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Georgia Health Insurance

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 individuĀ­als 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.