Welcome to our 2025 Guide for Health Insurance in Georgia and the new Georgia Access system!
We have written this guide to help you make an educated decision about your health insurance plan for the 2025 plan year. It includes information about the carriers, their networks, and guidance for the different plans available in Georgia for the 2025 plan year.
We will also cover the new Georgia Access system that is replacing the Federal Marketplace in Georgia.
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.
Georgia Access is new for 2025 but does not represent a major disruption for our clients. Learn more about Georgia Access here!
The Quoting and Enrollment system that we use “Health Sherpa” is directly linked to Georgia Access and automatically pulls pricing and information direct from the Georgia Access (there is no difference in price). 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. Secure our expertise, guidance, advocacy and help for no cost by letting us be your agent!
Frequently Asked Questions
Question 1: What is Georgia Access?
Answer 1: Georgia Access is a new state-run Marketplace program designed to help Georgia residents exclusively find, compare, and enroll in affordable health insurance in our state.
Question 2: Do I need to be concerned about the transition to Georgia Access?
Answer 2: Not at all! Our system is directly integrated into Georgia Access so we can quickly and easily help you get signed up with the new system! If you have questions or want our help, just schedule a phone or video appointment with one of our agents.
Question 3: Will you sell my information to call centers so that I get spammed by 100’s of emails and calls?
Answer 3: 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 4: Does my insurance cost more through you? How are you paid?
Answer 4: 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 the full range of options in Georgia.
Question 5: What is a major medical plan?
Answer 5: 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 6: Can I get a PPO health insurance plan?
Answer 6: 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 8 insurance companies offering major medical plans in Georgia so there are lots of good options for 2025. There are even some options that let you visit providers out of state!
Aetna (AetnaCVSHealth Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Emory
Piedmont
Wellstar
Children’s HealthCare of Atlanta
2980+ Primary Care, 18,660 Specialist, 161 Urgent Care in Network
Our thoughts for 2025
Aetna remains a solid pick for 2025. They have a great hospital and doctor network, great CVS benefits (such a $0 CVS Virtual Primary Care and $0 CVS Minute Clinic vists) and excellent customer service. 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.
Key Athens Network – Piedmont Hospital
Key Augusta Network – Doctors Hospital of Augusta and Augusta University Medical Center
Key Brunswick Network – Southeast Georgia Health System – Brunswick Campus
Pros
- No referral required – PCP selection required.
- Strong network, good pricing.
- Aetna Insurance Card gives 20% discount on CVS Health Products in retail CVS stores.
- Up to a $100 yearly allowance to use on over the counter CVS health and wellness items.
- Free 24/7 CVS MinuteClinic in network nationwide (on most plans).
- Free CVS Virtual Primary Care (on most plans).
- Large pharmacy network – CVS, Costco, Publix, Walmart, Walgreens and more!
- New cap of $25 copay for preferred insulin
Cons
- Missing some major hospitals in Atlanta.
Recommended plans in each category
-
- Bronze – AetnaCVSHealth Bronze 4 Advanced
- Silver – AetnaCVSHealth Silver S
- Gold – AetnaCVSHealth Gold 3 Advanced
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 2025
Alliant will be a decent choice for many in rural counties, however there is more competition in rural counties in 2025 than ever before. They offer some benefits like dental and chiropractic care as options to some plans. They still have PPO options (however the cost to use the PPO network is HIGH) for those that need out of network coverage and they have very rich platinum plans. They have on and off exchange plans.
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
- Very expensive to actually use the PPO benefits
- Not available in Metro Atlanta Counties
- Missing Children’s HealthCare of Atlanta hospitals and other major hospital systems in Georgia
- Telemedicine has a Copay or Coinsurance cost
Recommended plans in each category
-
- Bronze – SoloCare Standard Exp Bronze
- Silver – SoloCare Silver HMO 6000/60
- Gold – SoloCare Gold HMO 2300
- Platinum – SoloCare Standard Platinum HMO
Ambetter (Premier and Select Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Ambetter Premier Network. :
Emory Hospital
Northside Hospital
Piedmont Hospital
WellStar Hospital
Grady Health System
Plus MANY more!
Ambetter Select Networks (Chatam, Cobb, Clayton, Cherokee, Fulton, Henry, Newton and Rockdale counties):
The Select Networks have a smaller network but a lower price.
Our thoughts for 2025
Ambetter is shaping up to be THE top option for 2025. They are the largest Marketplace carrier in Georgia and are continuing to expand to more rural counties. Their premier network is the largest doctor and hospital network in the state and even including recoprocity in other states. They also have a new off exchange network that works in every Ambetter state except CA and NY (27 states total). Ambetter seemed to improve their customer service in 2024 and we had no major issues. They offer great pricing, industry best Healthy Reward programs, huge network with multiple options and strong dental and vision options. They also recently released a very well done app that all members should download and utilize!
Pros
- No referrals required
- Largest Overall Network in Georgia – Premier network can work in any other Ambetter state!
