Georgia Short Term Health Insurance: Self-Employed And SMB Guide
Currently, you can be penalized for not having health insurance if you live in certain states, but this doesn’t apply to Georgia. So, if you’re freelancing or a small or medium business (SMB) owner, you don’t need coverage.
It does make smart financial sense, though.
Many self-employed workers opt for short term health insurance while looking for permanent coverage. If you’re one of these solopreneurs or small business owners, you should know what’s out there for you.
This guide walks you through how Georgia short term health insurance works and what other types of coverage you might qualify for when you’re in the self-employed field in the Peach State.
Do You Need Short-Term Health Insurance In Georgia?
Quitting your “employee” job and venturing out on your own and become a freelance barber or freelance content strategist is exciting and intimidating. If it’s something you’re considering or if you recently jumped in, losing your health insurance coverage is always a concern.
You might be able to invest in short term coverage as a stopgap between policies.
Georgia short term health insurance is usually available in 30, 60, or 90-day periods. Some insurers even allow you to take out policies for up to one year.
Your premiums will likely be lower than a major medical plan, but there’s a catch: short term plans have limited coverage.
The Details On Short Term Insurance
Usually, some coverage is better than no coverage. But before you use that strategy of thinking to grab the first short-term plan you see, check out what it covers first.
Most short-term plans include benefits for:
- Unexpected illness or injury
- Hospital services
They work within a preferred network of providers, giving you discounts if you use their physicians. You’ll have a deductible and coinsurance, as well as a lifetime coverage limit.
However, short-term plans frequently don’t cover:
- Pre-existing conditions
- Pregnancy or maternity
- Preventative and wellness visits
Is Short-Term Coverage Right For Your Needs?
When you analyze the policy’s cost, coverage, and benefits, you’ll know if it’s worth the premium or not for what your intent is.
For instance, if you wanted help in between policies to cover treatment for your ongoing diabetes, you’d need a short-term policy that includes pre-existing health conditions.
As a general rule of thumb, these policies benefit anyone who plans on getting a long-term major medical policy but missed the open enrollment period.
They’re a good choice if you recently lost your job and are looking for a new one with insurance benefits, will be on Medicare soon, or are heading out on a trip where insurance coverage is a smart idea.
How To Buy Short-Term Coverage In Georgia
From Georgia’s short-term health insurance page, you can get quotes for your monthly premiums, review coverage options, and complete an application. The insurance company will contact you directly should they need more clarification.
What Are Your Family Coverage Options?
Since the Affordable Care Act (ACA) was initiated in 2010, many states have implemented their own marketplace for consumers to shop for health insurance. Here, this is the Georgia Healthcare Marketplace, and open enrollment takes place from November 1 to January 15.
The state’s coverage options are for individuals and families. The marketplace compiles a list of the top companies, then displays them by rates and benefits. It’s an easy way to look for affordable long-term medical insurance each year.
Even better, short-term, dental, and vision plans are now offered.
Other Types Of Family Coverage
The healthcare marketplace is a go-to stop for millions of Georgians looking for affordable coverage, but it’s not your only option. If you can’t or don’t want to use this government-based insurance shopping center, here are other opportunities to look into.
Are you looking for insurance because you recently left a salaried or full-time position?
You don’t have to lose your insurance entirely during your transition to self-employment and freelancing. You can opt for COBRA coverage.
Short for the Consolidated Omnibus Budget Reconciliation Act, COBRA lets you keep your group health benefits for a limited period after you leave your job.
Whether the job loss is voluntary or involuntary, you may qualify for this temporary healthcare extension.
However, you will likely need to pay up to 102% of the plan’s cost to keep the coverage. It may be worth the cost if your essential prescription drugs are expensive or you know you’ll need substantial medical or mental health treatment during this extended time.
Should you want the same type of health insurance options as the government-based plans but without going through the state, a private policy can help.
You’ve heard of Anthem/Blue Cross, UnitedHealthcare/Golden Rule, and other major health insurance companies. They offer a variety of coverage, from employer-sponsored to private short-term health plans and long-term insurance policies.
Talk to a general licensed insurance agent who can give you the best rates for multiple insurers.
Compare the health insurance cost and benefits, then decide which is right for your family.
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Can You Get Short-Term Pregnancy Coverage?
When you’re bringing a baby into your world, it should be one of the most magical times of your life.
But if you don’t know how you’ll pay for your pre- and postnatal care, it’s terrifying instead. Thankfully, short term pregnancy coverage is easier to find than you think.
After all, insurers want you and your baby to be healthy.
Most Georgians qualify for Right From the Start Medicaid, a government program for pregnant women.
Right From the Start subsidies pay for medical care — including labor and delivery — plus up to 60 days of care for mom and baby.
