Who can enroll in a plan on Georgia Access?
You must meet the following criteria to be eligible to enroll in a Qualified Health Plan (QHP) on Georgia Access:
- Be a U.S. citizen, national, or lawfully present immigrant.
- Be a Georgia resident.
- Not be incarcerated.
To be eligible to enroll in a Stand-Alone Dental Plan (SADP) you must meet QHP eligibility requirements. To be eligible to enroll in a Catastrophic Plan, you must be 30 years old or younger, or request an exemption. You must enroll in health and/or dental coverage during the annual Open Enrollment period for the upcoming year unless you qualify for a Special Enrollment Period (SEP) mid-year.
What financial assistance is available?
When you apply for coverage on Georgia Access, you can select if you want to apply for financial assistance. If you select yes, Georgia Access will first assess your eligibility for Medicaid and PeachCare for Kids®, including all members of your household. If you or any of the members of your household are potentially eligible, Georgia Access will automatically route your application to the Department of Human Services Division of Family and Children Services for an eligibility determination. If you are not potentially eligible, you will be assessed for two types of financial assistance available on Georgia Access:
- Premium Tax Credits.
- Cost-sharing Reductions.
What is a Premium Tax Credit (PTC)?
A Premium Tax Credit (PTC) is a federal income tax credit available to eligible consumers enrolled in a QHP. Your tax credit is based on your household’s Modified Adjusted Gross Income (MAGI) during tax filing, the associated affordability threshold set annually by the Internal Revenue Service (IRS) for health insurance based on the Federal Poverty Level (FPL), and the cost of the Second-Lowest Cost Silver Plan (SLCSP) in your county.
You can claim your tax credit at the end of the year when you file your income taxes with the IRS or you can opt to have your estimated tax credit applied up front. This is known as Advanced Premium Tax Credits (APTCs). APTCs are payments made in advance by the federal government to your insurance company each month on your behalf to lower your monthly premium costs. If you apply APTCs to your monthly premium, you will be required to reconcile the premium credits paid with the amount you are actually eligible for when you file your taxes.
- If you receive less APTC than what you qualify for, you may get the difference as a refundable credit when you file your income tax return.
- If you receive more APTC than what you qualify for, you may be required to repay the difference when you file your taxes.
To be eligible for PTCs, you must:
- Get your health insurance coverage through Georgia Access or through certified web brokers or an insurance company operating on a State-based Exchange (SBE).
- Not be eligible for or enrolled in other types of health care coverage (e.g., Medicaid, Medicare, Employer Coverage).
- Have an estimated household income above 100% of the FPL.
- Not be claimed as a dependent on someone else’s tax return.
- File a joint return if married.
What is a Cost-Sharing Reduction (CSR)?
Cost-sharing is what you pay for medical services covered by your health insurance plan. A Cost-Sharing Reduction (CSR) is a discount for eligible consumers that lowers the total costs you could incur for health care services for the year (e.g., total costs for co-insurance, deductibles, and co-pays). CSRs can help lower your total out-of-pocket costs for medical expenses.
To be eligible for CSRs, you must:
- Have a household income between 100% – 250% of the FPL.
- Be enrolled in a silver plan.
American Indian or Alaska Native
If you are of American Indian descent and a member of a federally recognized tribe, or if you are otherwise eligible for services from Purchased/Referred Care, a tribal program, or an Indian health program, you are eligible for additional protections to reduce cost-sharing:
- Ability to enroll in coverage any month of the year, regardless of Open Enrollment.
- Zero cost-sharing if your income is between 100% – 300% of the FPL.
- Limited cost-sharing if your income is below 100%.
- Limited cost-sharing if your income is above 300% of the FPL.