Navigating the cost of health insurance if you’re self-employed in Georgia doesn’t have to be confusing.
Understanding the factors that influence your premiums is important for managing your finances, protecting your health and growing your business.
The cost of health insurance for self-employed individuals in Georgia is based on your age, where you live, household size, and income.
If you qualify for a premium tax credit, monthly premiums around $200-$300 for individual coverage are not uncommon.
However, you must consider additional costs like deductibles, copays, and coinsurance.
Previously, Healthcare.gov was your resource for individual health insurance, but the launch of Georgia Access has streamlined the process, making it easier to shop for the coverage you need.
As a Georgia Access Certified Broker, we can help you find the best plan for your needs and budget.
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Open Enrollment is the best opportunity to secure health insurance in Georgia for self-employed professionals.
Outside of that, you’ll need a Qualifying Life Event to sign up during a Special Enrollment Period.
Try our quoting tool to see plans and prices in your area. Contact us to get started!
How to Sign Up for Health Insurance in Georgia
If you’re a self-employed sole proprietor as defined by the IRS, with no employees, you can sign up for individual health insurance from the Georgia state-based marketplace.
Enrolling in health insurance as a self-employed individual in Georgia involves several pathways:
- Georgia Access: This is the state-based marketplace offering a range of plans and potential subsidies based on your income.
- ACA Certified Broker Websites: Affordable Care Act certified agents and brokers have access to the same plans available on Georgia Access and can provide personalized guidance at no additional cost.
- These websites streamline the enrollment process and offer expert assistance.
The ACA Marketplace, now Georgia Access, is the primary source, offering qualified health plans with financial assistance for qualified applicants.
Understanding the ins and outs of the Marketplace, including coverage levels, provider networks and related costs is essential for informed decision-making.
We can help.
Understanding Bronze, Silver & Gold Plans
Affordable Care Act (ACA) Marketplace plans are categorized into metal tiers – Bronze, Silver, and Gold – which represent varying levels of coverage and cost-sharing.
- Bronze Plans: These plans typically offer the lowest monthly premiums, making them attractive for budget-conscious individuals. However, they also come with the highest out-of-pocket costs, meaning you’ll pay more for deductibles, copayments, and coinsurance when you receive care.
- Silver Plans: Silver plans strike a balance between premiums and out-of-pocket costs. They often provide a good middle ground, making them a popular choice for many.
- Gold Plans: Gold plans feature the highest monthly premiums but the lowest out-of-pocket costs. This means you’ll pay less when you receive care, making them suitable for those who anticipate frequent medical needs.
In some states, Platinum plans are available. These plans offer the most comprehensive coverage and the lowest out-of-pocket costs, but also come with the highest premiums.
Understanding these tiers helps you choose a plan that aligns with your budget and healthcare needs.
Deductibles, Cost Sharing & Out of Pocket Maximum
Understanding how these costs work is one of the most important steps for managing your healthcare expenses.
Deductibles are the amount you pay before insurance kicks in, coinsurance is the percentage you pay for covered services, and the out-of-pocket maximum is the most you’ll pay in a year.
Deductible
Understanding your deductible is key to managing healthcare costs. Think of it as the amount you pay out-of-pocket before your insurance coverage kicks in.
Just like different individuals have varying needs, health insurance plans offer diverse deductible amounts.
A healthy person might opt for a higher deductible with lower premiums, while someone with chronic conditions may prefer a lower deductible for more immediate coverage.
Generally, higher deductibles result in lower monthly premiums, and vice versa.
Coinsurance
Coinsurance represents the cost-sharing agreement between you and your insurance provider after you’ve met your deductible.
It’s typically expressed as a percentage.
For example, under the Affordable Care Act (ACA) plans, you’ll find Bronze, Silver, and Gold tiers, each with varying amounts.
- Bronze: Insurance pays approximately 60%, you pay 40%
- Silver: Insurance pays approximately 70%, you pay 30%
- Gold: Insurance pays approximately 80%, you pay 20%
So, with a Silver plan, for instance, the insurer covers 70% of eligible medical expenses, while you’re responsible for the remaining 30%.
Out-of-Pocket Maximum
Importantly, ACA plans include an annual out-of-pocket maximum, which limits the total amount you’ll pay for covered services in a given year, providing financial protection.
Other than your monthly premium, anything you pay throughout the year goes toward your maximum OOP.
This includes your deductible, copays and coinsurance.
So, if your plan has an OOP max of $2,500 the insurance company will pay 100% of your costs for the remainder of the year — minus your monthly premium of course.
Our Picks for Best Health Insurance for Self Employed in Georgia
To find the best health insurance in Georgia, self-employed individuals can choose involves a careful assessment of personal health needs and finances.
Are you managing a chronic disease like diabetes that requires certain medications or specialists?
Or are you a healthy individual seeking basic preventative care?
Your answers will guide your selection of plan tiers and coverage levels.
Consider your budget, too.
High-deductible plans offer lower premiums but require greater out-of-pocket expenses before coverage kicks in, while lower-deductible plans provide more immediate coverage at a higher monthly cost.
Most Affordable: Ambetter
Ideal for budget-conscious individuals, Ambetter offers competitive premiums and bundled dental/vision options.
For illustration. Plans & prices will vary. Check your ZIP Code >>
Best Network: Anthem
Provides extensive provider access and comprehensive coverage, widely accepted.
For illustration. Plans & prices will vary. Check your ZIP Code >>
Best Overall: Aetna
Aetna offers a balanced approach with robust coverage, a broad network, competitive pricing, and strong mental health benefits.
Dental and vision bundles are also available.
