Tag: affordable care act

Governor Kemp’s health care plans approved: What do they mean and what’s next

Georgia’s Medicaid proposal to begin July 2021, but leaves thousands in the coverage gap

Both of Governor Kemp’s health care proposals received approval from federal health officials in the last two weeks. Unfortunately, both proposals fall short of the bold, evidence-based action that Georgians need their state leaders to take. These plans may impact you or people you know. While some details of the plans are still being sorted out, we have tried to answer some of your early questions here. As we learn more and these plans roll out, GHF will keep you updated with the information you need to get covered, stay covered, and help your loved ones do the same.

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New! Getting Georgia Covered 2020

Despite repeated claims otherwise, Georgia’s health insurance marketplace has proven to be resilient for consumers in our state. GHF examined the data about Georgia’s 2020 marketplace for our annual Getting Georgia Covered report. We found rising enrollment, lower premiums, and increased choices for consumers. This annual release tells the story of how Georgia individuals and families are faring in the health insurance marketplace. Explore the new interactive digital report to find out more about Georgia’s 2020 marketplace, how it differed from previous years, the Georgians who enrolled and costs of plans, and policy opportunities to increase enrollment, ensure access to care, address affordability, and protect consumers.


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Sign up for 2021 health coverage before Dec. 15th!

Healthcare.gov is open for business from November 1 to December 15, 2020. Georgians can now shop for comprehensive, affordable health plans and enroll in coverage. Nine out of 10 Georgians qualify for financial help to lower their premiums and other costs! Make sure that you are covered in 2021!

Most Georgians who qualify for health insurance & financial help through the Affordable Care Act (also called “Obamacare”) are still uninsured. If you or people you know need more information about how health insurance works, how to enroll in coverage, or what to do after you have signed up, we have you covered! Check out and share these tools so you and your networks can get covered and stay covered:


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GHF submits comment to federal government about Governor’s revised private insurance proposal

On July 9, 2020, Georgia’s Governor announced that his administration had revised his 1332 private insurance proposal. The new proposal consists of two parts:

  1. A reinsurance program to lower premiums; and
  2. The Georgia Access model—which would separate Georgia from healthcare.gov but would not replace it, instead directing consumers to insurers and web brokers to shop and enroll in coverage.

After a 15-day public comment period during which more than 600 comments were received from the public, Georgia’s Department of Community Health made no changes and submitted the proposal to the Centers for Medicare and Medicaid Services (CMS) for their review on July 31.

CMS deemed the waiver application complete on August 17. The designation began a 30-day public comment period, allowing Georgians, health advocates, and any other interested party to weigh in on the revised proposal. Because of technical difficulties with the comment submission link, the comment period was extended another seven days to September 23, 2020.

More than 1800 individuals and organizations commented during this time, including GHF. You can read GHF’s full comment letter here.


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GHF comments on Governor’s revised private insurance proposal

On July 9, 2020, Georgia’s Governor announced that the state was re-opening the public comment period on his 1332 private insurance proposal. The proposal was considerably revised since it was last considered in February of this year. The new plan still consists of two parts:

  1. A reinsurance program to lower premiums; and
  2. The Georgia Access model—which would separate Georgia from healthcare.gov but would not replace it, instead directing consumers to insurers and web brokers to shop and enroll in coverage.

Other provisions of the previously proposed Georgia Access model were dropped (cap on financial assistance, new kinds of health plans, etc.).

The Governor’s announcement began a 15-day public comment period on the new proposal, allowing Georgians, health advocates, and other interested parties to weigh in. Along with more than 600 others, GHF submitted comments to communicating our deep concerns about the plan’s continued shortcomings. You can read GHF’s full comments here.


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Health insurance options for Georgians during COVID-19

Line of diverse workers with umbrellas symbolizing health insurance

More than 1 million Georgians have lost their health coverage due to job loss during the COVID-19 pandemic. If this is your situation, you can keep yourself and your family covered during this health crisis.

You have three main pathways to coverage:

  1. Affordable Care Act
    • With financial assistance—half of Georgians who lose their insurance will qualify for ACA coverage with financial help to lower the premium they pay each month. In some cases, you may see lower deductibles & co-pays too.
    • Without financial assistance—some Georgians, despite a job loss, will still make too much for financial help but you should still shop for coverage to see if there’s a plan that fits your new budget.
  2. Medicaid & PeachCare for Kids—About 25% of Georgians losing their health coverage may qualify for Medicaid. Georgians most likely to qualify for Medicaid coverage include children, low-income pregnant women, and very low-income parents. Other Georgians who qualify for Medicaid are people with disabilities, seniors, and low-income women with breast or cervical cancer.
  3. COBRA—in most cases, you will be able to find less expensive coverage from the ACA marketplace. COBRA may be the best option for you if it is important that you maintain a consistent provider (pregnant women, people with chronic or complex conditions).

Some Georgians who have lost their health coverage due to job loss will fall in Georgia’s coverage gap because the state has not expanded Medicaid. That means they can’t get financial help through the ACA and they also don’t qualify for Medicaid.

If you are in the coverage gap because you lost your job, please read the If you are uninsured section (click to go directly there). Then contact Georgians for a Healthy Future at 404-567-5016 x 4 to learn how you can share your story and help fix the problem!


Affordable Care Act (ACA) coverage

You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. You only qualify for coverage for 60 days after you lose your health coverage, so shop and enroll as soon as possible. Visit healthcare.gov to shop and enroll.

Financial assistance is available!

When you begin the shopping/enrollment process, healthcare.gov will ask you about your estimated income for 2020. With that information healthcare.gov will let you know if you qualify for financial help to lower your premiums and other costs. Most Georgians qualify for financial help!

When you estimate your income, include the money you made from your job before you were laid off, any unemployment checks that you expect to receive, and any money that you expect to make from getting re-hired/a new job later in the year. Do not count your stimulus check as income!

Table that is titled "You are likely to qualify for financial help if your income falls in these ranges".

For free help with the enrollment process, contact Insure Georgia at insurega.org or 866-988-8246.

Coverage through the ACA marketplace covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Contact your insurance company for more information.


Medicaid & PeachCare for Kids

You can enroll yourself, your family, or your children in Medicaid or PeachCare for Kids at any time, if you qualify. Enroll at gateway.ga.gov.

Cartoon mom and child standing together

Children are most likely to quality for Medicaid and PeachCare. Pregnant women and some parents may be eligible for Medicaid coverage depending on your monthly income. (The amount of unemployment you get from Georgia counts as income but the additional $600 per week from the federal government does not.)

Click here to see if you can qualify as a parent and to see if your kids qualify. If you are pregnant, you must make less than these amounts to qualify for Medicaid:

Medicaid is required to cover COVID-19 testing and treatment for free. In addition, you do not have to pay any Medicaid or PeachCare premiums or co-pays during the COVID-19 national emergency.

If you have or enroll in Medicaid coverage, you cannot be disenrolled (kicked off) during the COVID-19 national emergency.

If you have questions about Medicaid and whether you qualify, call the Georgia Division for Family & Children Services at 877-423-4746.

You may also contact Atlanta Legal Aid (find the phone number for your county here) or Georgia Legal Services Program at 1-800-498-9469 with questions or concerns.


If you are uninsured/unable to get health coverage

Do not skip or avoid health care just because you are uninsured! You can get free or low-cost health services at:


References & resources

COVID-19 Town Hall PowerPoint slides by Center on Budget & Policy Priorities
Frequently Asked Questions by Center on Budget & Policy Priorities


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Your health coverage, health care, and well-being during the COVID-19 pandemic

Updated: November 20, 2020

The Georgians for a Healthy Future team is continuing to monitor the COVID-19 (coronavirus) outbreak closely. As always, GHF strives to be a resource for Georgia consumers. While things continue to change quickly during this health care pandemic, we will share practical advice and actionable information to help you navigate a confusing time and find the answers you need. Here we present information about how to access health care services and what to expect from your health insurance coverage when you do. We will keep the corresponding blog post updated as things change and with links to helpful resources as they become available.


Georgia’s statewide shelter in place ended on April 30, 2020 for most Georgians. Vulnerable populations including those who are medically fragile and elderly should continue to shelter in place until June 12, 2020.

Governor Kemp also extended Georgia’s public health state of emergency through December 09, 2020. He also issued executive orders requiring businesses to operate by strict social distancing and sanitation rules through May 13, 2020. As of June 1, 2020 restaurants are still required to abide by 39 restrictions to open their dining rooms.

