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The Individual Health Insurance Market continues to improve with smaller rate increases

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.


  • No Gatekeeper
  • Largest Provider network, including Piedmont, Emory, Northside/St. Joseph and WellStar
  • Customer service continues to improve
  • Lowest rates of all companies for Silver and Gold plans


  • Gatekeeper required in metro Atlanta
  • Member must choose a PCP at enrollment and get referrals to Specialist approved before going
  • Small Provider network in Atlanta, primarily Northside and Grady hospital
  • Competitive rates on Bronze high deductible plans


  • No Gatekeeper
  • New to Georgia, well respected non-profit company based in Ohio
  • Solid network in metro Atlanta & Savannah, including Piedmont, WellStar and Northside
  • Lowest rates on Bronze high deductible plans with copays for doctor office visits – will be popular


  • 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
  • Highest rates of all plans
  • New to Georgia, financial backing from Warren Buffet and Google… not bad
  • They will be a non-event in Georgia this year, but stay tuned for next year
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