For illustration. Plans & prices will vary. Check your ZIP Code >>
Save on Health Insurance in Georgia as a Self-Employed Individual
As a self-employed individual, you can take steps to maximize affordability. Explore premium tax credits through Georgia Access, which can significantly reduce your monthly costs.
While health insurance may feel like a significant expense, there are ways to make it more affordable:
Most Americans use the tax credit in advance, hence “APTC” to help reduce their monthly premium now.
Keep in mind you will need to account for this credit at tax time. You should seek professional tax advice if you have questions.
Taxes & Health Insurance for Self-Employed
One of the significant advantages of being self-employed is the ability to deduct health insurance costs from your taxable income.
This can lead to substantial savings at tax time. Here’s how it works:
- Self-Employed Health Insurance Deduction
If you’re self-employed and not eligible for coverage under a spouse’s plan, you may deduct your health insurance premiums, including dental and vision, directly from your gross income.
This deduction is available whether you itemize deductions or not. - Deduction Limits
The deduction cannot exceed your net self-employment income. If your business operates at a loss, you won’t be able to claim the deduction. - Health Savings Accounts (HSAs)
If you choose a High-Deductible Health Plan (HDHP), you can contribute to an HSA and deduct contributions from your taxable income.
Funds in the HSA can be used tax-free for qualified medical expenses.
Consult a tax professional to ensure you’re taking full advantage of these benefits while staying compliant with IRS rules.
Income & Health Insurance When Self-Employed
Many of our self-employed clients experience income fluctuations throughout the year, which can make budgeting for health insurance a challenge.
The great thing about the Affordable Care Act (ACA) and Georgia Access is that if you qualify for a tax credit based on your income, it adjusts as your earnings change. Here’s how it works:
- Update Your Income Regularly
As a self-employed individual, you’re responsible for reporting any significant income changes to the marketplace.
This ensures that your Premium Tax Credit (PTC) is calculated accurately, preventing you from owing money at tax time or missing out on savings. - Income Fluctuations and Subsidies
If your income decreases mid-year, you may qualify for additional subsidies, reducing your monthly premium.
Conversely, if your income increases, updating your information helps you avoid overpayment of tax credits. - End-of-Year Reconciliation
When you file your federal taxes, the IRS will reconcile your estimated income with your actual income for the year.
Keeping your marketplace account updated minimizes the risk of surprises during tax season.
Cost of Health Insurance in Georgia for Self-Employed
The cost of health insurance for self-employed individuals in Georgia varies based on factors like age, location, income, and the type of plan you choose. Here’s what to expect:
- Average Monthly Premiums
According to Georgia Access, the average cost of marketplace health insurance for a single adult in Georgia ranges from $350 to $600 per month, depending on the plan tier (Bronze, Silver, Gold, or Platinum).
Subsidies can significantly lower this cost for those who qualify. - Out-of-Pocket Costs
Beyond premiums, consider deductibles, copayments, and coinsurance.
Bronze plans have lower premiums but higher out-of-pocket costs, while Gold and Platinum plans offer more comprehensive coverage at a higher monthly rate. - Tax Credits and Subsidies
Many self-employed individuals qualify for Premium Tax Credits through Georgia Access.
These credits reduce your monthly premium based on your income level. Cost-sharing reductions may also be available if you select a Silver plan. - Customizing Your Coverage
Georgia Access allows you to tailor your health insurance by comparing plans from leading insurers like Aetna, Cigna, Ambetter, and UnitedHealthcare.
Use their platform or consult a licensed broker to find the best value.
Pro Tip: Always evaluate your total healthcare spending, including premiums and out-of-pocket costs, to find the most cost-effective plan for your needs.
Self-Employed Health Insurance TIPS
- Budget
Balance premiums with potential out-of-pocket costs.
High-deductible Bronze plans might work for those with minimal healthcare needs, while Silver or Gold plans are better for individuals with moderate to high medical expenses. - Provider Networks
Ensure your preferred doctors and hospitals are in-network to avoid unexpected expenses. - Prescription Drug Coverage
Check formularies to confirm your medications are included at an affordable cost. - Tax Savings
Self-employed individuals can often deduct health insurance premiums from taxable income, reducing overall costs. Consult a tax professional for guidance.
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Self-Employed Health Insurance vs. Small Group Health Insurance in Georgia
If you work for yourself with no employees, you’re likely shopping for individual health insurance through Georgia Access.
However, if you own a small business with employees, you may have the option to explore small group health insurance plans. Here’s a quick comparison:
- Self-Employed Health Insurance
- Ideal for individuals with no W2 employees or those running solo operations like freelancers, consultants, and gig workers.
- Available through the individual marketplace, offering a range of plans from Bronze to Platinum.
- Tax credits and subsidies may lower monthly premiums based on income.
- Small Group Health Insurance
- Requires at least three W2 employees in most cases to qualify for group plans in Georgia.
- Offers broader coverage options and potential savings, as premiums are often shared between the employer and employees.
- May provide additional benefits, such as lower premiums for the employer and employees compared to individual plans.
Key Consideration: If you’re on the fence about hiring employees to expand your business, small group health plans can be an attractive benefit to attract and retain talent.
However, for solo entrepreneurs, individual plans through Georgia Access remain the most practical option.
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Information is meant to be accurate and educational and not intended to be legal, medical or financial advice. Do your own research and contact a professional for help. We earn revenue from partners & advertisers. Read our disclosure for more.
Owner, BenZen Insurance. Licensed insurance broker making it easy for individuals, families and business owners to get affordable health benefits.
His background in marketing, research, insurance, and financial services gives him a unique perspective to help others plan for a secure future and improve their physical, mental, and overall well-being.