Georgia switches to state-run health insurance Marketplace for 2025 coverage

How do Georgia residents currently enroll in Marketplace coverage?

From 2014 through 2023, Georgia relied fully on the federally run health insurance Marketplace, HealthCare.gov, for enrollment. For 2024, the state transitioned to a state-based Marketplace on the federal platform.²

This meant Georgia was responsible for some aspects of running the Marketplace, including operating and funding a Navigator program,³ and certifying the plans offered for sale via the Marketplace.² But residents have continued to use HealthCare.gov to enroll in coverage with a 2024 effective date.

That changes for 2025 coverage, as Georgia will be running all aspects of their Marketplace, including the enrollment platform.

Can Georgia residents use Georgia Access to enroll in 2024 coverage?

No. Georgia residents who have a special enrollment period this fall and are using it to sign up for coverage that takes effect before the end of 2024 will still use HealthCare.gov to do that – even after Nov. 1. But then they will need to renew or change their coverage for 2025 using the Georgia Access platform.

To clarify, the Georgia Access platform cannot be used for enrollment with an effective date prior to Jan. 1, 2025, as it’s been approved by the federal government for enrollments starting with plan year 2025.¹ The state-run enrollment platform will be operational as of Nov. 1, 2024, but only for coverage effective in 2025.

What’s changing for Georgia residents who need Marketplace health insurance?

If you’re enrolling in 2025 individual/family health coverage in Georgia, you’ll be using the Georgia Access enrollment platform instead of HealthCare.gov this fall. Existing HealthCare.gov accounts for Georgia residents will be transferred to Georgia Access. The Marketplace will send enrollees instructions for logging into the new Marketplace portal and accessing their accounts so that they can renew or change their coverage for 2025.

Georgia Access will also be operating the state’s Marketplace call center,⁴ as all state-run exchanges are required to do.⁵ So Georgia residents will no longer use HealthCare.gov’s call center if they need phone assistance with the enrollment process.

Those are the primary changes from a consumer perspective. But there will also be the same sort of changes that enrollees see every year, in terms of adjustments to plan designs, provider networks, and premiums – including changes to subsidy amounts that can affect net premiums.

What’s staying the same for Georgia Marketplace enrollees?

Although Georgia residents will no longer use HealthCare.gov to enroll in coverage for 2025, many aspects of the Marketplace will remain the same:

Open enrollment schedule

Open enrollment in Georgia will run from Nov. 1, 2024 to Jan. 15, 2025,⁶ for coverage effective in 2025. This is the same overall schedule used by HealthCare.gov.

But Georgia residents will need to complete their enrollment by Dec. 16, 2024 to have coverage effective Jan. 1, 2025.⁷ This is one day later than the Dec. 15, 2024 deadline for a Jan. 1 effective date on HealthCare.gov.⁸

Subsidy eligibility

After the transition to Georgia Access, enrollees will continue to have access to the same federal premium tax credits (premium subsidies) and cost-sharing reductions that are available via HealthCare.gov. Eligibility for these subsidies is the same regardless of whether a state runs its own exchange or uses the federal platform.

• Premium tax credit eligibility is governed by IRS rules that are applicable nationwide.⁹ The amount of each enrollee’s tax credit depends on their household income and the cost of the second-lowest-cost Silver plan (benchmark plan) for that person. Since both of those can change from one year to the next, premium subsidy amounts also change from one year to the next. But the underlying structure of the subsidies is not changing with Georgia’s transition to a state-run Marketplace. In February 2024, 96% of Georgia’s Marketplace enrollees received advanced payments of premium tax credits.¹⁰
• Cost-sharing reductions are available to enrollees with income between 100% and 250% of the federal poverty level as long as they select a Silver level plan.¹¹ This will continue to be the case in Georgia’s state-run Marketplace.