We encourage all of you to continue to help prevent the spread of the virus by taking the necessary steps to “flatten the curve” including staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.


If you are experiencing symptoms of COVID-19 or may need a test

If you believe that you are experiencing symptoms of COVID-19 or have been exposed to the novel coronavirus, call your primary care doctor or an urgent care clinic. Let them know you think you may have COVID-19, so they can take the proper precautions and direct you to available testing sites. You may also call the Georgia Department of Public Health on their COVID-19 hotline at 844-442-2681. Public health officials are urging people not show up unannounced at a doctor’s office, emergency room or other health care facility.

The Centers for Disease Control and Prevention have a Coronavirus Self-Checker which may be a helpful tool if you think you are experiencing symptoms of the virus.

You can find out more about COVID-19, its symptoms, what to do if you think you are sick, and other COVID-19 information at dph.georgia.gov/novelcoronavirus.

COVID-19 testing is available for all Georgians, regardless of whether you have coronavirus symptoms. Anyone can call their local health department to get scheduled for testing. They can also download the Augusta University ExpressCare app, visit augustahealth.org, or call (706) 721-1852.

Effective May 7, 2020, COVID-19 testing is available to all Georgians who request it, whether they have symptoms or not. Call your local health department to schedule an appointment at a location near you and to inquire if testing is free.


What to expect from your health insurance

If you have insurance, make sure to use it for any testing and medical exams related to COVID-19 and any other medical services you may need during this time.

The COVID-19 crisis has caused many Georgians to lose their jobs and also lose their employer-sponsored health care coverage. If you have lost your coverage or have had a drop in your income, you may be eligible for Medicaid or financial assistance to buy health insurance through the Affordable Care Act. Please read the If You Lose Your Job section below.

If you have Medicaid or PeachCare for Kids

If you and your family have lost your source of income in this crisis, or are in lower-income work with no health coverage, enrolling in Medicaid may be an option for you.

Medicaid provides all “medically-necessary” services to its members. During the national public health emergency period, your Medicaid coverage will cover the cost of a COVID-19 test.  If you are diagnosed with COVID-19 and need medical treatment, Medicaid should also cover those costs. 

Check with your Medicaid insurance company for more information and guidance. Click the name of your Medicaid company to find out more: AmerigroupCareSourcePeachState Health Plan, and WellCare.

If you need other health care services during this time, check with your Medicaid insurance company and doctor to see if you can have a “virtual appointment” using the internet, video call, or telephone call, instead of going in-person.

Georgia’s Department of Community Health (DCH) has announced that Medicaid & PeachCare members will not owe any co-payments for any health service from May 1, 2020 until the end of the national public health emergency.

No one can willingly lose their Medicaid coverage during the public health emergency. If you lose your Medicaid coverage during this time, contact your Medicaid insurance company.

If you have private insurance

If you have insurance through your job, the State Health Benefit Plan, or the Affordable Care Act marketplace (also called healthcare.gov), use it for any testing or medical exams related to COVID-19. The Families First Act requires that health plans and insurers cover testing for COVID-19 so your test should be free. If someone wants to charge you for a test, call the DPH’s COVID-19 hotline.

If you are diagnosed with COVID-19 and require medical treatment, you should expect to pay some out-of-pocket costs like your deductible.

As of March 21, 2020 Cigna, Humana, Aetna, and UnitedHealthcare have waived cost-sharing for COVID-19 treatment. Aetna and Cigna have pledged to waive COVID-19 treatment costs for qualified medical bills until June 1, 2020. Humana has not announced an end date to their COVID-19 cost-sharing policy.

If you purchased coverage outside of the ACA marketplace or you have a short-term plan or health-sharing ministry, call your insurance company to find out how they are covering COVID-19 testing and treatment. The cost-sharing requirement under the Families First Act does not apply to people who are enrolled in non-ACA compliant plans (ex: short-term plans).

If you need other health care services during this time, check with your insurance company and doctor to see if you can have a “virtual appointment” using the internet, a video call, or a telephone call instead of going in-person.

In order to ensure people affected by COVID-19 have access to health care Georgia’s Insurance Commissioner issued a directive on March 20, 2020, that instructed health insurers to refrain from canceling health policies due to non-payment. That directive expires on May 31st. If you are behind on your premium payments or expect to be, call your insurance company right away to see if they can offer a payment plan, financial assistance, or other help to keep you enrolled.

