Every year on November 1st, healthcare.gov and state-specific health insurance marketplaces open so that Americans who don’t have job-based health insurance or other coverage can shop for and enroll in health insurance. In 2024, 1.3 million Georgians enrolled in coverage in this way, and this year their marketplace will look a little different. Here’s what Georgians need to know about the changes.
Since 2013, Georgians have used healthcare.gov to view health insurance plans, qualify for financial help to lower their costs and enroll in the health plan of their choosing. In 2023, Georgia lawmakers moved to change that. The state legislature and Governor Kemp passed a new law that allows Georgia to create its state-based marketplace (SBM). Since then, the Georgia Department of Insurance has been working to create and launch Georgia Access (GeorgiaAccess.gov). Georgia Access launches November 1st.
A Brief Timeline of Georgia Access
2019: Governor Brian Kemp announced the Georgia Access Model, which sought to change how Georgians buy health insurance. The state submitted a Section 1332 waiver to the federal government, proposing to exit HealthCare.gov without building a state-based marketplace to replace it. Among other provisions, the model would have turned back the clock to a time when consumers didn’t have the advantages of a “one-stop shop” marketplace that put their financial assistance and quality health plans in one place for easy shopping and enrollment.
Georgia advocates, including GHF, vocally opposed this proposal as being harmful to Georgians.
October 2020: the Trump administration approved the Georgia Access model.
2021-2022: After the Biden administration took office, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Treasury reconsidered concerns from advocates and others about Georgia’s plan. Going without a centralized marketplace could reduce access to affordable and comprehensive health coverage. As a result, the federal government paused the Georgia Access Model’s implementation.
2023: Legislation to authorize the state-based marketplace (SBM)
May 2023: Governor Kemp signed into law Senate Bill 65, which granted the Department of Insurance (DOI) authority to operate a State-based Exchange (SBE) for Open Enrollment 2024. The legislation also authorized Georgia Access as the name of the state’s SBM.
July 2023: After reviewing Georgia’s proposed transition to an SBM, the Department of Health and Human Services (HHS) required Georgia to use a hybrid enrollment model in 2024 and transition to a standalone SBM in 2025. HHS’s decision meant in 2024, Georgians could use the Georgia Access website, but GA Access would ultimately take them to healthcare.gov to view, compare, and enroll in health plans. Then, following a successful hybrid transition year, the state would take on all aspects of operating the SBM.
2024:
Fall 2024: The Georgia DOI takes over full management of the state’s health insurance marketplace.
November 2024: Open enrollment for 2025 opens using Georgia Access as the entirely state-run health insurance marketplace. Georgians looking to buy individual health coverage will use GeorgiaAccess.gov to shop for, compare, and enroll in a plan.
Growth in Enrollment
In the past five years, Georgia has seen remarkable growth in enrollment in plans sold through the ACA Health Insurance Marketplace. In 2024, over 1.3 million Georgians enrolled in health coverage through the ACA, compared to just over 458,000 enrollees in 2019.
The considerable enrollment growth is primarily due to legislation passed by Congress in 2021 that created more generous subsidies to lower the premium and out-of-pocket costs for many enrollees.
Note: 2021 was the first year ePTCs were available to eligible Marketplace enrollees
ePTCs: A Powerful Lifeline with An Uncertain Future
These enhanced subsidies, known as Enhanced Premium Tax Credits (ePTCs), have been especially important in lowering the health insurance costs for low- and middle-income Georgia families. Out of the over 1.3 million Georgians who enrolled in ACA coverage in 2024, 1.2 million received a tax credit to help them lower the cost of their coverage (Families USA). Without the subsidy, the average monthly premium for ACA plans in Georgia was $583. However, the enhanced tax credits lowered the average monthly premium to $75 (an 87% decrease) (Families USA).
Unfortunately, the eTPCs are set to expire at the end of 2025 unless Congress takes action to extend them or make them permanent.
Many components of the marketplace will remain the same
Georgia Access is a new website and a new call center, but otherwise, many components of the marketplace will remain the same.
The Georgia Access 2025 Open Enrollment period mirrors that of healthcare.gov. However, Georgia Access’s Open Enrollment goes one-day past healthcare.gov’s. Here are the important dates for Georgia Access:
Oct. 28th, 2024: Window shopping opens to allow consumers to view the plans available through Georgia Access before Open enrollment.
Nov. 1st, 2024: Open Enrollment starts.
Dec. 15th, 2024: Last day to enroll in or change plans for coverage to start on January 1st.
Jan. 16th, 2025: Open Enrollment ends – the last day to enroll in or change plans outside of a special enrollment period.
