2023 Guide to Individual and Family Health Insurance in Georgia

2023 Guide to Individual and Family Health Insurance in Georgia

Welcome to our 2023 Guide for Health Insurance in Georgia!

We have written this guide to help you make an educated decision about your health insurance plan for the 2023 plan year. It includes information about the carriers, their networks, and guidance for the different plans available in Georgia for the 2023 plan year.

Keep in mind that our services to you are 100% FREE to you!  If we are your agent our help extends throughout the year to any issues that may arise with your Health Insurance! We encourage you to check out our Google reviews. We are the highest rated Individual and Family agency in Georgia because we provide expert advice, we are always honest and customer service is our top priority.

There are two ways to get coverage for 2023:

1.) Are you comfortable with selecting a plan and applying yourself? You can read our comprehensive guide below, run your own quotes, and apply for a plan by clicking HERE! If you get stuck on your application you can call us for help.

2.) Do you want more personalized help and guidance? You can schedule a phone or video appointment with us to go over all your options and get help applying, just click HERE!

The Quoting and Enrollment system that we use “Health Sherpa” is directly linked to the Marketplace and automatically pulls pricing and information direct from the Marketplace. It is one of the most secure systems available and is used by millions across the United States. If you sign up through our link, we are your agent! Our link is here: https://www.healthsherpa.com/?_agent_id=daniel-potter. You can also add us to your plan if you sign up directly to the marketplace. Just add Daniel Potter as your agent, NPN 180-32-692.

Elite Plus Circle of Champions 2022

Daniel Potter and Team
Georgia Health Insurance, Inc

770-452-9335 or Contact us Here

Frequently Asked Questions

Question 1: Will you sell my information to call centers so that I get spammed by 100’s of emails and calls?

Answer 1:  NEVER! We will never send you spam mail or spam you with phone calls. We will never give your information out to marketing organizations. We are a Georgia based, family owned agency that has local employees and we care about you having a good experience when you work with us. That means no spam.

Question 2: Does my insurance cost more through you? How are you paid?

Answer 2: Your insurance will not cost any more when you go through us. Major medical plan pricing is set by the marketplace and cannot be changed. We are paid a commission by the insurance company we help you enroll with. We are an independent agency so we are not required to sell one product vs another. We help you find the best product for your situation by looking at ALL the options in Georgia.

Question 3: What is a major medical plan?

Answer 3: A “Major Medical Plan”, also known as a “Qualified Health Plan” is a plan that is certified by the Healthcare.gov Marketplace to provide coverage for “essential health benefits” as well as a plan that has limits on cost-sharing and covers pre-existing conditions. These are the most comprehensive plans available on the market in Georgia and are the best option for most individuals and families. Beware that there are many plans out there that do not meet these requirements and people are often tricked into buying them. We often get calls from people who bought some other type of plan and did not find out how it worked until it was too late.

Question 4: Can I get a PPO health insurance plan?

Answer 4: No (with one exception). The Major Medical plans offered in Georgia for Individuals and Families are limited to HMO options. However some carriers have  large networks and do not require referrals to see a specialist. There are 10 insurance companies offering major medical plans in Georgia so there are lots of good options for 2023.

How to pick the most appropriate plan to meet your needs

  1. Run your quote HERE. Be sure to save your quotes using your proper name.
  2. Enter your preferred Doctors & Hospitals when given the chance during the quoting process.
  3. The key with any plan is to confirm that your doctor is in-network before you apply. All plans but one are HMO Networks, meaning there is NO out of Network Coverage except for true emergencies.
  4. Choose your Plan then click Add to Cart then Start Application.
  5. Call us if you run into trouble while applying and tell us you are stuck so we can help you. As long as you use the link found in this email to quote & apply, we can pop into your application on the page you are stuck on and finish the application with you over the phone if you need help.

Confused, still have questions after saving your quotes?

Click here to schedule a time to talk to Daniel

Prepare for your Appointment – To make the most out of your appointment time with us you can run your quotes, including entering your providers, and saving your quotes under your proper name so that we can quickly pull up your quotes to discuss with you at your phone appointment.

You need an agent you can trust! Check out our Google reviews HERE to see why our clients value our help so much.

Aetna (Aetna CVS HMO Network)

Key Metro Atlanta Hospitals In-Network (check with providers)

Emory

Piedmont

Children’s HealthCare of Atlanta

2980+ Primary Care, 18,660 Specialist, 161 Urgent Care in Network

Our thoughts for 2023

Aetna remains a strong option in 2023 for those that use the Emory and Piedmont hospital networks. They also work well from those the in Albany and Savannah areas. With CVS being their parent company they offer strong pharmacy benefits and choices. Aetna customer service has been some of the best in the industry for years and our clients have been happy with the insurance and service.

