All state insurance regulations will have to adjust over the next two years to comply with the provisions of the 2010 Patient Protection and Affordable Care Act. Insurers can no longer exclude children from health coverage due to pre-existing conditions, and adults will enjoy the same protection by 2014. Additionally, children can remain as beneficiaries on their parents’ coverage to age 26 even if they are not students or have married.
Initially, the states have been required to implement temporary high risk insurance pools and to evaluate their options for implementing the required health insurance exchanges.
General Insurance Regulations
Insurers in Georgia are required to have a guaranteed renewability provision as long as all premiums are paid and no false information was provided upon application. Currently, if there is a pre-existing medical condition, insurers can put an exclusion into the contract for an unlimited period, but normally the exclusion is two years.
The Georgia Health Policy Center (GHPC) is in charge of developing health policy. They are assigned with improving health care quality and making it more accessible and affordable. Because of this unique private program, Georgia is one of the leaders in community health care initiatives. The GHPC is based out of Georgia State University’s Andrew Young School of Policy Studies and works on a local, statewide and national level to improve Georgia health insurance and care
Georgia health insurance companies are faced with many state mandated regulations. If an employer is providing group coverage, an individual may not be denied coverage due to a pre-existing condition. Any small business between 2 and 50 employees must be sold the same Georgia health insurance policy that is offered to other small businesses. However, there are minimum participation requirements. If this minimum level is not met, the policy may be terminated. If the employee group has a higher risk status, they may also be charged higher policy premiums.
For individuals and families who cannot afford Georgia health insurance, there are many options available. Georgia offers Medicaid, the PeachCare for Kids Program and the Georgia Cancer Screening Program. These programs are free or subsidized by the state and provide coverage of medical services to low income individuals and families. Families who do not qualify for the Medicaid program and live below 235% of the federal poverty level can qualify for the PeachCare for Kids Program.
Health Insurance Exchange
Georgia is continuing to evaluate its options regarding the exchange and has made more progress in considering a small business health insurance marketplace than in establishing an individual exchange. Legislation regarding the small business program may be introduced during 2012.
Pre-Existing Condition Insurance
The Georgia Pre-Existing Condition Insurance Plan is administered by the U.S. Department of Health and Human Services and includes benefits for hospital care, drugs, primary, and specialty care and carries monthly premiums in a range of $147 to $633 depending on age and option chosen. Deductibles range from $1000 to $3000 and there may be a separate deductible for prescription medications. Combined out-of-pocket expenses for care in and outside of the network cannot exceed $7000.
Medicaid eligibility is determined as a percentage of the Federal Poverty Level and in Georgia is 185% for infants under the age of 1. For the 1-5 age group the qualifying point is 133%, dropping to 100% for the 6-19 class. Pregnant women can qualify at 200% FPL, parents at 27%, and disabled non-elderly Social Security recipients at 74%.
More than 1,100,000 Georgians, about 12% of the state’s population, are enrolled in the Medicare program, with 1,160,00 taking advantage of Medicare prescription drug coverage. Approximately $7000 is spent per Medicare enrollee in the state.