Georgia is one of 12 remaining states that has not "expanded Medicaid" under the Affordable Care Act. This means that Medicaid coverage is available to a limited number Georgians with very specific circumstances (minor children and their parents, pregnant, elderly, disabled, need nursing home care):

Peachcare for Kids/Children's MedicaidFull-coverage Medicaid available to low-income children ages birth-18.

Georgia Families/Low-Income Medicaid (LIM): Full-coverage Medicaid available to very low-income parents of children under the age of 18. Typically, the child must live with you and you must have legal custody to qualify. Married parents are both eligible, while single parents must reside with the child and be the custodial parent.

Pregnancy/Right from the Start (RSM) MedicaidFull-coverage Medicaid available to low-income women who are pregnant that lasts up to 60 days after delivery. If you are eligible, you can get a presumptive Medicaid certification form at the local health department on the same day that you apply. You can get prenatal care for yourself and your baby immediately. 

Planning for Healthy Babies Medicaid (P4HB)Limited-coverage (GYN services and GYN medications only) Medicaid available to very low-income women between the ages of 18-44 who are still physically able to have children.

Breast and Cervical Cancer MedicaidFull-coverage Medicaid available to very low-income women diagnosed with breast or cervical cancer. Apply in-person at your local health department for this coverage. 

Aged, Blind or Disabled Medicaid (ABD)Full-coverage Medicaid available to very low-income people who are legally blind, or age 65+, or classified as disabled by Social Security. 

Medicaid Plans for Medicare Recipients:

Qualified Medicare Beneficiary (QMB) Medicaid: acts as secondary insurance for Medicare

Special Low-Income Beneficiary Medicare Beneficiary (SLMB) Medicaid: no medical coverage, pays Medicare Part B premium only

Qualified Individual (QI) Medicaid: no medical coverage, pays Medicare Part B premium only

TO APPLY FOR MEDICAID:

  • Visit www.gateway.ga.gov.

  • Select Apply for Benefits to begin.

  • Select Medical Assistance as a program.

  • Follow the online prompts to apply for Medicaid.

  • If you have medical bills from the past three months that you were not able to pay, report them on your application when you apply. If you are eligible for Medicaid, it’s possible that Medicaid will pay for some of these bills, even if you were not enrolled in Medicaid at that time.

  • Once you complete an application, a Medicaid caseworker will contact you by phone for an interview. It is important to not miss the interview. However, the more information you are able to upload in the computer (see below), the shorter your interview will be.

  • You will find out by mail whether you are eligible for Medicaid within 45 days after you apply. If you are eligible for Medicaid, you will receive a Medicaid card in the mail.

 

Documents you will need (the more you upload, the easier it is to be approved):

  • A copy of your birth certificate or other proof of identity and citizenship or immigration status

  • Photo ID cards issued by federal, state, or local government agencies

  • Social Security number for each person applying

  • Paycheck stubs, payroll records, or recent W-2 forms covering at least the past four weeks

  • Letters or forms that show income from Social Security, Veterans Administration, retirement, pensions, unemployment insurance, worker’s compensation, or any other sources of income

  • Current health insurance policies, health insurance cards, or other health insurance information

  • Life insurance policies

  • Recent bank statements or bank books

  • Most recent tax return

  • Information about assets you own (such as land or stocks and bonds)

The Affordable Care Act makes insurance more affordable for low-income, working people. Low-income people that make at least 100% of the Federal Poverty Level are eligible for tax credits that can make health insurance more affordable. 

Due to the COVID-19 pandemic, these tax credits were increased for the next two years and many working people can get insurance for as low as $0 per month if the choose a "Silver" tier plan.

NOTES:

  • You can apply for the ACA during the end-of-year open enrollment period or if you have a major life change like losing other coverage, getting married, moving, or having a baby.

  • You can get FREE help applying for the ACA from specially-trained Health Marketplace Navigators

  • People who are eligible for Medicaid or Medicaid or have insurance offered through a jobs are typically not eligible for ACA.

  • People who use tobacco will pay more for their ACA plans.

TIPS FOR CHOOSING A PLAN:

  • Look at the plans carefully, some plans have a very high deductible that must be met before the plan starts paying for your care.

  • Check if your preferred doctors, hospitals and medications are covered by the plan

  • Some plans advertised are not accepted at the local hospitals or by many local doctor offices.

    • At this time, we understand that the Ambetter plans are accepted by the Piedmont Hospitals and Piedmont doctor offices.

    • At this time, we understand that the Caresource plans are accepted by the Piedmont Hospitals and a few doctor offices

    • At this time, we understand that Kaiser plans are accepted at the Kaiser offices in Conyers and Lithonia.

    • At this time, we have not been able to find many local hospitals or doctors accepting the Blue Cross Pathway X plans.

TO APPLY FOR ACA COVERAGE: