Health care is never a simple
topic. In Georgia, as in the rest of the United States, new laws and other changes
can have a significant impact on your health plan options. Below are six things
you probably didn’t know (but should know) about individual health insurance in
Georgia.
1.
New Report Shows Average Monthly Premium of $710 for Gold Health
Plan in Georgia.
The Georgia Department of
Community Health Waiver Project has released the Georgia Environmental Scan
Report, which looks at the current health care environment in the state.
Here are some of the
surprising facts revealed in the report:
·
14.8
percent of Georgia’s population was uninsured in 2017. In some counties, the
uninsured rate exceeded 30 percent. For comparison, 10.5 percent of the
national population is uninsured.
·
The
number of consumers in Georgia who selected a plan on the Marketplace fell 15
percent from 2015 to 2019. In 2019, the average monthly premium was $710 for a
Gold plan, $622 for a Silver plan and $496 for a Bronze plan.
·
A total
of seven rural hospitals have closed in Georgia since 2010. This is the third
highest closure rate in the country. Two-thirds of Georgia’s 159 counties are
considered rural, while 83 percent of the state’s population resides in urban
areas.
Key Takeaway: When you shop for individual health insurance, see if you
can find rates that are better than those available in the Marketplace.
2.
Research Shows Big Discrepancies in How Much Hospitals
Charge.
Research from the RAND Corporation finds that private
health insurance plans pay high prices to hospitals compared to Medicare, and
that there is significant variation in prices. The study looked at the hospital
prices paid between 2015 and 2017 in 25 states.
Georgia was among the states included in the report.
According to the findings, private health plans paid amounts that were 243
percent of Medicare costs in Georgia.
Key takeaway: When you need an expensive
health care procedure or surgery, make sure to ask how much it will cost and
get pricing from three potential providers if possible.
3.
Georgia Receives the Third Worst Ranking in Nation for
Health Care Conditions.
MoneyRates.com ranked states
based on several criteria related to health care conditions. States could be
given a label of robust, healthy, average, frail or critical for both the
overall health care conditions and the individual criteria. Here’s what the
ranking revealed about Georgia:
·
Georgia
received an overall label of critical. It was ranked the third worst state in
the nation, beating out only Mississippi and South Carolina.
·
Georgia
earned a critical ranking in health insurance coverage rates, infant survival
and the number of patient care doctors per capita.
·
The
state earned a frail ranking for longevity and hospital capacity. The state’s
nursing home capacity was ranked average.
·
Georgia
earned an above-average ranking in only one category: child vaccination. In
this category, Georgia earned a robust ranking, meaning the state’s child
vaccination rates fall into the top 20 percent.
Key takeaway:
Prevention is the best medicine. Take steps now to keep yourself and your
family members healthy. Schedule check-ups annually, keep up on your vaccines
and any take advantage of screenings covered by your health insurance.
4.
Kids Without the Measles Immunization Can’t Attend School
in Georgia.
Despite the relatively high
child vaccination rates in Georgia, the state has not escaped outbreaks of
preventable viral diseases completely. At least six cases of measles have been
reported in Georgia this year, including three in January and three in April.
The infected patients were unvaccinated.
According to the CDC, measles
is a highly contagious virus. It causes a painful rash, cough, runny nose and
fever, but it can also lead to more serious complications, including deafness,
intellectual disability and death. Approximately 20 percent of unvaccinated
people in the United States who contract measles have to be hospitalized.
The Georgia Department of
Public Health says that children should receives two doses of the MMR vaccine
age at one year of age and four to six years of age, and unvaccinated adults
should also receive the vaccine. Immunization is required for childcare and
school attendance in Georgia.
Under the Affordable Care Act
(ACA), health insurance plans should cover preventative care including the
measles vaccine.
Key takeaway: If you haven’t already done so, talk to your pediatrician
about the measles immunization.
5.
Association Health Plans Are Now an Option for Georgia Small
Businesses.
Association Health Plans are
designed to let self-employed individuals and small businesses to band together
in order to obtain health coverage. This gives them more negotiating power,
similar to what larger employers enjoy. In June 2018, the U.S. Department of
Labor expanded access to Association Health Plans.
Key takeaway: If you own a business, look for association health plan
opportunities in your industry.
6.
Hospital Patients are Often Hit with Surprise Medical
Bills.
Patients in Georgia and throughout
the country have been struggling with surprise medical bills. Sometimes called
balance billing, the practice refers to large bills that are sent to insured
patients after the insurer has made its payments.
A common scenario goes
something like this. An individual goes to the hospital. The hospital is in the
patient’s insurance network, so the patient assumes that treatment will be
covered, aside from the standard deductibles and copays. However, unbeknownst
to the patient, one or more of the providers delivering care is out-of-network.
The patient receives a large bill as a result.
Like other states, Georgia
has been working on legislation to tackle the problem of surprise bills. Senate
Bill 56 and House Bill 84 both address the issue of out-of-network providers.
The House Bill requires information to be provided upon request. The Senate
Bill requires a database of prices that the insurance company will pay for
out-of-network services. The House failed House Bill 84, but the Senate passed
Senate Bill 56.
Key takeaway: Don’t assume that every provider associated with your
hospital is in-network. Verify your insurance with each provider if possible.
Wondering how much an
individual health insurance in Georgia costs? Get a quote
here.
Sources:
·
https://medicaid.georgia.gov/patients-first-act
·
https://www.rand.org/pubs/research_reports/RR3033.html
·
https://www.money-rates.com/research-center/compare-healthcare-by-state.htm
·
https://dph.georgia.gov/three-new-measles-cases-georgia-get-vaccinated
·
https://www.cdc.gov/measles/index.html
·
https://www.dol.gov/general/topic/association-health-plans