Family members with an unaffordable offer of family health insurance coverage from a spouse or parent’s employer may now qualify for financial assistance through Georgia Access. In October 2022, the Biden administration changed what “affordable” means for job-based family health insurance. As a result, more families in Georgia will now be eligible for financial assistance (advance premium tax credits, or ‘APTC’) to enroll in Georgia Access coverage. Starting with 2023 coverage, health coverage through a family member’s job will only be deemed “affordable” if the actual cost to enroll each family member is affordable. When employer coverage for all family members is not affordable (for 2025 plan year, more than 9.02 percent of household income) the family may qualify for financial assistance to help purchase coverage through Georgia Access.
Employees seeking coverage for themselves, or family members will need to submit a Georgia Access application to find out whether they and/or their family members qualify for financial assistance on a plan through Georgia Access. If family members are enrolled in job-based health insurance coverage through a spouse or parent’s employer but want to see whether they qualify for financial assistance on a Georgia Access family plan, they should fill out and submit a Georgia Access application.
Individuals and families enrolled in job-based coverage should not drop their job-based coverage prior to submitting a Georgia Access application. Those with job-based coverage should submit a Georgia Access application, then wait to hear from Georgia Access on whether they qualify for financial assistance on a Georgia Access plan.
Georgia Access encourages anyone interested in learning whether they or their family members qualify for financial assistance to submit a Georgia Access application to see if they may be newly eligible. If an individual submits a Georgia Access application and finds out they or their family qualify for financial assistance to purchase a Georgia Access family plan, they will need to disenroll from employer coverage and enroll in coverage through Georgia Access.
Once an individual has confirmed their family is eligible for financial savings AND has enrolled in Georgia Access family coverage, they should let their employer know they are declining (or “opting out” of) the employer coverage.
(Note: The policies governing eligibility for financial assistance are set by the federal government, and not the State of Georgia or Georgia Access).
Also See:
How do I apply for a Hardship Exemption to enroll in Catastrophic coverage?