Feb. 1st, 2025: The first day of coverage for consumers that enrolled after December 15th and before the end of Open Enrollment.
Other components from healthcare.gov that will remain the same in Georgia Access
Eligibility requirements for financial assistance
Plans must still cover the 10 essential health benefits and free preventive care
Financial help is still available and at the same level as the federal marketplace
Free, local help is still available through Georgia Access certified enrollment assisters (i.e. Navigators and Certified Application Counselors). Many of whom can also help consumers and families that may also be eligible for Medicaid.
To find free, local help, you can visit the Georgia Access Local Help Support page to find free in-person help in your area. You can also connect with one of GHF’s two Georgia Access Certified Navigators by completing the Navigator contact form on our website.
Healthcare.gov consumers will have their account and plan information automatically transferred to Georgia Access.
Consumers currently enrolled through Healthcare.gov will have their account and plan information transferred to Georgia Access. This automatic process aims to ensure continuity, so personal details, plans, and subsidies move over without requiring re-entry. Georgia Access is set to provide comparable services, along with additional resources specific to Georgia residents. It is important to note that Georgians will no longer be able to use healthcare.gov on and will be redirected to GeorgiaAccess.gov starting November 1st.
What to Watch for in Georgia Access’s First Year as a State-Based Exchange
The transition to Georgia Access will impact not only the 1.3 million Georgians who currently purchase coverage through the marketplace but also the state’s ability to reach and enroll the estimated 400,000 Georgians who are eligible for but remain unenrolled in marketplace coverage. As such, there are a few key aspects of the state’s new marketplace that may impact how and if Georgians enroll in coverage this year.
Enhanced Direct Enrollment puts some Georgians at risk
Georgia Access relies heavily on a model called Enhanced Direct Enrollment (EDE). EDE allows consumers to shop for and enroll in plans without visiting GeorgiaAccess.gov. The EDE model may negatively impact enrollment in Georgia Access for a few reasons, including allowing websites to show non-ACA compliant plans (i.e. junk plans) alongside ACA-approved plans. Because the non-ACA compliant plans have lower premiums (because they frequently do not cover services like mental health, maternity care, or prescriptions), consumers may be tempted by the lower costs and unknowingly enroll in plans that don’t cover their needs. Additionally, EDE companies operate on commission-based models, meaning there are financial incentives for them to behave in ways that do not benefit consumers or harm consumers, like:
Steering individuals or families to a specific insurance company’s plans instead of the plan that’s best for the consumers;
Avoiding help to families with Medicaid enrollments (for instance when a parent is eligible for marketplace coverage but their child is eligible for Medicaid or PeachCare);
Offering little or no assistance to consumers with complex health or social needs because the consumer or family would take too much time or effort to help (ex: consumers who speak languages other than English); and
Selling consumers’ information to “bad actor” companies or agents/brokers who fraudulently change an individual or family’s plan without their permission or knowledge. This puts the consumer at financial risk and impacts their access to care. It’s especially problematic for consumers with high health needs (like people with diabetes, hemophilia, or a disability).
Two Georgia Access-approved EDE companies have been suspended from healthcare.gov because of their problematic behavior.
*These two EDE companies have been suspended from healthcare.gov.
Groups at risk of being uninsured and/or groups with complex enrollment needs
The success of Georgia Access will depend on the state’s ability to reach and ultimately enroll Georgians who remain eligible but unenrolled in marketplace plans. These Georgians may be unaware of their ability to enroll in subsidized comprehensive coverage, unaware of the financial assistance available, or in need of more complex enrollment assistance than is typically available through an agent or broker. These groups often overlap with one another and include:
Low-income families where at least one person (usually a child) qualifies for Medicaid
Georgians who need language assistance or help with immigration-related problems
Hispanic Georgians
Georgians from hard-to-reach communities, such as rural areas
Georgians with incomes of 100-138% FPL
Note: this group is especially at risk of fraudulent/improper enrollments or plan changes.
Through Georgia Access–a marketplace built specifically with Georgians in mind–our state has an exciting opportunity to better meet the health insurance enrollment needs of Georgians in ways healthcare.gov could not due to its utilitarian design for use across multiple states. How well the state takes advantage of this opportunity and the success of Georgia Access depends on its ability to enroll all eligible Georgians, especially those at the highest risk of being uninsured and those with complex needs.
GHF will continue to monitor and assess the first year of the Georgia Access marketplace. We look forward to informing consumers about what to expect and how to successfully enroll in affordable coverage and working with state leaders to ensure the marketplace works well for all Georgians.
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