The full spectrum of coverage is available to those who qualify and includes all:
- Doctor visits
- Inpatient services
- Outpatient services
Qualifying healthcare coverage is for anyone who falls within 200% of the federal poverty level for your household size.
Other Maternity Coverage Options
When Medicaid isn’t an option, some private plans and all coverage on the health insurance marketplace help with maternity care.
Whether you’re pregnant now or intend to be soon, if you’re willing to pay the premiums, there’s an insurance policy for you.
Technically, maternity and newborn care are considered essential health benefits. All qualified healthcare plans within and outside the marketplace are supposed to cover them, unless they’re specifically excluded in your plan. Some people accept this exclusion because it doesn’t pertain to them and can reduce the monthly premiums.
Remember that even though the benefits are included, they aren’t all equal.
Is Indemnity Care A Smart Choice For You?
Maybe you and your family are in good health, and you just want something to cut your costs when you do need the doctor.
Indemnity care is inexpensive and kicks in only when you need it most.
These plans work a little differently from major medical coverage. With an indemnity plan, you’re in charge of your healthcare journey. You can visit nearly any physician or hospital you prefer, with no referrals necessary for specialists.
Indemnity Plans In Action
Treatment costs are under a “fee-for-service” category, meaning the indemnity company pays a set portion of your total charges, and you pay the rest. Some plans require you to pay the full bill upfront and submit the claim to them for reimbursement.
You’ll still have things like deductibles and annual caps. But after your deductible is met, the insurance company will pay the “usual, customary, and reasonable” (UCR) rates for each bill.
This usually works in your favor, as you only have to pay your part of the often discounted UCR rates.
The process usually breaks down as follows:
- You pay a reasonable premium each month.
- When you go to a doctor, you don’t need any referrals or pre-approvals for your services.
- You pay the bill when you receive it, then submit the claim to the insurance company.
- The insurer reduces the charges to the UCR if applicable and reimburses you for their portion of the services.
Who Benefits From Indemnity Plans
Indemnity plans can be the ideal solution for people who want the freedom to choose to see any healthcare provider without referrals or designated primary care physicians.
They work well for freelancers and gig workers, too.
Would A Long-Term Policy Be Better For You?
Being in charge of your healthcare journey sounds like the ideal way to care for your body and mind as a freelance engineer or freelance accountant. Yet, indemnity and short-term plans aren’t for everyone. There is an out-of-pocket responsibility that isn’t possible in many households.
Would a long-term major medical policy be better for you?
The premiums might be more than you wanted to budget for. Still, if it is currently an open enrollment period or you’ve qualified for a special enrollment period through a qualifying life event, you can sign up for long-term coverage.
Why Major Medical Is A Good Idea
Major medical coverage takes care of most serious illness or injury expenses. If you’re hospitalized, the costs can add up to tens of thousands of dollars or more.
Even with a large deductible, you are sheltered from much of the responsibility.
Most insurance policies have an out-of-pocket maximum (OOPM), so your share would be — at the most — what that limit is. For example, if your OOPM is $10,000, that’s the most out-of-pocket cost you’ll have to pay for treatment in a calendar year.
It sounds like a lot, but if you consider that the average bill for a heart attack is about $50,000, your insurance just saved you $40,000.
Sounds a lot more reasonable that way, doesn’t it?
Essential Health Benefits
Indemnity care gives you the peace of mind of knowing your share of the costs of any service will be less than 100%. Major medical helps limit your responsibility to copays, coinsurances, and deductibles, but it only covers essential health benefits.
Per HealthCare.gov, these “essential benefits” are services that every approved insurer, whether an ACA plan or not, must cover for their insured. The benefit amount isn’t regulated, so each plan’s coverage may differ.
However, with your long-term insurance, you should have coverage for:
- Outpatient care
- Emergency services
- Inpatient and outpatient hospitalization for surgeries and extended stays
- Preventive care and wellness services
- Mental health and substance use treatment, such as counseling and psychotherapy
- Prenatal and postnatal care for mom and baby
- Prescription drug coverage
- Rehabilitative services to help in the event of a disability or injury
- Bloodwork and other lab services
- Chronic disease management
- Oral and vision care for pediatrics
- Birth control and breastfeeding coverage
These broad benefits are required before an insurer makes the list of approved Marketplace plan providers.
Compare the plans and costs, as well as your projected family or individual health needs for the next year. If a major medical plan seems a little too pricey, short-term medical plans and indemnity plans are still options.
Choosing the right healthcare coverage for you and your family is an important decision. Your options depend on your situation and your budget.
When you’re self-employed, including as a freelance chef or remote medical assistant it often seems like your choices are limited, but they don’t have to be. Head to Gigly, the platform for all things gig-related, and see how your membership can help you save money on insurance.