friendly public site that honors the strict privacy of Georgia residents. We never share your information with any other private entity. On the upper portion of your quoting screen you will see a name of a Georgia Health Insurance Marketplace authorized and certified representative. That person will be the only individual who will have access to your quote and application and enrollment and Dashboard. The inclusion of that name is for your convenience and lets you know that there is an identifiable individual available to help you only at your request. There will never be an initiated call from Georgia Health Insurance Marketplace. You deserve to be able to complete your own application undisturbed in the privacy of your own home without receiving any unwanted follow-up calls.

Moreover, using a “fake” name or “fake” email address or “fake” phone number when you click our red “Get a Quote & Enroll / Re-Enroll” icon may put you at risk for that information to become pre-populated onto your federal application. Undoing that false information can be problematic, particularly when you reach the “initial” part of your federal application that includes your Privacy Statement attestation from HealthSherpa and your Identity Verification questions in the marketplace’s Enhanced Direct Enrollment platform.

If you’ve ever gone online in the past looking for health insurance .and suddenly your phone becomes bombarded with unwanted phone-calls from unknown phone numbers from unknown private health insurance agents all over the country, you can take comfort in knowing that it is impossible for this to ever happen as a result of visiting Georgia Health Insurance Marketplace. We guard your privacy and we respect your privacy.

We enable Georgia residents to apply for marketplace plan through the federal health insurance marketplace and enroll in a marketplace plan through online enrollment through our secure enrollment website

When you apply for marketplace plan, your application for marketplace plan is not considered to be complete until you have made your initial payment (premium). If you qualified for monthly financial federal assistance (APTC / Advanced Premium Tax Credit), this means that there will actually be 2 payments made each month (on your behalf) to your own chosen marketplace insurance company. Those participating Georgia state exchange health plans are Alliant, Ambetter, Anthem, CareSource, Kaiser and Oscar. One payment is made by the government and one payment is made by you. If you fail to make your initial payment before the start date of your new plan, your enrollment will be cancelled. Don’t let this happen. Your confirmation page will give you the payment phone number for your selected private insurance company. You will also get an invoice from them through the mail. However, whatever the circumstance, make sure you make your initial payment before the effective date.

When Georgia household qualify for financial assistance, the monthly payment alone does not represent the full cost of the marketplace plan. The full monthly cost of marketplace insurance plans minus monthly financial assistance from the federal health insurance exchange equals the Georgia household’s monthly payment. If you never make your initial payment, the payment already made by the government on your behalf will be returned and your policy will not go into effect and you will have to wait until next year’s open enrollment in order to enroll again.

Your federal health insurance exchange enrollment will always have an effective date. When you re-enroll or enroll in the health insurance marketplace during Open Enrollment Period (OEP 11/1-12/15), your effective date will be January 1. The initial payment (also called a binder payment) is vitally important. Generally speaking, companies won’t send out cards until the payment is made. If you do receive a card prior to making your initial payment, you’ll discover that an attempt (intentional or unintentional) to use the card prior to the initial payment being will result in the applicable medical office letting you know that your coverage is not in force yet due to non-payment.

During Special Enrollment Period (SEP 12/16-10/31), the effective date will depend on the exact date that you completed your marketplace plan enrollment. If completed prior to the 15th of any given month, the effective date will be the 1st of the following month. If completed after the 15th of the month, the effective date will be the 1st of the month after the following month.

Those private insurance companies available for Affordable Care Act health insurance enrollment carry with them enormous liability for every Georgia policyholder. When you enroll in a marketplace plan, all pre-existing conditions and unlimited hospitalization costs are covered. Because they carry unlimited liability (there is no ceiling with marketplace plans), the timeliness of your payment to them becomes important. Once a company cancels you and your plan enrollment, there is no special enrollment period for those who lost their coverage due to non-payment. It’s a “non-qualifying” life event.

This liability begins on the first day of the effective date. Federal health insurance exchange plans have no waiting periods. Full coverage is immediate once you have made your initial payment. The federal health insurance marketplace makes their payment (on your behalf) prior to the beginning of the month. When you re-enroll or enroll in the marketplace, you are expected to make your payment before the effective date.

Georgia Health Insurance Marketplace never accepts initial payments or ongoing payments for Georgia state exchange health plan enrollment. Instead, a Georgia consumer who completes their application for marketplace plan will make their initial payment and their ongoing payments directly to the private insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar). There is also an option for you to make your initial payment (but not ongoing payment) through your own Dashboard. Your payment is transmitted directly to your chosen company. However, every enrolling Georgia resident always has 3 different options for making their initial payment. It doesn’t make any difference to us. Just understand that we cannot accept any payments on behalf of Georgia resident.

Through the health insurance marketplace Enhanced Direct Enrollment platform, there are 3 options:

(1) After clicking “Enroll in this plan”, call the phone number provided for your chosen marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) that appears on your enrollment confirmation screen.

(a) You must provide the name, date of birth and social security number of the primary policyholder.

(b) During Open Enrollment Period (OEP November 1 through December 15) it is highly recommended that you allow your chosen marketplace insurance company 3-4 working days (sometimes more) to fully process your marketplace plan enrollment. Understand that the 45-day Open Enrollment Window is a very compressed time when private insurance companies are overloaded with new enrollments and re-enrollments from marketplace applications. Also keep in mind that private insurance companies do not and cannot accept direct enrollments without them first going through the marketplace. Authorization and enrollment must always come from the marketplace first.

(c) An application for marketplace plan is a process that tens of thousands of Georgia households all do within a confined 45-day period during every open enrollment period. As long as you make your initial payment prior to either December15th (highly recommended) or at the latest any time prior to January 1st, your health insurance marketplace plan will be fully in force on the 1st day of your effective date. Don’t forget to pay your chosen company before the due date or you may be uninsured for the remainder of the calendar year.

(2) The email from “no_reply@healthsherpa.com” “Subject: (Action required)” also provides you with the phone number for your chosen marketplace insurance company and gives you the additional option to pay through your Dashboard. HealthSherpa is the Enhanced Direct Enrollment certified platform that works with the health insurance marketplace. Your Dashboard is an invaluable and very useful post-enrollment tool that provides Georgia households with literally everything about your health insurance marketplace enrollment.

(a) Your Dashboard accepts the initial payments only and not accept ongoing payments.

(b) The initial payment through your dashboard is transmitted directly to your chosen insurance company

(c) All of your data from your application for marketplace plan is also transmitted directly to the company.

(d) To make your initial payment through your Dashboard, you will need to create a 6+digit password. Your username is pre-populated as the email address used in your health insurance marketplace enrollment

(3) Wait to receive an email and/or regular mail invoice from your chosen private marketplace insurance company Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) and they will also give you several options as well.

(a) You may call their payment line phone number (the same number provided on your enrollment confirmation screen and in the email from “no_reply@healthsherpa.com” “Subject: (Action required)” They will take your initial payment and can also set up your payments for automatic future payment. This is highly recommended in order to avoid a lapse of coverage or temporary suspension or cancellation due to missed payments(s).

(b) You can create an online account with your chosen insurance company enabling you to make your initial payment and to make ongoing future payments or ongoing automatic payments online.

Again, Georgia Health Insurance Marketplace does not accept either initial payments or ongoing payments for Georgia state exchange health plans through the health insurance marketplace. Payments are made directly to your chosen private marketplace insurance company (Alliant, Ambetter, Anthem, CareSource, Kaiser, Oscar) and are only made through any of the 3 options detailed above.

In the summer of 2013, in anticipation of Georgia’s inaugural Affordable Care Act health insurance enrollment, Georgia Health Insurance Marketplace conducted a comprehensive set of rate studies in order to understand the wide rate variances (and accompanying APTCs) for all of Georgia’s districts encompassing all 159 Georgia Counties. The first open enrollment period was marked by massive confusion by many Georgia households. Of all the state health exchanges, the state of Georgia (among others) is a federally facilitated marketplace state. This means that the state of Georgia does not have expanded Medicaid. This also created confusion because many Georgia residents whose household income was below 100% of the federal poverty level, did not actually qualify for monthly federal financial assistance.

Since 2013 was the first year for Georgia state exchange health plans, we had a learning curve ourselves and we wanted to be fully prepared to deal with the many questions that would arise. We began to understand the federal algorithms that led to particular monthly rates for households within various percentages of the federal poverty level.

The study underscored the importance of being able to explain why one particular family with similar socio- economic data might pay more or less than a similar Georgia family. When an application for marketplace plan was completed, we were able to comfortably explain to a Georgia resident why he or she was paying more or less than others they knew.

Since monthly rates are not derived from health conditions but rather by numbers (zip code, family size, household income, how many are applying, etc), it became awkward in the early days to explain the rate divergence.

During the early years, there were also 7-8 different private health insurance companies participating in the health insurance marketplace in Georgia. Today there are 4. At the time, since each private insurance company had its own group of actuaries to determine the pre-subsidy rates for each of the counties in which they were participating, there were often marked differences in “original rates”’ (before the subsidy) amongst all of the companies.

Since marketplace insurance plans included unlimited coverage for pre-exiting conditions, no one company had any track record of the amount and size of medical claims they might expect. To put the initial situation in an even greater sense of flux, there were some Georgia counties with 4-6 different participating companies and other Georgia counties with only 1. These counties with only one participating provider were usually counties in Georgia’s lower income counties in southeast and southwest Georgia.

The state of Georgia has more counties (159) than any other state in the union (except for Texas). With all of the state exchange health plan enrollment in Georgia’s poorest counties being represented by only one insurance company, this eventually led to the original company leaving and another one coming in to replace it. Primary Care Physicians in those underserved counties had to quickly change from one marketplace insurance company to another. This was also a point of confusion since many primary care physicians were unaware of this until it had already happened. We were there from the beginning through the initial state of flux

Since that time, Georgia Health Insurance Marketplace has helped tens of thousands of Georgia residents to re-enroll and enroll in the federal health insurance marketplace. Even though things have settled down somewhat, we continue to do fully comprehensive annual rate studies (for each Georgia county) in order to be aware of the rate changing landscape.

We’ve come a long way since 2013 and we will continue to help all Georgia residents to: (a) Obtain marketplace quotes that will qualify them for the maximum allowable financial assistance; (b) Choose among plans that are affordable and make sense for their household; (c) Easily enroll or re-enroll using our new Enhanced direct enrollment platform; (d) Get enrollment documented confirmations in real-time; (e) create their own marketplace dashboard so that they can manage their own application, enrollment and documents.

We are here to help Georgia residents almost 365 days per year. Our new health insurance marketplace certified Enhanced Direct Enrollment platform now makes it easier for any Georgia household to be able to fully compare prices, savings, benefits, plan details, co-pays and deductibles all before they apply for marketplace plan and receive full documented confirmations.

After the first open enrollment period in 2013, we began a comprehensive summary of all of Georgia’s federal health insurance exchange geographical districts in order to gain a deeper understanding of the rate structures of all of the offered plans. In the early years, Alliant, Ambetter, BlueCross BlueShield, Coventry, Humana, Kaiser and United Healthcare all participated. However, Coventry, Humana and United Healthcare all eventually stopped offering individual marketplace insurance.

In 2018, Anthem (BlueCross) also stopped offering individual marketplace insurance plans in the metropolitan Atlanta area as well but then returned again in 2019. The plans that remained steadily from the very beginning (Alliant, Ambetter and Kaiser) experienced growing plan enrollment. Those plans that dropped out did so because they lost billions (in Georgia and in other state health exchanges). Over time we became acutely aware of the details involving the ebb and flow of all of the different rate structures of all Georgia health plans.

Every year since then, prior to the applicable annual open enrollment period, we conduct our own ongoing marketplace plan rate studies for all Georgia state exchange health plans in all 159 Georgia counties. During the late summer and early fall months (preceding the November 1 start of the annual open enrollment period), we receive information from all private insurance companies offering Georgia state exchange health plan enrollment. This information gives us a better understanding of plan changes for the upcoming open enrollment and those changes become available to the public on our Enhanced Direct Enrollment quoting system as well.

During that same period, we are revising federal poverty levels by family size. These change every year as the cost of living goes up. A Georgia household’s percentage of the federal poverty level and the number of family members (enrolling or not) in the tax household have a direct bearing on the Georgia household’s monthly rate quote for both open enrollment period and special enrollment period. Federal health insurance exchange enrollment for those Georgia households between 100%-400% of the federal poverty level means that when they complete their application for marketplace plan, they will be paying a percentage of the actual plan cost.