Key Albany Network – Phoebe North, Phoebe Putney, Phoebe Sumter, Phoebe Worth and Crisp Regional Hospital.

Key Savannah Network – Appling Healthcare, Evans Memorial, Liberty Regional Medical, Wayne Memorial, Candler, Landmark Hospital, Memorial Health Uni, Select Specialty Hospital, Effingham County hospital and Optim Medical.

Pros

  • No referral required
  • Free CVS MinuteClinic in network nationwide (on most plans)
  • Free CVS MinuteClinic Virtual Care (on most plans)
  • Large pharmacy network – CVS, Costco, Publix, Walmart, Walgreens and more!

Cons

  • Only offered in Atlanta, Albany, and Savannah
  • Missing some major hospitals

Recommended plans in each category

    • Aetna CVS Bronze Low-Cost $5500
    • Aetna CVS Silver 2 $6000
    • Aetna CVS Gold $1450

Alliant (Alliant Health Plans network)

Key Hospitals In-Network outside of Atlanta (check with providers)

Northeast Georgia Medical Center

Piedmont

WellStar

Other rural hospitals

Our thoughts for 2023

Alliant will be a good choice for many in rural counties, especially in North Georgia. They have even more Silver and Gold options this year with some new benefits like dental and chiropractic care. They still have PPO options for those that need out of network coverage and they have very rich platinum plans. Their pricing will be competitive for 2023 for many counties and plans. They have on and off exchange plans.

They will have more competition this year with Cigna and Ambetter, so make sure to check out those carriers!

Pros

  • No referral Required
  • PPO & HMO Networks (Plans are only offered In select counties)
  • Live It health lifestyle program allows you to earn rewards
  • Only Platinum plans in Georgia

Cons

  • Not available in Metro Atlanta Counties nor Southeast Georgia
  • Missing Children’s HealthCare of Atlanta hospitals
  • Can be very expensive to see out of network providers
  • Left many counties for 2023 (around Talbot)

Recommended plans in each category

    • Bronze – SoloCare Bronze No Referral HMO 110015
    • Silver – SoloCare Silver PPO 40331
    • Gold – SoloCare Gold PPO 40330
    • Platinum-SoloCare Platinum PPO 40184

Ambetter (4 different networks for 2023 so look closely at plan name)

Key Metro Atlanta Hospitals In-Network (check with providers)

 

Bronze, Silver, Gold “Core” Network:

Emory Hospital

Northside Hospital

Piedmont Hospital

WellStar Hospital

Grady Health System

Three Ambetter Select Networks (Chatam, Cobb, Clayton, Cherokee, Fulton, Henry, Newton and Rockdale counties):

1.)  Select Wellstar – Only WellStar Hospital

2.) Select Piedmont – Only Piedmont Hospital

3.) Select St. Joseph – Only St. Joseph’s Hospital

Our thoughts for 2023

Ambetter is one of our top picks for 2023. They the largest Marketplace carrier in the entire United States. Many of our clients use Ambetter because their “Core Bronze, Silver and Gold” network is the largest network available on a Georgia Marketplace plan. We have had great experience with Ambetter’s customer service and their network for years now and our clients have been happy with Ambetter. They offer great pricing, industry best Healthy Reward programs, huge network with multiple options, strong dental and vision options and great overall customer service and satisfaction.

Pros

  • No referrals required
  • Largest Overall Network in Georgia
  • Large number of Rural hospitals
  • Free Telemedicine and Virtual Care on most plans
  • Easy to use Health Program with potential rewards of $500 – My Health Pays
  • We have a lot of experience with Ambetter and have had only a few complaints from clients. Our transplant clients and cancer patients are quick to praise Ambetter.
  • Offers some lower cost Off Exchange plans for those that do not qualify for a Subsidy
  • Dental and Vision with no waiting period (but limited network)

Cons

  • Plans have different networks and can be confusing, look closely at the plan name
  • No Children’s HealthCare of Atlanta
  • No Northeast Georgia Medical Center

Recommended plans in each category

    • Bronze – Everyday Bronze
    • Silver – Everyday Silver
    • Gold – Everyday Gold
    • Dental and Vision plan – Great benefits with no waiting period however the network is not large.

Anthem Blue Cross (Pathway X Network-HMO)

Key Metro Atlanta Hospitals In-Network (check with providers)

Emory

Northside – back in network

Children’s HealthCare of Atlanta

Our thoughts for 2023

Anthem is a solid choice now that they have Northside back in network. We do not like that they seem to continue to have disputes with hospitals that result in poor member experience. We usually only recommend Anthem if your doctors take nothing else as the price, network and needing a referral are not amazing.

Pros

  • Anthem Blue Cross name is familiar

Cons

  • Referrals Required for the metro Atlanta Pathway X Guided Access plans
  • The Pathway X Networks are the smallest Anthem Blue Cross networks. You must confirm that your provider is in the Pathway X network for All Individual/Family Anthem plans.
  • Disputes with hospitals.

