Our office is offering No Fee Benefit Reviews this year. Please use the top right menu link to schedule.
The Individual Health Insurance Market is improving in 2020:
- Smaller rate increases and two new insurance companies, CareSource & Oscar Health
What is a Gatekeeper Plan and why is it so important?
Gatekeeper – a form of managed care; it requires the member to get a referral approved from their Primary Care doctor (PCP) to see a Specialist, frequently this requires an office visit to the PCP first.
A plan with a Gatekeeper is intended to reduce frequent/excessive visits to the higher cost Specialist.
No Gatekeeper – allows the member to make appointments directly with Specialist, no referral required.
Ambetter
- No Gatekeeper
- Largest Provider network of all companies includes Piedmont, Emory and WellStar
- Customer service has been steadily improving
- Lowest rates of all companies for Silver and Gold plans
BlueCross
- Gatekeeper required for members in nine metro Atlanta counties
- Small Provider network in Atlanta
- Competitive rates on Bronze high deductible plans
- Left a bad taste after non-renewing the WellStar contract right after open enrollment last year
CareSource
- No Gatekeeper
- New to Georgia, well respected non-profit company based in Ohio
- Solid network in metro Atlanta and Savannah, includes Piedmont, WellStar and Northside
- Lowest rates on Bronze high deductible plans with copays for doctor office visits – will be popular
Kaiser
- Gatekeeper staff model – the strictest type of managed care
- Network is Kaiser doctors and facilities only, unless referred out
- Rates are higher than all above companies
Oscar Health
- No Gatekeeper
- Small Provider network, WellStar only
- Highest rates of all plans
- New to Georgia, financial backing from Warren Buffet and Google… not bad
- Oscar will be a non-event in Georgia this year, stay tuned for next year
Clients without pre-existing conditions may want to consider the lower cost UnitedHealthcare Short Term PPO Plans. Rates are approximately 50% less than ACA plans.
