Private Health Insurance in Georgia
Private health insurance in Georgia is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Georgia Marketplace premiums rising 20.7% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Georgia and when the Marketplace is the better call.
Who buys their own coverage in Georgia
Georgians now shop on Georgia Access, the state-run exchange, and its 2026 open enrollment produced 1,324,295 plan selections, the fourth-largest total of any state. That was roughly 12 percent below the 1,510,852 of 2025, a sharp drop as the enhanced federal credits ended. CMS data show 89.1 percent of 2026 enrollees got an advance premium tax credit, so about 10.9 percent, close to 144,000 people, paid the whole premium, up from 7.4 percent a year earlier. In the 2024 Census survey, about 39.6 percent of Georgia households reported incomes of $100,000 or more.
How Georgia regulates private plans
Georgia rule 120-2-12-.05 makes any advertisement for coverage of a specified illness or accident state in prominent type that it is a limited policy, and ads quoting a hospital maximum must also show the daily rate and day limit. Under O.C.G.A. section 33-1-20, a faith-based sharing ministry that sends members monthly statements of needs and a not-insurance disclaimer falls outside Title 33 and the commissioner's reach. Georgia has no statute exempting agricultural organization plans. Multiple employer self-insured plans need a license under Chapter 50 of Title 33 and must disclose that no insurer or guaranty association backs their benefits.
Protecting yourself when you buy in Georgia
O.C.G.A. section 33-29-11 requires every individual accident and sickness policy to carry a notice giving the buyer 10 days after delivery to return it for a premium refund, voiding it from the start. The Office of the Commissioner of Insurance and Safety Fire runs a License Lookup that shows whether an agent or insurer holds a Georgia license. Its Consumer Services Division takes complaints through an online portal or at 1-800-656-2298. The office also warns that discount health cards are not insurance and lists red flags such as spam faxes, pressure to act now and requests for card numbers.
The Georgia Marketplace you would be comparing against
Georgia runs its own exchange, Georgia Access, which certifies plans and lets residents enroll directly or through licensed agents and approved web brokers. The state also funds a reinsurance program that lowers premiums. Georgia's continuation law applies to insured group plans of any size and lasts three months plus the rest of the month coverage ends, with a longer option for people 60 and older leaving larger employers. Georgia sets no state duration limit for short-term plans, so federal rules apply. Final 2027 individual rates average about 20.7 percent higher, one of the larger increases in the Southeast.
Other Georgia rules to know
- Leaving a small employer: Georgia requires insured group plans to offer three months of continuation, plus the rest of the month coverage ends, after at least six months of coverage. People 60 and older leaving larger employers can continue longer, until Medicare or other coverage, at up to 120 percent of the premium.
- Short-term plans: Georgia has no state duration limit for short-term plans, so federal rules apply; with federal enforcement of the four-month limit paused, some Georgia plans run up to 36 months.
- Where to enroll: Georgia uses its own exchange, Georgia Access. Georgia Access sets its own open enrollment dates; check its site for 2027 deadlines. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 20.7% on average. See the Georgia 2027 rate page.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
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Georgia questions
Where do Georgia residents enroll in 2027 coverage?
Georgia uses its own exchange, Georgia Access. Georgia Access sets its own open enrollment dates; check its site for 2027 deadlines.
What continuation rights does Georgia give after leaving a small employer?
Georgia requires insured group plans to offer three months of continuation, plus the rest of the month coverage ends, after at least six months of coverage. People 60 and older leaving larger employers can continue longer, until Medicare or other coverage, at up to 120 percent of the premium.
How much are Georgia premiums rising for 2027?
Individual-market premiums are set to rise 20.7% on average.
What is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, rules.sos.ga.gov, rules.sos.ga.gov, codes.findlaw.com, oci.georgia.gov. Facts checked October 2026. See all Georgia health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Georgia and 30 other states, NPN 21032307.