If you have Medicare

Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs. All necessary hospitalizations are also covered by Medicare, including hospitalizations for quarantine. More information about Medicare’s coverage and services is available here.

If you are uninsured
If you need a COVID-19 test, contact your local public health department to find a testing site and to ask whether the test will be free. Request that they waive any testing costs.

If you need other health care services during this time, find a local community clinic, or apply for financial assistance through a hospital charity care program. Georgians should not let their insurance status get in the way of getting needed testing or treatment.

If you lose your job

Many Georgians across the economy have lost their jobs and may be at risk of losing their coverage. If this is your situation, you can keep yourself and your family covered during this health crisis. You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. When you begin the enrollment process, healthcare.gov will ask you about your estimated income for 2020 and will let you know if you qualify for financial help to lower your premiums and other cost-sharing. 

For free help with the enrollment process, contact these organizations:

Coverage through the ACA marketplace (healthcare.gov) covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Call your insurance company for more information.

If you are unable to enroll in a health insurance plan, you may have other options through services such as a community clinic, which can connect you with the care you need.


Resources for you and your loved ones

During this uncertain time, many of our partner organizations are doing the hard work of finding and centralizing the information that you and your loved ones may need. Here are a few that we think are most helpful. We will continue to update this list with actionable resources and information so you can stay healthy, safe, and well. 

  • COVID-19 guidance and information
    • Information from public health experts: Visit the Georgia Department of Public Health’s website for the latest guidance and updates about COVID-19 in Georgia.
    • Coronavirus resources for people who are not strong readers: Georgia State University has published a library coronavirus materials for people who may not have strong reading or literacy skills. They have included materials up to a 9th-grade reading level.
  • COVID-19 guidance and information for people who do not speak English as a first language
    • The GSU School of Public Health’s Prevention Research Center has compiled COVID-19 information sheets (from CDC & the International Rescue Committee) in 25 languages
  • Make sure your basic needs and finances are taken care of:
    • If you need help finding food:
    • Food Bank of Northeast Georgia: Visit www.foodbanknega.org, click “Need Help”. Call the office at (706) 354 8191
    • Atlanta Community Food Bank: Text the word FINDFOOD to 888-976-2232 with your ZIP code and street address and you will be sent a list of the three closest distribution centers.
      Text service also available in Spanish, using the word COMIDA
    • Georgia Mountain Food Bank: uses the same system as Atlanta Community Food Bank
    • Golden Harvest Food Bank Visit www.goldenharvest.org, click on ‘Find Help’ at the top of the page, you will be taken to a map where you can enter your zip code to find the nearest food distributor
    • Middle Georgia Community Food Bank–Call 211 and you will be connected with an associate who will be able to tell you where you can find food
    • Feeding the Valley Food Bank: Visit feedingthevalley.org, on the front page, enter your zip code into the ‘Need Food’ box and you will be shown the closest food pantries to your location
    • America’s Second Harvest of Coastal Georgia: Visit helpendhunger.org, select ‘Find Food’ on the homepage, you will be taken to a map where you can enter your zip code or county to be shown the nearest food distribution centers
    • Second Harvest of South Georgia: Visit feedingsga.org, select ‘Find Help’ in the ‘Learn’ section at the top of the page, you will be taken to a map where you can find the closest distributors to you


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GHF comments on Governor’s proposed reinsurance program

On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s 1332 private insurance proposal to federal health officials.

The plan consists of two parts:

  1. A reinsurance program to lower premiums; and
  2. A dramatic erosion of the ACA’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections in private insurance

DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the second part of his plan, Governor Kemp and DCH sent the proposal to federal officials with no meaningful changes.

On February 5, 2020, Governor Kemp wrote a letter to requesting that the reinsurance program be considered separately from the second part of his proposal, and that CMS’s consideration of the second part of the plan be paused. CMS responded to Governor Kemp on February 6 in a letter that deemed the reinsurance program application complete and requested more information about the remaining parts of the Governor’s proposal.

CMS’s response began a 30-day public comment period on the proposed reinsurance program, allowing Georgians, health advocates, and any other interested party to weigh in.

