Health Insurance in Georgia

Health insurance is a vital aspect from financial planning point of view. Buying appropriate health insurance coverage for your family is costly and requires a good consideration of all potential risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. The rising healthcare costs lead to the financial burden faced by these families in the event of physically crippling hazards. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.

Georgia stands at 41st place in the Healthiest States List issued through United Health Foundation’s 2008 Health Rankings. The state, having the population of more than nine million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Georgia who meet specific eligibility requirements.

The Georgia Department of Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 17.7% of the residents are uninsured as the state lawmakers strive to increase public health funding, decrease the high percentage of children in poverty and provide easy access to health care. Approximately, 32.3% uninsured Georgia citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

Health insurance is one thing that you cannot afford to survive without. When shopping for health coverage, make sure to contact a licensed health insurance agent/broker to avail the benefits of health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Georgia. These regulations apply to all insurance companies offering individual or family health insurance in Georgia:

Medical Underwriting
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
No Limit
Look Back Standard
No Definition
Mandatory Benefits
Cancer screening including screening of breast cancer, cervical cancer and ovarian cancer, inpatient mastectomy stay as determined by the physician, osteoporosis screening, direct access to OB/GYNs, infertility treatment, maternity care
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Georgia. These regulations apply to all insurance companies offering small group health insurance in Georgia:

Small Group Size
Employee Qualifications
Owner can count as an employee
Guaranteed Issue
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Georgia. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
3 months
Extension of Benefits Period – Disabled
3 months
Maximum Premium Increase
State Legislation Reference
Georgia Official Code Title 33, Chapter 24, Sections 33-24-21.1 and 33-24-21.2
Additional Notes
Mini-cobra applies to any employee that has had at least 6 months of coverage under the group plan and excludes employees that were terminated due to misconduct. Extension of benefits must be offered to individu­als over the age of 60.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Georgia to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Georgia does not offer health insurance coverage through high risk pool for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Georgia provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
PeachCare for Kids
Phone Number
Apply Online
Age Limits
Under 18
Insurance Carrier
Dependent on County of Residence
Length of Coverage
12 months
Residency Requirements
Georgia residents, U.S. citizens, certain qualified legal residents, refugees or asylees who reside in Georgia
Other Eligibility Requirements
Family income should be less than or equal to 235% of the federal poverty level,
Pre-Existing Condition Exclusions
No cost for children under age six. The cost per month is $10 to $35 for one child and a maximum of $70 for two or more children living in the same household.

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Georgia:

Governing Agency
Georgia Department of Community Health
Phone Number
Residency Requirements
Georgia residents, documented immigrants
Federal Poverty Line Income Limits
Pregnant women at or below 200% FPL
Children age 0-1 up to 185% FPL
Children age 1-5 up to 133% FPL
Children age 6-19 up to 100% FPL
Working parents up to 58% FPL
Medically needy individual up to 44% FPL
Medically needy couple up to 39% FPL
Non-working parents up to 32% FPL
Additional Resources

Georgia Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Georgia’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Georgia: At-A-Glance
Provides exclusive health data of the Georgia state., a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.