Key Facts for Georgia
Medicaid in Georgia
Georgia has not fully expanded Medicaid under the Affordable Care Act. Instead, the state implemented a limited waiver program called Georgia Pathways to Coverage in 2023, which covers fewer people and includes work requirements.
Georgia has a significant coverage gap. An estimated 270,000+ Georgians earn too much for traditional Medicaid but too little to qualify for marketplace subsidies. Many don't qualify for Georgia Pathways due to work requirements.
Georgia Pathways to Coverage
Georgia Pathways is a limited Medicaid expansion program with work requirements:
- Income limit: Up to 100% FPL (about $14,580/year for an individual)
- Work requirement: 80 hours/month of work, education, job training, or volunteer activities
- Age: 19-64 years old
- Documentation: Must report and verify qualifying activities monthly
Georgia Pathways requires participants to complete and report 80 hours of qualifying activities each month. Failure to report can result in loss of coverage. Some exemptions apply for certain health conditions or circumstances.
Who Qualifies for Traditional Georgia Medicaid?
- Children: Up to 252% FPL through PeachCare for Kids
- Pregnant women: Up to 225% FPL
- Parents/Caretakers: Very limited (approximately 35% FPL)
- Elderly and disabled: Must meet income and asset requirements
- Childless adults: Generally do not qualify (unless through Pathways with work requirements)
How to Apply for Georgia Medicaid
- Online: Visit Georgia Gateway
- Phone: Call 1-877-423-4746
- In Person: Visit your local Division of Family and Children Services (DFCS) office
Health Insurance Marketplace
Georgia uses the federal Health Insurance Marketplace at HealthCare.gov. Georgia has one of the highest marketplace enrollments in the nation.
November 1, 2024 through January 15, 2025. Enroll by December 15 for coverage starting January 1, 2025.
How to Enroll
- Visit HealthCare.gov
- Create an account or log in
- Complete your application with income and household information
- You'll be screened for Medicaid/Pathways eligibility first
- If not eligible, compare marketplace plans
- Select a plan and complete enrollment
Special Enrollment Periods
You can enroll outside of Open Enrollment if you experience a qualifying life event such as losing other coverage, getting married, having a baby, or moving to Georgia.
Average Costs in Georgia
Georgia has a competitive marketplace with multiple insurers in most areas:
- Benchmark Silver Plan: Average of $400-550/month before subsidies for a 40-year-old
- With Premium Tax Credits: Many Georgians pay $50-150/month after subsidies
- Bronze Plans: Lower premiums starting around $250-350/month before subsidies
- Gold Plans: Higher premiums, lower out-of-pocket costs
If your household income is between 100% and 400% of the Federal Poverty Level, you likely qualify for subsidies. Enhanced subsidies through 2025 make coverage more affordable for many Georgians.
Alternatives for the Coverage Gap
If you fall into Georgia's coverage gap or don't qualify for Pathways, consider these options:
- Federally Qualified Health Centers (FQHCs): Georgia has numerous community health centers with sliding-scale fees
- Grady Health System: Atlanta's safety-net hospital with financial assistance programs
- Free Clinics: Volunteer medical clinics throughout Georgia
- Hospital Charity Care: Many hospitals offer financial assistance
- Prescription Assistance Programs: Help with medication costs
- Short-Term Health Insurance: Limited coverage option (review exclusions carefully)
Frequently Asked Questions
Has Georgia expanded Medicaid?
No, Georgia has not fully expanded Medicaid. Instead, Georgia implemented a limited waiver program called Georgia Pathways to Coverage, which provides coverage to a smaller population with work requirements. This leaves many low-income Georgians without affordable coverage.
What is Georgia Pathways to Coverage?
Georgia Pathways to Coverage is a limited Medicaid waiver program that began in 2023. It requires participants to work, volunteer, or participate in qualifying activities for at least 80 hours per month. It covers adults ages 19-64 earning up to 100% of the Federal Poverty Level who meet the work requirements.
When is Open Enrollment for Georgia health insurance?
Georgia uses the federal HealthCare.gov marketplace. Open Enrollment for 2025 coverage runs from November 1, 2024 through January 15, 2025.
How do I apply for Georgia Medicaid?
You can apply through Georgia Gateway at gateway.ga.gov, by phone at 1-877-423-4746, or in person at your local Division of Family and Children Services (DFCS) office.
Need Help Finding Coverage in Georgia?
Georgia's coverage landscape can be complex. Our licensed agents can help you understand all your options, including Pathways, marketplace plans, and alternatives.
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