Recommended plans in each category

    • Bronze – Pathway X 5600
    • Silver – Pathway X 4950
    • Gold – Pathway X 1900

CareSource (Marketplace Network-HMO)

Key Metro Atlanta Hospitals In-Network (check with providers)

Children’s HealthCare of Atlanta

Northeast Georgia Medical Center

Northside

Piedmont

WellStar

Grady

Our thoughts for 2023

CareSource is appealing due their low price, large hospital network and unique benefits. They are the only carrier to have a combo dental, vision and fitness benefit. The fitness program is robust and includes a home kit, on demand online workouts and membership access to a large network including LA Fitness, Snap Fitness, Anytime Fitness, Planet Fitness and more! They also offer a good pediatric vision benefit.

Pros

  • Referrals not required
  • Largest Hospital network in Metro Atlanta
  • 4th year in Georgia, network is growing
  • Free Telehealth on most plans

Cons

  • Emory is missing from their hospital network

Recommended plans in each category

    • Bronze – Marketplace Bronze First
    • Silver – Marketplace Low Premium Silver
    • Gold – Marketplace Gold

Cigna HealthCare (Cigna Connect Network-HMO)

Key Metro Atlanta Hospitals In-Network (check with providers)

Northeast Georgia Medical *New for 2023*

Piedmont

Wellstar

Children’s HealthCare of Atlanta

Grady

Our thoughts for 2023

Cigna will be a good option for 2023. They have expanded to new counties for 2023 and they have added Northeast Georgia Medical Center. Their Silver level plans are also the most competitive on the market. They offer great customer service, numerous benefits (Virtual care, enhanced complex care management, Healthy Reward program) and some specialized benefits for Diabetes. If you have Diabetes Cigna will be on of your top option for 2023. They have limits of the cost of insulin, free diabetes supplies, management training and some labs and exams. They also offer special plans with even more diabetes care benefits.

New for 2023, Cigna offers multiple plan levels for dental and vision with some of the best benefits on the market!

Other notable hospitals in network: Flint River Hospital, St. Josephs Hospital, Candler Hospital, Upson Regional Medical Center.

Pros

  • No referral Required
  • Special plan for people with Diabetes
  • Special plan for people with Asthma/COPD
  • Walgreens, Rite Aid, Costco, Publix pharmacies in network
  • Added Northeast Georgia Medical
  • Cheap Silver plans
  • Good dental and vision options

Cons

  • Offered in limited counties in Georgia for 2023

Recommended plans in each category

    • Cigna Connect Bronze 6500
    • Cigna Connect Silver 3700
    • Cigna Connect Gold 1600

Friday Health Plans (Friday Health Plans HMO Network)

Key Metro Atlanta Hospitals In-Network (check with providers)

Piedmont

WellStar

Children’s HealthCare of Atlanta

Some Grady

Our thoughts for 2023

Friday continues to improve in Georgia. The network is getting larger and they offer some attractive benefits/pricing. If you primarily use WellStar or Piedmont they will be a strong option for 2023 (as well as some of the counties listed below). Their pharmacy network is also very large including CVS, Walmart, Kroger, Costco and Walgreens.

Columbus Region – Piedmont

Macon Region – Piedmont

Savannah Region – HCS Memorial, Effingham, Southcoast, Optim Medical, Encompass Health, Curtis V Cooper, Strategic Health Partners

Augusta Region – Piedmont, Doctor’s Hospital, Lighthouse Care Center

Pros

  • Referrals not required
  • Lowest cost plans in some counties
  • $0 for Primary Care visits, general drugs, mental health visits, Teladoc and wellness exam
  • +Vision plans that give a $0 annual eye exam
  • National Access program for out of area dependent students (Zelis)

Cons

  • Newer company to Georgia
  • Smaller hospital and doctor network

Recommended plans in each category

    • Friday Standard Expanded Bronze
    • Friday Standard Silver
    • Friday Standard Gold Copay

Kaiser (Signature HMO Network Only)

Key Metro Atlanta Hospitals In-Network

Emory Saint Joseph’s Hospital and Emory Decatur

Northside (for maternity only)

Children’s HealthCare of Atlanta

Our thoughts for 2023

Kaiser is unique in the health insurance market as they are the only company that is not only an insurer but also a health care provider. Kaiser leverages this fact to provide both insurance and care that is tailored for the best possible patient outcomes. Kaiser is expanding their capabilities in Georgia and we think they will be a major player for years to come. If you do not mind getting integrated into the Kaiser system they can be a good choice for 2023. Kaiser is also offering pediatric and adult vision and dental options.

