The New Healthcare Exchange: What Georgians Need To Know Before Choosing

It’s Time to Rise Up, Georgia! Now I’m not talking about the Atlanta Falcons, I’m talking about the government reaching into our pockets yet again! For those of you who have to get healthcare from the government exchange, you’re going to find challenges at every turn. Before you make your selection, there are a few key points to keep in mind.

From what I understand, those of us in the metro Atlanta area have the most choices when it comes to insurance providers. That is good news. What is also good news is that our premiums are the lowest in the state. What isn’t such good news is that your options for insurance providers are very narrow. So before you choose one of them I have some things for you to consider.

First, if you are loyal to a particular hospital chain (Wellstar, Northside, etc.), doctor, or just happen to live closer to a particular hospital, choose your insurance provider carefully. Large providers, such as Blue Cross and Blue Shield, don’t offer coverage at most of the larger hospitals. This shocks me!

Here’s a small list of facilities and the insurance they accept: (taken from the AJC 10/13)

·         Northside: Humana HMO and POS, Blue Cross and Blue Shield HMO, Alliant PPO, and Kaiser HMO.

·         Emory: Humana POS and Alliant POS

·         Piedmont: Humana POS and Kaiser HMO

·         Wellstar: Humana POS and Alliant PPO

·         Gwinnett Medical: Blue Cross and Blue Shield HMO, Humana POS, Alliant PPO, Kaiser HMO

·         Dekalb Medical: Blue Cross and Blue Shield HMO, Humana POS

So if you feel good about enrolling with the largest insurance provider Blue Cross and Blue Shield, just know that it will cost you more to go to a hospital other than Gwinnett or Dekalb Medical. The AJC is reporting that you would be responsible for 100% of the cost if you go out of network for anything other than emergency care.

Secondly, you need to consider the actual cost of this insurance. The Kaiser Family Foundation has a nice insurance calculator. Simply plug in your state, number of people (adults and children) in the household, total yearly income and it gives you a rough estimate of your total cost. I played with it a little bit to see how the numbers change depending on your income and whether or not you have children. Bottom line, it really comes down to your income as to whether or not you get a subsidy. Expect to pay anywhere from 6%-9% of your yearly income just for insurance. And the subsidy, well, the Kaiser Foundation says “you could get up to…” so you might not get as much as it shows.

The rub comes in this new information that the Kaiser Foundation has uncovered. It seems that because Governor Deal didn’t want to further expand Medicaid to cover families in a slightly higher income bracket. This means there will be a gap of over 400,000 Georgians who make too much for Medicaid but too little to be able to afford private insurance. They expect this to result in the continued flooding of emergency rooms with people who have no coverage, the one thing they were trying to avert.

I respect Governor Deal for saying no to expanded social programs. Welfare already eats up at least half of the Georgia budget as it is. But did he do so at his own political expense? I feel badly for those families who fall in this income gap, who struggle as it is to make ends meet and who are kicked again by their government.

What is this income gap? Begin by going to the Medicaid eligibility page. It’s measured based on your ability (disabled or elderly) as well as the age of your children. If you have no children, you will not qualify for Medicaid.

Bottom line, be wise before you decide. Read everything you can.