As the actual plan costs increase, the monthly subsidies generally do as well. When you apply for marketplace plan, your monthly payment is designed to be equal than or less than a pre-specified percentage of your estimated household income based on your tax household size. The accuracy of your household income estimate is vitally important when you re-enroll or enroll in the federal health insurance marketplace. Each year, the participating private insurance companies all have contrasting rate increases.

Every year, marketplace insurance plans, acting independently, announce different rate increases for the state of Georgia. However, they are only able to announce their overall rate increase for the composite of the counties in which they are participating. While their plans in one set of counties may be minimal, rate increases in other counties may be more significant. This is another reason why every Georgia household already enrolled in a plan should revisit all of the health insurance marketplace plans available.

This is important because the data inside every Georgia resident’s own personalized upcoming IRS Form 1095A includes the applicable cost of what is referred to as the “benchmark” rate. The benchmark rate is the 2nd lowest cost silver plan was available during the prior year’s health insurance marketplace enrollment. Unless a Georgia resident resides in a Georgia county with only one private company participating in the health insurance marketplace, that 2nd lowest silver plan for one year may well not be the 2nd lowest silver plan for the next year. This phenomenon is most evident in the Atlanta metropolitan area.

If this scenario isn’t complicated enough to you already, consider the fact that you may enroll in a marketplace plan during a prior year and never notice that the same plan has higher co-pays and deductibles the following year. Even though all plans on the federal health insurance exchange must offer (by federal law) the same 10 essential health benefits (whether bronze, silver or gold), they are not required to offer the same co-pays and deductibles. These are the other moving parts that change every year as well.

All we do is Affordable Care Act health insurance enrollment. It is therefore incumbent upon us to remain laser focused on all of the significant changes that occur each and every year inside the federal health insurance exchange. When Georgia residents click the “Get a Quote & Enroll / Re-Enroll” icon, they are assured of being able to choose among all of the updated marketplace insurance plans available. More importantly, each plan on the menu includes all plan details, benefits, updated co-pays and deductible options.

When Georgia residents enroll in the marketplace and then enroll in a marketplace plan, they are provided with every decision-making tool available. Because this is what we do and it’s all we do, the details available to Georgia residents are designed to help Georgia residents qualify for maximum allowable federal financial assistance for a plan that’s affordable and makes sense for you and your family. The federal health insurance marketplace offers valuable benefits not available in short term plans. Your enrollment and re-enrollment deserve your special attention. It should be one of the most important decisions you make each and every year.

Georgia Health Insurance Marketplace educates Georgia residents on Cost Sharing Reduction. Thoughtful and reasonably accurate yearly household income estimates (based on current income) are not only important in determining monthly federal financial assistance (advance premium tax credits) but are also important in determining Cost Sharing Reduction (CSR).

CSR is available only on silver marketplace insurance plans. Cost Sharing Reduction means Georgia household family sizes in certain income categories also qualify for lower co-pays and lower deductibles: This means lower hospital bills and lower co-pays for doctor bills and prescription drugs.

(For simplicity, amounts are rounded up)

Family Size of 1: Estimated 2020 yearly household income MORE than $12,500 and LESS than $31,000
Family Size of 2: Estimated 2020 yearly household income MORE than $17,000 and LESS than $42,000
Family Size of 3: Estimated 2020 yearly household income MORE than $21,500 and LESS than $53,000
Family Size of 4: Estimated 2020 yearly household income MORE than $26,000 and LESS than $64,000
Family Size of 5: Estimated 2020 yearly household income MORE than $30,500 and LESS than $75,000
Family Size of 6: Estimated 2020 yearly household income MORE than $35,000 and LESS than $86,000

When you apply for marketplace plan and successfully complete your marketplace plan enrollment, both the Georgia Health Insurance Marketplace quoting algorithm system and Enhanced Direct Enrollment platform will confirm your eligibility for both monthly financial assistance as well as cost sharing reduction.

There are distinct multiple advantages for lower and middle-income Georgia residents who enroll in the health insurance marketplace and in one of the state exchange health plans. Three different CSR levels (explained more fully on the homepage and in the KNOW MORE section of our website) are based on three different income levels: 100%-149%, 150-199% and 200%-249% of the federal poverty level.