Pros

  • Kaiser has a stable network of providers that work directly for Kaiser
  • They are the only insurance company that is a healthcare provider, so Kaiser has many of their own doctors and facilities and Doctors are incentivized based on patient outcomes and patient happiness!
  • 20 year collaboration with Emory hospital
  • Away from Home travel Hotline – 951-268-3900 or kp.org/travel and Cigna collaboration for out of network urgent and emergency care
  • Member benefits like ClassPass, self-care apps Calm and myStrength, Wellness coaching, online healthly lifestyle programs and reduced rates on health and wellness services
  • Available off-exchange as well.

Cons

  • Typically, you can only see Kaiser doctors
  • Limited Hospitals in network
  • Only sold in limited counties

Recommended plans in each category

    • Bronze – Bronze Virtual Complete 5500
    • Silver – Silver 3500
    • Gold – Gold 1800

Oscar (Oscar Network-HMO)

Key Metro Atlanta Hospitals In-Network (check with providers)

Emory

Wellstar

Grady

Southern Regional Medical Center

Our thoughts for 2023

Oscar continues to improve in Georgia. Their network is expanding and their benefits are getting better. Plus, with their “Oscar Care Teams” they offer some of the fastest and best customer service available! If Emory is important to you then Oscar will be one of your top options. They offer very competitively price plans along with benefits such as $3 prescriptions, Healthy Reward program, super easy to use online account and app, an excellent Diabetes plan and they require no referrals.
Their free virtual care is very fast as well!

Pros

  • No referral Required
  • You are assigned a Care Team
  • Oscar offers free, fast telemedicine through App
  • Competitive pricing
  • Easy to use and useful technology
  • Special plan for people with Diabetes

Cons

  • Available in limited counties
  • No Children’s HealthCare of Atlanta in network

Recommended plans in each category

  • Oscar Bronze Elite
  • Oscar Silver Simple or Classic
  • Oscar Gold Elite

United HealthCare (United HealthCare GA Individual Exchange Benefit Plan network)

Key Metro Atlanta Hospitals In-Network (check with providers)

Northside

Piedmont

Children’s HealthCare of Atlanta

Limited Wellstar (North and South Fulton)

Our thoughts for 2023

UHC is improving for 2023. Their plan pricing, network and other benefits are getting better. They are a top-tier, trusted insurance company and we look forward to their continued presence in the market. They will be a competitive option for those who use Northside and Piedmont. They are also a good option in Augusta and Savannah.

Augusta Network – Piedmont/University Hospitals, HCA, Augusta University

Savannah Network – St. Joseph’s/Candler

Pros

  • Most plans have $0 Primary Care visits and $0 Virtual Urgent Care
  • Member Benefits – Free 1 year Peloton Digital membership, Free AARP membership, up to $100 health reward program
  • Low Cost Prescriptions at Walgreens
  • Dental and Vision on select plans

Cons

  • Referrals are Required from your listed PCP to see other in-network doctors
  • Hospital network is limited

Recommended plans in each category

    • UHC Bronze Value
    • UHC Silver Value
    • UHC Gold Value

Dental and Vision

Dental Options for 2023:

1.) You can run your own quotes and easily apply for dental/vision with top companies like Delta Dental, Nationwide and the Standard by clicking the link below:

Run Dental and Vision Quotes and Apply Here!

 

2.) You can get a stand alone plan through United Health Care – This is a great option and UHC offers very versatile options such as no waiting periods, see any doctor regardless or network, different coverage and price points, etc… contact us for a quote.

3.) If you want a dental only plan through the marketplace we recommend one of the Anthem offerings. Note all the stand alone dental options in the marketplace have a waiting period. Stand alone vision is not offered.

4.) A combo dental/vision plan on the Marketplace with either Ambetter, CareSource or UHC can be great options. There is not as much flexibly with the plan options or network on these but they offer GREAT value.

We always recommend checking with your dental or vision office if it is important that they remain in network!

Schedule your Phone or Video Appointment

Need Help? Schedule a phone or video appointment with us today! Just pick a date and time from our calendar , it is easy! Click here to schedule: https://calendly.com/ga-health-insurance/daniel-meeting?month=2022-10

Here is our link to view plan pricing and apply: https://www.healthsherpa.com/?_agent_id=daniel-potter. Feel free to schedule an appointment or call anytime if you run into trouble or have questions!

Do you want to sign up directly on the marketplace? We can still be your agent! Just enter Daniel Potter and my NPN #18032692 as your agent that is helping you. Please let us know if you apply this way so we can follow up on your application status!

If you want to know a little bit more about us please feel free to check out our website https://ga-health-insurance.com/ and check out our Google Reviews so you can see what people think of our services. We look forward to working with you to help you have a smooth transition into your new plan.

Sincerely,           

Daniel Potter // Georgia Health Insurance, Inc.

P: 770-452-9335 F: 770-452-9335

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