GHF, along with several partner organizations, submitted a comment communicating our support of the reinsurance program, while noting our deep concerns about the remainder of the Governor’s proposal. You can read the full comment letter here.


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Court ruling in health care repeal lawsuit endangers Georgia consumers

Atlanta, Georgia – Statement by Laura Colbert, Executive Director of Georgians for a Healthy Future, regarding today’s ruling by the 5th Circuit Court of Appeals in the Texas v. U.S lawsuit.

The lawsuit seeks to invalidate the Patient Protection and Affordable Care Act; Georgia is a plaintiff in the case.

“Today’s ruling by the 5th U.S. Circuit Court declaring the Affordable Care Act’s individual mandate unconstitutional and remanding the law back to District Court only serves to prolong Georgians’ uncertainty about their access to quality, affordable health care.

“More than 480,000 Georgians enrolled in health coverage through the ACA’s marketplace in 2019 and nine in 10 benefit from financial help to reduce their costs. Many, many more Georgians benefit from the standards and protections put in place by the ACA.

“As long as the court continues to entertain this legally dubious case, thousands of Georgians are at risk of losing their health coverage, protections for people with pre-existing conditions, and access to basic health services like mental health care and prescription drugs. Revoking the ACA’s protections and disentangling the law from Georgia’s health care system would only serve to sow chaos and confusion, to the detriment of Georgia families. These losses would disproportionately affect Georgians of color who already face inequitable barriers to care.

“The support of this lawsuit by Georgia Governor Kemp and Attorney General Carr is incongruent with their respective statements about increasing access to care and improving affordability for Georgia families and individuals. We urge Georgia leaders to re-consider their support of this case.

“It is important for Georgia consumers to know that this does not change the coverage they have today or their 2020 insurance plans. Georgians should maintain their health coverage and seek help at healthcare.gov if a life change results in a loss of their current coverage.”

For more information about Georgia consumers and Georgia’s ACA marketplace: Getting Georgia Covered: What we can learn from the 6th open enrollment period

About GHF:

With a mission to build and mobilize a unified voice, vision, and leadership to achieve a healthy future for all Georgians, Georgians for a Healthy Future provides a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. Georgians for a Healthy Future has a three-pronged approach which includes: 1) outreach, education, and engagement with consumers and communities; 2) coalition building and mobilization; and 3) public policy advocacy. For more information, visit www.healthyfuturega.org.


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GHF comments on Governor’s health care proposals

In March, Georgia’s Governor and state legislature approved SB 106, legislation that allows the state to pursue an 1115 “waiver” to make changes to Georgia’s Medicaid program and a 1332 state innovation waiver to make changes to private insurance in the state. (Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

In June, the Governor hired Deloitte Consulting to develop the proposals for Georgia’s Medicaid program and the private insurance market. Five months later, on October 31st and Nov. 4th respectively, Governor Kemp announced the details of his proposed plans.

The Governor’s proposed 1115 Medicaid waiver, called Georgia Pathways plan, would allow Georgians with incomes below the poverty line to enroll in Medicaid coverage but only if they can meet monthly work requirements (at least 80 hours per month of work, school, training, or volunteering per month). The plan would cover only a fraction of those who could be covered by a full Medicaid expansion.

The Governor’s proposal to re-shape the state’s private health insurance market consists of two parts:

  1. A reinsurance program to lower premiums; and
  2. A dramatic erosion of the Affordable Care Act’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections (like the requirement that health plans cover essential health services).

This plan would result in many Georgians who currently have health insurance becoming uninsured or underinsured.

The announcement of the Governor’s plans kicked off a 30-day public comment period during which Georgians impacted by these proposals, health advocates, health care industry stakeholders, and others could weigh in on the plans. 

Georgia’s 1115 waiver process. Note: the 1332 waiver process runs through the Department of Insurance, rather than Community Health

The Governor’s Medicaid proposal does not go far enough towards closing Georgia’s coverage gap and his plan to dramatically scale back the ACA in Georgia would turn back the clock on Georgians with pre-existing conditions and consumers who need financial help to afford private coverage, among many others. GHF submitted comments to state officials communicating our deep concerns about both plans. You can read GHF’s full comments here:


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Nov 11, 2020
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“Every Georgian, whether they know it or not, benefits from the standards and protections that have been put in place by the Affordable Care Act,” Laura Colbert, executive director of…

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