Julie’s Step by Step 2020 Open Enrollment Guide

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September 26, 2019

Julie’s Step by Step 2020 Open Enrollment Guide

Open enrollment is here and nobody can seem to figure out where to start! If you need to learn what’s out there from a reliable source here is a blog that serves as a guide with information and our professional opinion and observations of the plans available for Georgia’s 2020 open enrollment. We will be your agent and our help, as always, is free!

Simply click here Get a Quote Now to get a quote and then feel free to call Georgia Health Brokers at 404-316-7514 – we are standing by and ready to help. Also, visit our website at www.gahealthbrokers.com to schedule an online appointment with us.

We are a family-owned business and we have been advising clients on Health Insurance in Georgia for over 15 years. The reason for our success is simple, we start every day with the goal of helping our clients – whether to find the best policy available or to help with claims and our clients’ healthcare needs. Don’t listen to us, check out our Google reviews here: Google Reviews. Through client care, we have earned the spot as the number one and best choice for individual, family and group health insurance in Georgia.

After reading this blog you should be able to narrow down your healthcare choices and be able to apply for a plan by calling Georgia Health Brokers at 404-316-7514  or by visiting our website at www.gahealthbrokers.com to schedule an online appointment with us.

Start with the basics at your fingertips:

  1. The First step – click here to get a quote Get a Quote Now
  1. Make a list of your doctors and remember to call Dr’s as many are not showing up yet on some newer plans.
  2. While analyzing plans, focus in on the carrier that has more of your doctors, and preferred hospitals, in-network.
  3. Selecta plan with an idea of the deductible and maximum out of pocket limit start here by t that is acceptable to you and your family.
  4. Then start the application.

Confused? Still not making sense. Call or text Julie at 404-316-7514 (or email at julieb@gahealthbrokers.com) to take you the rest of the way so you’ll be covered come January 1.

Pros and Cons of the different Carriers and their 2020 Plans:

Alliant (Alliant Health Plans network)

  • Pros
    1. Alliant’s Hospital System includes:
      • Northeast Georgia Medical Center
      • Piedmont Mountainside Hospital, Inc.
      • WellStar Kennestone
      • Emory John’s Creek
    2. Referrals are not required for in-network providers!
      • No Alliant plans require a referral. See any in-network provider without a referral.
  • Cons
    1. People complain of the small provider doctor network
    2. Available in only a few northern Georgia counties
  • Standout Plans
    1. Their Gold Plan is one of their lower-cost plans and has good benefits
    2. Only carrier with Platinum plans (lower out of pocket maximums)

Ambetter (Ambetter network)

  • Pros
    1. Ambetter’s Hospital System is large and includes:
      • Emory
      • Piedmont
      • WellStar
  • Grady
  • Children’s Healthcare of Atlanta
  • Referrals are not required for in-network providers!
    • No Ambetter plans require a referral. See any in-network provider without a referral.
    • Not official or in writing from the carrier-but experience has shown that Ambetter, unlike most carriers, tends to pay claims for prescriptions, lab work and tests ordered or written by an out of network provider. But ONLY IF the service is performed at an in-network pharmacy, lab or imaging center. However, nothing related to surgery would be paid if the surgeon is not in-network.
  • They offer Free Telemedicine on all plans except the HSA plan.
  • I have a lot of positive experience with Ambetter and have had very few complaints from clients. They have become much better over the past couple of years. The key is to confirm that your doctor’s office is in-network before you apply!
  • Cons
    1. I had a few complaints that doctors showed as in-network on the carrier website when they were not in-network. So again, check network status with your provider.
  • Standout Plans
    1. Lower Deductible Silver Plan  Ambetter Balanced Care 15 (2020) with a $2950 Deductible
    2. Richest Gold plan for the money, Ambetter Secure Care 5 (2020)

 Anthem Blue Cross (All Anthem 2020 plans only include the Pathway Networks)

