Individual Health Insurance in Georgia: 6 Things You Probably Didn’t Know

Health care is never a simple topic. In Georgia, as in the rest of the United States, new laws and other changes can have a significant impact on your health plan options. Below are six things you probably didn’t know (but should know) about individual health insurance in Georgia.  

1.      New Report Shows Average Monthly Premium of $710 for Gold Health Plan in Georgia.

The Georgia Department of Community Health Waiver Project has released the Georgia Environmental Scan Report, which looks at the current health care environment in the state.

Here are some of the surprising facts revealed in the report:

·         14.8 percent of Georgia’s population was uninsured in 2017. In some counties, the uninsured rate exceeded 30 percent. For comparison, 10.5 percent of the national population is uninsured.

·         The number of consumers in Georgia who selected a plan on the Marketplace fell 15 percent from 2015 to 2019. In 2019, the average monthly premium was $710 for a Gold plan, $622 for a Silver plan and $496 for a Bronze plan.

·         A total of seven rural hospitals have closed in Georgia since 2010. This is the third highest closure rate in the country. Two-thirds of Georgia’s 159 counties are considered rural, while 83 percent of the state’s population resides in urban areas. 

Key Takeaway: When you shop for individual health insurance, see if you can find rates that are better than those available in the Marketplace.

2.      Research Shows Big Discrepancies in How Much Hospitals Charge.

Research from the RAND Corporation finds that private health insurance plans pay high prices to hospitals compared to Medicare, and that there is significant variation in prices. The study looked at the hospital prices paid between 2015 and 2017 in 25 states.

Georgia was among the states included in the report. According to the findings, private health plans paid amounts that were 243 percent of Medicare costs in Georgia.

Key takeaway: When you need an expensive health care procedure or surgery, make sure to ask how much it will cost and get pricing from three potential providers if possible.

3.      Georgia Receives the Third Worst Ranking in Nation for Health Care Conditions.

MoneyRates.com ranked states based on several criteria related to health care conditions. States could be given a label of robust, healthy, average, frail or critical for both the overall health care conditions and the individual criteria. Here’s what the ranking revealed about Georgia:

·         Georgia received an overall label of critical. It was ranked the third worst state in the nation, beating out only Mississippi and South Carolina.

·         Georgia earned a critical ranking in health insurance coverage rates, infant survival and the number of patient care doctors per capita.

·         The state earned a frail ranking for longevity and hospital capacity. The state’s nursing home capacity was ranked average.

·         Georgia earned an above-average ranking in only one category: child vaccination. In this category, Georgia earned a robust ranking, meaning the state’s child vaccination rates fall into the top 20 percent.

Key takeaway: Prevention is the best medicine. Take steps now to keep yourself and your family members healthy. Schedule check-ups annually, keep up on your vaccines and any take advantage of screenings covered by your health insurance.

4.      Kids Without the Measles Immunization Can’t Attend School in Georgia.

Despite the relatively high child vaccination rates in Georgia, the state has not escaped outbreaks of preventable viral diseases completely. At least six cases of measles have been reported in Georgia this year, including three in January and three in April. The infected patients were unvaccinated.

According to the CDC, measles is a highly contagious virus. It causes a painful rash, cough, runny nose and fever, but it can also lead to more serious complications, including deafness, intellectual disability and death. Approximately 20 percent of unvaccinated people in the United States who contract measles have to be hospitalized.  

The Georgia Department of Public Health says that children should receives two doses of the MMR vaccine age at one year of age and four to six years of age, and unvaccinated adults should also receive the vaccine. Immunization is required for childcare and school attendance in Georgia.

Under the Affordable Care Act (ACA), health insurance plans should cover preventative care including the measles vaccine.

Key takeaway: If you haven’t already done so, talk to your pediatrician about the measles immunization.

5.      Association Health Plans Are Now an Option for Georgia Small Businesses.

Association Health Plans are designed to let self-employed individuals and small businesses to band together in order to obtain health coverage. This gives them more negotiating power, similar to what larger employers enjoy. In June 2018, the U.S. Department of Labor expanded access to Association Health Plans.

Key takeaway: If you own a business, look for association health plan opportunities in your industry.

6.      Hospital Patients are Often Hit with Surprise Medical Bills.  

Patients in Georgia and throughout the country have been struggling with surprise medical bills. Sometimes called balance billing, the practice refers to large bills that are sent to insured patients after the insurer has made its payments.

A common scenario goes something like this. An individual goes to the hospital. The hospital is in the patient’s insurance network, so the patient assumes that treatment will be covered, aside from the standard deductibles and copays. However, unbeknownst to the patient, one or more of the providers delivering care is out-of-network. The patient receives a large bill as a result.

Like other states, Georgia has been working on legislation to tackle the problem of surprise bills. Senate Bill 56 and House Bill 84 both address the issue of out-of-network providers. The House Bill requires information to be provided upon request. The Senate Bill requires a database of prices that the insurance company will pay for out-of-network services. The House failed House Bill 84, but the Senate passed Senate Bill 56. 

Key takeaway: Don’t assume that every provider associated with your hospital is in-network. Verify your insurance with each provider if possible.

Wondering how much an individual health insurance in Georgia costs? Get a quote here.

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