- New off-exhange, natiowide EPO network
- Large number of Rural hospitals
- Easy to use Health Program with potential rewards of $550 – My Health Pays
- Offers some lower cost Off Exchange plans for those that do not qualify for a subsidy
- Dental and Vision with no waiting period
Cons
- Plans have different networks and can be confusing, be way of “Select” plans
- No Children’s HealthCare of Atlanta
- No Northeast Georgia Medical Center
Recommended plans in each category
-
- Bronze – Everyday Bronze
- Silver – Focused Silver
- Gold – Everyday Gold
- Dental and Vision plans – Great benefits with no waiting period however the network is limited.
Anthem Blue Cross/AMGP (Pathway X and Blue Value X Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Emory
Northside
Children’s HealthCare of Atlanta
Many other hospitals:
HCS Memorial, HCA Meadows, Tift, Southeast GA, Atrium, Evans Memorial
Our thoughts for 2025
Anthem remains one of the top options in 2025 with a massive expansion from 61 counties to 102 counties where they will offer coverage in 2025. They have a strong doctor network overall, good customer service and their pricing is quite good in 2025. Anthem has historically been a good health insurance provider and they have put a renewed focus on customer service and satisfaction over the past years. Most of their plans still require referalls.
Pros
- Anthem Blue Cross name is familiar.
- Very competitive pricing in 2025
- Strong network all across Georgia
- Good app (Sydney) and additional benefits
Cons
- Most networks still require referalls
- Walgreens is not in network.
- Multiple networks can be confusing
Recommended plans in each category
-
- Bronze – Anthem Bronze Pathway X Guided Access 5000
- Silver – Anthem Silver Pathway X Guided Access 4500
- Gold – Anthem Gold Pathway X Guided Access 1350
-
- Bronze – Anthem Bronze Blue Value X 5000
- Silver – Anthem Silver Blue Value X 4500
- Gold – Anthem Gold Blue Value X 2550
CareSource (Marketplace Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Northside
Piedmont
WellStar
Grady
Children’s HealthCare of Atlanta
Our thoughts for 2025
CareSource is appealing due their low price, large hospital network and unique benefits. They continue to improve in Georgia and are going to be well priced in many counties. Their unique benefits include free fitness benefits and benefits for specific heart and diabetes conditions.
Pros
- Referrals not required
- Plans that focus on heart health and diabetes – New for 2025
- Large Hospital network in Metro Atlanta
- 5th year in Georgia, network is growing and pricing is competitive
- Free Telehealth on most plans
Cons
- Emory is missing from their hospital network
Recommended plans in each category
-
- Bronze – Bronze First 7500
- Silver – Low Premium Silver 6000
- Gold – Core Gold 1500
Cigna HealthCare (Cigna Connect Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Northeast Georgia Medical
Piedmont
Wellstar
Children’s HealthCare of Atlanta
Grady
Our thoughts for 2025
Cigna has recored some from 2024 but they are still not the lowest priced carrier. They offer numerous benefits (Virtual care, enhanced complex care management, Healthy Reward program) and some specialized benefits for Diabetes. These plans have limits on the cost of insulin, free diabetes supplies, management training and some labs and exams.
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
- Good dental and vision options
Cons
- Offered in limited counties in Georgia for 2024.
- Network lists not always accurate.
- Customer Service needs work.
Recommended plans in each category
-
- Cigna Connect Bronze 6500
- Cigna Connect Silver 3700
- Cigna Connect Gold 500
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 2025
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 2025.
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 – KP GA Signature Bronze Virtual Complete 5500/1500
- Silver – KP GA Signature Silver 4500/35
- Gold – KP GA Signature Gold 1000 Ded/500 Rx Ded
Oscar (Oscar Network)
Key Metro Atlanta Hospitals In-Network (check with providers)
Northside
Emory
Wellstar
Grady
Southern Regional Medical Center
Our thoughts for 2025
Oscar continues to improve in Georgia and they are one of the low cost options for 2025! Their network keeps expanding and their benefits are getting better. Plus, with their “Oscar Care Teams” they are working to provide a good customer experience. They have a strong hospital network. 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 on many of their plans. Their free virtual care is very fast as well!
Pros
- No referral Required unless the plan says “Guided Care”
- 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
- $0 deductible plan – new for 2025!
Cons
- No Children’s HealthCare of Atlanta in network
- 2 star rated on the Marketplace – improved from last year
Recommended plans in each category
- Oscar Bronze Classic Standard
- Oscar Silver Simple PCP Saver
- Oscar Elite Saver Plus
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 2025
UHC’s pricing is still high in 2025 but it has become a bit more competitive. They are a top-tier, trusted insurance company and we look forward to their continued presence in the market. They will be a good 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 – Fitness benefits, built in diabetes benefits
- 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
- Expensive
Recommended plans in each category
-
- UHC Bronze Value
- UHC Silver Value
- UHC Gold Standard
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 Cigna and they offer great plan – contact us!
3.) If you want a dental only plan through the marketplace we recommend one of the Anthem or Delta Dental 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