  • Pros
    1. The Carrier name popularity of Anthem Blue Cross. That does influence some doctors to join the plan as an HMO in-network Pathway provider.
    2. Some plans do not require a referral.
      • Pathway X plans don’t require a primary care doctor selection or a referral from a primary care doctor to see other network doctors. However, these plans are only available outside of Metro Atlanta, in mostly rural counties.
  • Cons

The hospital system in-network is small and only includes:

  • Northside
  • Grady
  • Children’s Healthcare of Atlanta
  • The HMO Pathway network is very small compared to all other Anthem Blue Cross networks. You must confirm that your provider is in the Pathway network with Anthem.
  • Anthem has confusing rules regarding different plan names (based on the plan name shown on your quote, which will be the only plans available in your county with Anthem for 2020).
    • Pathway X Guided Access plans require referrals from your listed PCP to see other in-network doctors. This is the only Anthem option available in most metro counties.
  • Standout Plans
    1. Lower Deductible Silver Plan, Anthem Silver Pathway X Guided Access HMO 2000 (deductible)

CareSource (Marketplace Network)

  • Pros
    1. CareSource has an impressive list of hospital systems in-network, especially considering this is their first year in Georgia:
      • Northside
      • Piedmont (Hospital not showing up on doc finder yet, but I was assured they have a signed contract with Piedmont hospitals)
      • WellStar (Hospital not showing up on doc finder yet, but I was assured they have a signed contract with Wellstar hospitals)
      • *Grady (I could not get an official confirmation at the time of this writing)
      • *Children’s Healthcare of Atlanta (I could not get an official confirmation at the time of this writing)
  • Cons
    1. As noted, the carrier is brand new to Georgia for 2020
      • This makes it difficult to find out what providers are in-network since it takes the carrier awhile to get the new, constantly changing, list of providers updated on their Find a Doctor search. It is best to call your doctor and ask if they are in-network.
  • Standout Plans
    1. Richest Bronze Plan for the money based on Plan design, Marketplace Bronze
      • Offers the only Bronze plan with office visit co-pays for PCP AND Specialist before the deductible is met, with the lowest premium in available counties.

Kaiser (Signature HMO Network Only)

  • Pros
    1. Kaiser has a stable network of providers because you mostly see Kaiser Doctors.
    2. They are the only insurance company that is a healthcare provider. Kaiser has its own doctors and facilities; its integrated care model helps drive successful patient outcomes.
    3. Doctors are incentivized based on patient outcomes and patient happiness!
  • Cons
    1. The hospital system in-network is small and includes:
      • Emory
      • Northside (for maternity only)
      • Children’s Healthcare of Atlanta
    2. Their premiums are among the highest in the market.
    3. Kaiser will only pay claims if all services are ordered by a network doctor.
  • Standout Plans
    1. Only $500 deductible Gold plan, Signature Gold 500/20

Oscar (Oscar Network)**Only available in limited counties for 2020: Butts, Clayton, Cobb, Douglas, Fulton, Paulding, Spalding, and Troup counties.

  • Pros
    1. Oscar offers free telemedicine on all plans!
    2. They have a strong emphasis on technology, hopefully, this will mean they are easy to work with.
  • Cons
    1. The hospital system in-network is small and only includes:
      • WellStar
    2. They are only available in very limited counties for 2020.
      • 1st year in Georgia. A very limited network of providers (they plan to be stronger and more competitive in 2021)

Each carrier has a search tool where you search for your doctors: Use the search feature cautiously with the knowledge that not all providers have been updated by the carriers this far ahead of January, so it is best to call your doctor’s office to confirm if they are in-network for 2020. In particular, the search for CareSource is still not updated with Piedmont and WellStar as in-network hospitals, but they have signed contracts and the system is in the process of adding them. Many other in-network providers are in the process of being uploaded.

If you have questions for me, I am happy to help! Please call 404-316-7514 or email me at julieb@gahealthbrokers.com anytime!

I look forward to working with you to take care of your health care needs for 2020!

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