Frequently Asked Questions

Employers allow you to sign up for coverage during specific time periods. These periods may be called by different names, such as initial enrollment, open enrollment, or open season. You will have a chance to sign up during the initial enrollment period, and you may also have a chance to enroll later if your situation changes, like if you get married or have a child.

If an employer offers health coverage, there are a minimum number of hours an employee is required to work in a week to become and stay eligible for benefits. Employers also usually require employees to have worked for a certain amount of time before they become eligible for benefits.

The employer may pay all or part of the premium; you'll pay the rest of the premium, plus any copayments, co-insurance, and deductible.

Employers are supposed to offer plans where the cost of the employee's monthly premium (not including premiums of any family members) is less than 9.02% of the employee’s total family income. Also, that plan must be at least at the bronze coverage level or meet the "minimum value" standard (which is about equivalent to a bronze-level plan) for copayment, co-insurance, and deductible expenses.

There is no legal limit to how much it may cost to add the employee's family members to the plan. However, at small employers (50 or fewer employees), a family plan premium can only charge you for a maximum of three children under age 21. Any additional children under 21 can be included in the plan without the premium cost going up. The employer's Human Resources department or personnel staff can explain the costs of adding family members and how much the employer will contribute to that cost.

Employers usually do not require re-enrollment in coverage within a plan year. The employee will need to continue to work the minimum number of hours to stay eligible for benefits, called an active work requirement. During the annual open enrollment or open season, you can change coverage plans.

Note: Employers may change coverage plans or coverage choices for you without your active participation. If the employer changes insurance companies, you will have to re-enroll.

Yes, if you are under age 26, you can be covered under your parent's insurance plan. Employers who offer coverage to their employees must also offer it to their children under the age of 26.

Dependent children with disabilities can continue to be covered under their parent’s plan past age 25. To qualify as a dependent child, you must be dependent on your parents for support and your disability must limit your ability to support yourself through work.

Employers do not have to offer coverage to the spouses of employees.

You (or your spouse or parent) must meet the active work requirement, pay any portion of the premium you're responsible for, and follow the plan's rules. If you do those things, the coverage will generally last as long as you (or your spouse or parent) work for the employer, assuming that the employer continues to offer health coverage.

When coverage ends, you have different options:

• You can switch to the employer-sponsored coverage of your spouse, if your spouse has it.
• You can check out your public and private individual coverage options on Georgia Access.
• You can continue on the same policy you had from the employer through COBRA. This option may be very expensive and should be viewed as a last resort.

If you can get affordable employer-sponsored coverage through your employer, you will not be able to get government help through tax subsidies to pay for an individual plan on Georgia Access. However, you can always choose to buy an individual plan on Georgia Access, as long as you are willing to pay the full price of the premium on your own. In some cases, buying an individual plan may be cheaper than getting coverage through your parent's or spouse's employer.

If your family's income is at or below 100% of the Federal Poverty Guidelines (FPG) ($15,650 for an individual; $32,150 for a family of four), you may be eligible for Medicaid through the Georgia Pathways to Coverage program, even if you have access to employer-sponsored health coverage. If you are in this situation, Medicaid will either pay your employer-sponsored coverage costs, like your premiums and copayments, or give you Medicaid coverage through a managed care plan, depending on which option is more cost-effective. Learn more about qualifying for Medicaid while you have employer-sponsored health coverage.

Affordable in this case means that your employer, your parent's employer, or your spouse's employer must offer coverage where the employee's monthly premium (not including premiums of any family members) would cost less than 9.02% of your family’s total income. Also, that coverage must be at least at the bronze coverage level or meet the "minimum value" standard (which is about equivalent to a bronze-level plan).

If the employee's spouse or children can also be covered, the plan is affordable for them if the premium for the entire family costs less than 9.02% of your family’s income. A plan could be affordable for the employee alone, but not affordable for the rest of your family.

If the plan offered by the employer does not meet these affordability standards, you or your family members may qualify for government help through tax subsidies to reduce the premium on an individual plan. Learn more about affordability rules for family members and how it affects eligibility for tax credits on Georgia Access.

Note: Before 2023, the spouse or children of an employee did not qualify for subsidies on Georgia Access 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."

Even if you have private health coverage through an employer, you may still be able to get public coverage through the Georgia Pathways to Coverage Medicaid program if your income is at or below 100% of the Federal Poverty Guidelines (FPG) ($15,650 for an individual; $32,150 for a family of four). If you are in this situation, Medicaid will either pay your employer-sponsored coverage costs, like your premiums and copayments, or give you Medicaid coverage through a managed care plan. Medicaid will determine which coverage option to offer you after you apply, based on which option is more cost-effective; you do not get to choose. Learn more about qualifying for Medicaid while you have employer-sponsored health coverage.

If you are over 65 or have been getting Social Security Disability Insurance (SSDI) benefits for two years, you will automatically be enrolled in Medicare Part A.

It is risky not to have coverage: you could have an accident or become ill at any time and health care is extremely expensive. With insurance coverage, you can get care when you need it. To find the right health coverage option for you, keep reading the articles in DB101’s Health Coverage section.

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