2021 Georgia Health Insurance Open Enrollment: Exchange Shutdown
On 1 November 2020, CMS announced that it has approved the shutdown of Georgia’s federally-run health insurance marketplace website (aka, healthcare.gov for Georgia).
This is truly fucking horrible and the fact that they did it on the first day of open enrollment is a particularly nasty bonus. I’m still parsing through all of the information i can find about it, but have tried to address some of the questions I imagine people are going to have below.
Please note that this is not legal advice in any way and it would be best if you confirm it with additional sources (Georgia-based insurance providers, presumably), but hopefully it will serve as a starting point:
Right now, it means that if you’re a Georgia resident who buys your health insurance through the marketplace (healthcare.gov), you will not be able to do that for the 2021 plan year. If you’re like most people on exchange plans, you’ve been passively re-enrolled each year, meaning that you don’t update your coverage election and are automatically re-enrolled in the same plan you were already on. You will not be automatically re-enrolled in your existing health insurance plan. The CMS notice regarding the shutdown indicates that, through the application of an approved 1332 waiver, Georgia no longer has to keep it’s healthcare.gov marketplace site running, and residents will need to research and purchase coverage through insurance brokers or directly from the insurance plan.
An important thing to take note of is that, unlike the marketplace (healthcare.gov), there is no requirement for any other site to only show you ACA-compliant plans. This means that you’ll have to be careful as you do your research to not just assess the pricing, but also plan coverage. The ACA has requirements (such as covering certain essential health benefits, no denial of coverage due to pre-existing conditions, and no dollar limits on the benefits you’re eligible to receive) for a plan to be offered on a marketplace, and with Georgia moving all plan purchasing to private sites or brokers, they can and almost certainly will list ACA-compliant plans next to other plans that are not.
Note: As of writing (2 Nov at around 1700 EST), healthcare.gov still has Georgia listed in the dropdown for states. I don’t have an account with the marketplace, so I can’t log in to see what it offers there. It’s possible that the site hasn’t been fully taken down yet, but I would suggest caution in using it and, if possible, try working with a health insurance company directly to enroll in a 2021 plan.
I’m still sorting through the implications information because there is a possibility that, if you’re already enrolled in a marketplace plan with an insurer that will be offering the same plan in 2021– for example, you’re on a Bronze HMO plan from Anthem– then that insurer will automatically re-enroll you. But I would highly suggest that you not count on that and assume the similarly likely scenario that you will not be automatically re-enrolled in your current plan. You will have to do research on your own with each available insurer in your area, or retain a broker to do so for you, to select the best plan for you.
I went to Anthem’s website, as they’re one of the largest insurers in the country, and searched for coverage in Jackson, GA to see what they have available, and currently they’re showing the standard bronze/silver/etc marketplace plans as available:
[Image ID: a screenshot of the Anthem website showing four different Bronze Pathway HMO plans, with deductibles ranging from $5,600 to $7,000 and monthly premiums ranging from $342 to $362. End ID]
I also checked Cigna’s website and found roughly similar results. So, the plans that you’re used to as a Georgia resident should still be available to you, but you have to go to the insurers’ websites to find them and they will likely be listed along with non-marketplace plans.
As always, be sure to check both covered and excluded services to minimize the chance of any nasty surprises regarding covered/not covered care.
If you like the plan you’re on now and want to continue with it, go to that insurance company’s website and sign up for that plan with them directly.
If you’re interested in switching to a different plan, open a tab for each insurer available in your area so you can compare all the plans next to each other. If you’re a nerd like me, make a spreadsheet; if not, just be sure to note the major factors of each plan in whatever way is easiest for you to compare them.
If you need a refresher on what to look at, you can get a detailed explanation of terms and plan factors here. A high level summary of the major factors to consider:
Monthly premium (how much you pay each month to stay in the plan)
Deductible (how much of your care costs you pay before the insurer starts to cover it)
Network type: HMO, EPO, PPO, HSA– there are several possible types that have their own advantages and drawbacks; find the one that fits you best
Out-of-pocket max: the maximum amount, not including premiums, that you have to pay in a year before the insurer covers 100% of covered services’ costs
Once you’ve done your research, pick the plan the suits your needs and financial capabilities best and sign up for it so you have 2021 coverage.
The government of Georgia, like many right/right-leaning states, has been fighting against the ACA since they day it was passed, including refusing to accept the Medicaid expansion in 2012 that would have provided additional funding to the state to support allowing more people onto Medicaid. Earlier this year, the state submitted a 1″332 State Relief and Empowerment: waiver– or just a waiver to section 1332 of the ACA, if you’re not buying into the propaganda titling– that would allow them “economic relief” in the form of addressing what they call “systemic issues” regarding low enrollment and utilization of the state’s healthcare.gov marketplace site. Seema Verma, the administrator of CMS and an all around atrocious human being by all standards, granted the waiver with the administration’s approval yesterday, 1 November 2020. The justification is that (1) it’s unduly burdensome on the state to maintain the (federally facilitated) marketplace website, and (2) that the removal of a centralized pipeline for plans will create competition and increase choice for people looking to buy health insurance.
It’s also important to note that this is a highly strategic move by the Trump administration: Georgia is a state in play for the election, and the state government has argued aggressively that the ACA is both useless and expensive for consumers (both of which are demonstrably false). The 1332 waiver was first submitted in July, in the midst of a pandemic; there’s little logic to it except for timing calculations accounting for processing and comment periods that would result in this waiver being announced immediately before the election. It’s an attempt to grab votes on an ideological basis from any Trump voters who might have wavered in Georgia.
It’s general garbage all the way around, but the most important thing right now is that you can still get insurance that adheres to ACA standards (ie, plans that cover all medically necessary testing and treatment, with no annual or lifetime dollar limits on the benefits, and that cannot deny you for any pre-existing conditions, including COVID-19).
Georgia will no longer have a centralized marketplace website for you to shop for and enroll in insurance plans
The marketplace plans are still available but will be listed on the insurers’ websites and will be listed along with non-marketplace/ACA-noncompliant plans
If you have historically done nothing and been passively re-enrolled in coverage for the next year, do not assume that it will work this year and actively enroll yourself in a 2021 plan
The healthcare.gov site may still be up right now for Georgians, but it could shut down at any time
From what I can see, your best option is to sign up for a plan directly on an insurance company’s website
As always, I’m available for any questions you might have regarding this situation specifically, or health insurance in general. If I don’t know the answer, I’ll try to point you towards someone who does or somewhere you can find more helpful information.
