Frequently Asked Questions

When you get health insurance, you know that your health needs will be covered and you don't have to worry about what would happen if you had an accident.

For most people, you (and your family) should get an individual health plan through Georgia Access if you cannot get public health coverage, like Medicaid or Medicare, or affordable health coverage through an employer.

Speak to your employer’s Human Resources department (or your spouse’s or parent’s Human Resources department) to learn if you can get coverage through an employer. Georgia Access can help you figure out if you are potentially eligible for public health coverage. If you have been determined disabled according to the Social Security Administration's rules, you may be able to get other types of Medicaid. Talk to a benefits expert to learn more about them.

If you need more help in understanding individual health plans, there are trained experts you can talk to. Here are some good resources:

• Georgia Access has a lot of great information introducing your options. You can also call Georgia Access at 1-888-687-1503.
• Georgia Access also lists organizations that offer local help for finding the right plan for you.
• If you have a disability, talk to a benefits expert to learn if you have additional options.

Yes. Plans cannot deny people coverage anymore. That means that when you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer much more comprehensive coverage than many health plans did in the past, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage.

"Health insurance marketplace" is a national term for the website in each state that lets individuals and small businesses sign up for health coverage. In Georgia, the website is called Georgia Access. It is operated by the state of Georgia. Before 2025, Georgia used the website HealthCare.gov, which is called the Health Insurance Marketplace and is operated by the federal government.

You may also see Georgia Access referred to as a "health insurance exchange," which is the same thing as a health insurance marketplace.

There are new programs that make health coverage more affordable if you have low income. If health coverage is too expensive for you, the government may help you pay for it via tax credits. If you still cannot afford a private health coverage plan, you may be able to get a public health coverage plan like Medicaid. Check Georgia Access to see if you can get one of these options.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

Depending on your situation, you may qualify to have the government help pay for your individual health plan via tax credits. Here's how it works:

1. When you sign up at Georgia Access, you give details about your family's situation. Georgia Access reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Georgia Access tells you and lists insurance options for you.
2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
3. In January or February, the government will send you a form listing how much your total health care tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

No, you do not need to get a silver level plan in order to get government subsidies, but you may get extra help if you do. Here's how it works:

• The government may help pay for your premium through tax credits. That means you would pay less each month. You might get this help no matter what metal your plan is.
  
• If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, you'll also have reduced costs, including lower copayments and co-insurance and a lower deductible and out-of-pocket maximum. That means you pay less each time you need medical services. A silver plan with these lower costs might actually be as good or better than many platinum or gold plans. You only get these cost reductions if you get a silver plan.

Note: There is no maximum income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

When Georgia Access looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

The bottom line: You may get help paying the premium, regardless of whether you get a platinum, gold, silver, or bronze plan, but if you make less than 250% of FPG, you will only get lower copayments and other expenses if you get a silver plan.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
	252
Georgia Pathways to Coverage Medicaid (100% FPG)
PeachCare for Kids (252% FPG)
Subsidized private plans, reduced fees (100% FPG - 250% FPG)
	to
Subsidized private plans (no upper income limit)	--
If your family's income is within the limits for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Not all Medicaid categories are included here. For private plans with subsidies, your monthly premium amount depends on your income.

Add to favorites

Add to favoritesAdd to favoritesOne of my favorites

Georgia Access is the best place for you to get individual health coverage. Georgia Access will calculate how much each plan's premium will cost you and how much the government will help with tax credits. You can compare health plans side-by-side, figure out which is best for you based on their costs and the benefits they offer, and sign up for coverage.

Georgia Access will also figure out if you are potentially eligible for Medicaid.

Usually, when you sign up for a plan through Georgia Access, you cannot change plans for an entire calendar year. So, if you are signed up for 2025, then you can’t get a new plan until 2026.

However, there are certain situations when you may be able to change plans mid-year:

• If your income changes and you gain or lose eligibility for government help paying for your coverage
• If you move
• In other life-changing circumstances, such as having a child or getting married

The first one is the key. If your income goes down and you can’t afford your plan anymore, you need to report your change in income to Georgia Access. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance via tax credits (meaning that you have to pay less).

Note: American Indians do not have these restrictions and can change plans up to once a month.

Most immigrants can get health coverage through Georgia Access. However, the rules are not identical to the rules for United States citizens. Here are the basic rules:

• Immigrants who have been legal residents for five or more years or who meet specific noncitizen requirements have the exact same benefits as citizens. They can pay for individual plans through Georgia Access, qualify to get government help paying for their premiums and other fees (if their income is low enough), and get public coverage through Medicaid and other programs.
• Some non-citizens who have legal immigration status in the United States do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who are undocumented cannot get individual plans through Georgia Access, cannot get government help paying for their coverage, and cannot get public coverage through Medicaid. They can purchase coverage through an insurance agent or directly from an insurer and they may qualify for other public programs or for emergency Medicaid coverage. Visit your local Division of Family and Children Services (DFCS) office to learn what programs may exist for undocumented immigrants.

If your immigration status changes and you become eligible for a public program or if you become eligible to use Georgia Access, you can sign up immediately—you do not need to wait until open enrollment begins.

Yes, but it is probably a bad idea. If your employer offers coverage that is affordable, you and your family will not get any help paying for an individual plan, so it will be much more expensive than the employer-provided plan.

Note: Before 2023, the spouse or children of an employee would not qualify for subsidies if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." Learn more about affordability rules for family members and how it affects eligibility for tax credits on Georgia Access.