Georgia Health Care

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In 2014, Obamacare subsidies are for the needy and unemployed.  For the rest of us, Insurance companies pay Obamacare 3.8%

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Obamacare in Georgia: Sticker shock

GEORGIANS WHO will be forced to buy health insurance under Obamacare later this year should be prepared to dig deeply into their wallets — then hold on for dear life.

That’s because of heart attack-inducing sticker shock.

The premiums for the five health insurers that will be offering policies in Georgia’s federally run insurance exchange are “massive,” according to Georgia Insurance Commissioner Ralph Hudgens.

“Insurance companies in Georgia have filed rate plans increasing health insurance rates up to 198 percent for some individuals,” Mr. Hudgens wrote in a July 29 letter to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services and the president’s point person on Obamacare.

The commissioner correctly said that Georgians cannot afford these steep hikes. For their protection, he asked for an emergency, 30-day delay on the July 31 deadline for his department’s approval of the increases.

Predictably, Ms. Sebelius gave the commissioner — an open foe of Obamacare — the cold shoulder. That left Mr. Hudgens no choice but to approve these rates Wednesday.

So what will this mean for people in the Savannah area who will be forced to buy health insurance or pay a penalty to the government when they file their personal income taxes?

They should shop around on the private market. Or, they may find that it’s less expensive not to buy a policy and pay a penalty — defeating the purpose of the president’s plan to reduce the percentage of uninsured Americans.

Interestingly, Mr. Hudgens said the premiums that these companies are charging aren’t excessive — if you look at the ground rules that Obamacare established. Put simply, insurers had to flatten premiums if they wanted to be players. Younger people, who are healthier and file fewer claims, would be forced to pay a lot more for an insurance policy than they do now. Older people, who tend to have more illnesses and require more services, would still pay more — but the percentage increase would be less than their younger counterparts.

Premiums would be tailored to regions of Georgia. Generally speaking, the more competition among health-care providers, the lower the premiums.

Prices weren’t available for this area for Georgians of different age groups. But they probably aren’t too far removed from what insurers will charge in the Atlanta market. Kyle Wingfield, a columnist for the Atlanta Journal-Constitution, outlined them this way:

• A 25-year-old, non-smoking male can currently buy the cheapest, no frills plan with high out-of-pocket costs for about $66 a month. If the premium hikes go through, that plan would cost from $150-197 a month, depending on the insurer.

• A 45-year-old male non-smoker can find a low-cost plan for $119 a month. A similar plan offered under the exchange would cost from $217 to $234 per month.

• A 64-year-old male non-smoker can find a low-cost plan for $293 a month. Similar plans offered through Obamacare would cost from $450 to $501 per month.

At the 11th hour, two private health insurers that do business in Georgia, Aetna and its subsidiary, Coventry Health Care, announced that neither would participate in Georgia’s exchange, expected to be operating Oct. 1. Officials for the companies doubted that the plans they would offer would be “financially viable” — meaning that they don’t make sense because they would be net losers for the company. That’s the not-so-hidden flaw in Obamacare — it’s going to require a massive subsidy to keep afloat.

But the so-called Affordable Care Act is the law of the land. Until Washington changes the rules, Georgia is stuck — as are Georgians who will pay more for what they have now.

Georgia insurance commissioner reviewing ObamaCare rates

ATLANTA – If the example one Georgia insurance company offered is true of the others, coverage under the individual plans to be offered in October under federal health reform will be about 45 percent higher than what a middle-aged family of five could get today.

“I am very concerned that the full implementation of ObamaCare will drastically increase the price Georgians pay for health insurance,” said Insurance Commissioner Ralph Hudgens.

But officials at the Georgia Department of Insurance aren’t ready to offer any public conclusions while independent actuaries evaluate the plans and premiums seven companies submitted in April. Hudgens has the power to reject rates he considers too high even though the federal government will operate Georgia’s online exchange where they’ll be sold in addition to private insurance agents.

“Insurers cannot expect to hide behind changes in federal law as a pretext for boosting their bottom line,” he said. “My first responsibility is to protect Georgia consumers, and as ObamaCare continues to unfold, I will do my best to fulfill that duty.”

One company, Blue Cross Blue Shield Healthcare Plan of Georgia, included an example of the cheapest option under the federally prescribed plans. For the middle-aged couple living in Albany and their three children – including one who smokes – the monthly premium is $1,605, which is higher than what the company offers now for the same family, at $1,100, according to Georgia Health Coverage Inc., an independent insurance agency.

The new plans will cover more situations – such as maternity – will have the same rates for men and women and can’t charge more or deny coverage for anyone with a serious medical condition like diabetes or cancer. So, it may be better to compare them to the plans offered to small companies, which also automatically accept all medical conditions, notes Bill Custer, director of Georgia State University’s Center for Health Services Research.

Custer reviewed all of the submitted premiums and concluded they’re in line with or slightly lower than the existing small-group plans sold in Georgia.

“They’re not necessarily cheaper. It depends on who you are,” he said. “A younger person may actually pay more than they are now, and an older person will pay less.”

Hudgens’ staff said he is on schedule to complete his review in time to approve sales of the plans before Oct. 1, when the federal government will open the state’s insurance exchange. Consumers will have until Jan. 1 to shop, either on the exchange or through an insurance agent. Those wanting help with the exchange will be able to get it free from a new type of federally-funded expert called a navigator, but Hudgens hasn’t yet set their licensing requirements.

• Follow Walter Jones on Twitter @MorrisNews and Facebook or reach him at and  (404) 589-8424 .

Individual Health Insurance in Georgia (including Self-Employed)
  • Insurers are not required to accept applicants with medical problems.
  • When there is a pre-existing condition, the provider can attach an elimination rider to the policy.
  • An exclusion period for the condition may be imposed.
  • There are no time limits for exclusion periods, no definition of a pre-existing condition, and no creditable coverage.
  • Most providers limit exclusion periods to 24 months.
  • There are no limits on the cost of a policy or on increases at renewal time.
  • Coverage cannot be cancelled due to sickness.
  • If leaving a fully insured group health plan, an applicant may be eligible for a conversion policy.

Self-Employed Health Insurance in Georgia

  • The self-employed may not purchase group health insurance.
  • For regulations which govern business or professional associations that offer group health coverage, contact the Georgia Office of Insurance and Safety Fire Commissioner.

Group Health Insurance in Georgia

  • Applicants cannot be refused or charged more for group coverage based on a medical problem, provided they qualify.
  • If the policy holder gets sick, coverage cannot be cancelled.
  • Certain life changes relating to children, marriage, family problems, or job loss may provide opportunities for coverage.
  • Newborn, adopted, and disabled dependents have additional coverage opportunities.
  • Providers may review medical history for the six months prior to group coverage.
  • In the case of a pre-existing condition, the provider can require an exclusion period of up to 12 months.
  • If coverage was maintained with no lapses longer than 63 days, an applicant may be given creditable coverage for a pre-existing condition.

Small Business Health Insurance in Georgia

  • Small businesses with up to 50 employees may not be refused group coverage.
  • For small groups, there are limits on the cost of a premium.
  • Coverage cannot be cancelled because of sickness within the employee group.

To get the most up-to-date and accurate information, please check with the Georgia Department below:

Office of the Insurance and Safety Fire Commissioner 
2 Martin L. King, Jr. Drive 
Atlanta, GA 30334
(404) 656-2056

Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
Georgia Default to Federal Exchange Opposes