Participating Marketplace carriers

Georgia’s health insurance Marketplace has nine participating carriers offering coverage in 2024, with varying coverage areas.¹² All nine will continue to offer Marketplace coverage in 2025 (including one that will be offering plans under two separate entities).¹³

As is always the case – regardless of whether a state runs its own Marketplace – carriers can change their coverage areas from one year to the next. So although all of Georgia’s 2024 Marketplace insurers will continue to offer coverage in 2025, the specific plans and participating insurers in each area might change. Enrollees should carefully consider all of their available options before selecting a plan or renewing their coverage for 2025.

Georgia residents can continue to use an EDE

This is a significant difference between Georgia’s Marketplace and other state-run Marketplaces. Georgia is the first state-run Marketplace that will partner with enhanced direct enrollment (EDE) entities the way HealthCare.gov does.¹⁴

The enhanced direct enrollment process allows consumers in states that use HealthCare.gov to enroll in an on-exchange / Marketplace health plan through approved web brokers’ and insurers’ sites, without having to visit HealthCare.gov.¹⁵

Georgia Access is requiring its EDE partners to be certified as EDEs with HealthCare.gov.¹⁴ (An entity that doesn’t pass the federal Marketplace EDE certification requirements cannot serve as an EDE in Georgia.)⁴

So if you’re already accustomed to using an EDE to enroll in your Georgia Marketplace coverage – as opposed to going directly through HealthCare.gov – you’ll be able to continue to use that approach for 2025.

“The partnership between Georgia Access and private enrollment sites gives consumers the option of shopping and choosing Marketplace coverage through a third-party web site they may already be accustomed to using or with the assistance of a trusted insurance broker or agent,” says Dave Keller, president of INSXCloud, Inc., one of the participating enhanced direct enrollment platforms Georgia residents can use.* “We’re convinced the added enrollment flexibility will further increase enrollment in an already growing Georgia market.”

Georgia’s reinsurance program

The Georgia Access model is part of a 1332 waiver that was approved by CMS in 2020. Another part of that same 1332 waiver included a reinsurance program that took effect in Georgia in 2022.¹⁶

Georgia’s reinsurance program will continue to operate in 2025 the same way it does now. Reinsurance programs are in use in 17 states, including Georgia. Some of these states use HealthCare.gov while others run their own Marketplaces.

Reinsurance operates in the background, helping to keep premiums lower than they would otherwise be. Reinsurance primarily helps enrollees who don’t get premium subsidies (about 4% of Georgia Marketplace enrollees)¹⁷ and thus have to pay the full cost of their coverage.¹⁸ Georgia’s reinsurance program will continue to do this in 2025, as it is currently authorized through 2026, and can be extended after that.¹⁶

(The effects of reinsurance on subsidized enrollees are mixed; some pay higher net premiums as a result of the reinsurance program, since lower overall premiums result in smaller premium subsidies.¹⁸ But this is not affected by whether a state runs its own Marketplace or uses the federally run platform.)

What do Georgia enrollees need to do this fall?

If you need to obtain your own health coverage for 2025, you’ll be using the Georgia Access platform or an approved enhanced direct enrollment entity.

If you already have coverage through the Georgia Marketplace in 2024, keep an eye out for any communications from HealthCare.gov, Georgia Access, and your health plan. You’ll receive instructions for claiming your account on Georgia Access, as well as information about how your current plan’s benefits and premium will change for 2025. And if you’re receiving a premium subsidy, you’ll also receive a notification of how much your subsidy will be in 2025.

As long as your current plan will still be available in 2025, it will auto-renew if you take no action during open enrollment. But it’s in your best interest to actively compare your plan options and decide whether you’d like to renew your existing plan or pick a different one.

If you worked with a broker or Navigator to enroll in your 2024 coverage, you can reach out to them to confirm that they’ll be certified with Georgia Access and will be able to help you with your 2025 coverage.

If you aren’t currently enrolled in a Georgia Marketplace plan, you’ll be able to use Georgia Access starting Nov. 1, 2024, to select a plan for 2025 – with income-based subsidies if you’re eligible.