Health insurance can be complex. If you live in Georgia, deciding between public and private coverage is one of the most important financial and healthcare decisions you can make. In 2026, the health insurance landscape in Georgia has shifted significantly due to policy changes, evolving marketplaces, and rising costs. This guide will help you understand how the system works, what options are available, how much coverage realistically costs, and who provides those plans.
Health insurance provides financial coverage for medical needs, prescription drugs, preventive care and emergencies. In the United States, health insurance is provided through a mix of public programs (government-funded) and private plans (offered by companies and regulated under federal and state rules). In Georgia, residents can access both types of coverage depending on eligibility, income, age and employment status.
In 2026, Georgia uses a state-based marketplace called Georgia Access where residents can shop for private plans. Georgia also participates in federal public programs such as Medicaid and Medicare, which cover millions of Georgians.(Commissioner of Insurance)
Public health insurance includes government programs that offer coverage at reduced or no cost based on age, income or disability. The two major public programs in Georgia are Medicaid and Medicare.
Medicaid is a state and federal program that provides health insurance to eligible low-income individuals. Eligibility in Georgia is primarily based on income and household size. Georgia has not expanded Medicaid under the Affordable Care Act, which means the income thresholds are stricter than in some other states.
Georgia also runs a special program called Pathways to Coverage, which is a Medicaid-based program for certain low-income adults that requires beneficiaries to meet work or community activity requirements. Critics argue that these requirements make coverage harder to obtain.
Key Features of Medicaid in 2026:
Medicaid enrollment is available year-round. If you qualify, you can enroll at any time.
Medicare is a federal health insurance program for:
Medicare has several parts:
| Medicare Part | Covers |
|---|---|
| Part A | Hospital insurance |
| Part B | Doctor visits, outpatient care |
| Part C | Medicare Advantage plans (private plans under Medicare) |
| Part D | Prescription drug coverage |
In 2026, there are dozens of Medicare Advantage and Part D plans available in Georgia, with many offering $0 premiums for certain benefit levels.(CMS)
For example, in 2026:
Medicare beneficiaries must still pay the Part B premium, which is set by the federal government.
Private health insurance in Georgia includes plans you buy yourself through the marketplace, coverage offered by your employer, or other individual policies available directly from companies.
Georgia Access is Georgia’s state-based health insurance marketplace where individuals and families can browse, compare and enroll in private health plans for 2026. It replaced the federal HealthCare.gov platform in late 2024.(Commissioner of Insurance)
Participating companies on Georgia Access include:
On Georgia Access, most plans are compliant with the Affordable Care Act (ACA) and fall into the following categories:
| Plan Tier | Description |
|---|---|
| Bronze | Lowest premiums, higher out-of-pocket costs |
| Silver | Moderate premiums and costs |
| Gold | Higher premiums, lower out-of-pocket charges |
| Platinum | Highest premiums, lowest out-of-pocket charges |
| Catastrophic | For people under 30 or hardship exemptions |
These plans have different deductibles, copays, and networks.
For 2026 coverage, open enrollment ran from November 1, 2025 to January 15, 2026. Outside this period, you can only enroll if you have certain life events (e.g., marriage, job loss).(healthinsurance.org)
Many Georgians receive federal premium tax credits to reduce the cost of marketplace plans. You must generally have income between 100% and 400% of the federal poverty level to qualify for subsidies. Georgia Access automatically checks eligibility for Medicaid before applying subsidies.(Georgia Access)
You can also buy private insurance directly from insurance companies without going through Georgia Access. These plans may not qualify for federal subsidies, so monthly premiums can be higher.
Many people in Georgia get private insurance through their employer. These plans are usually partially paid for by the employer and can offer generous coverage. Costs vary widely based on the employer’s contribution.
Some insurers offer short-term plans outside the ACA rules. These are usually less expensive but provide limited coverage and are not recommended for comprehensive health needs.
Here is a high-level comparison:
| Feature | Public Insurance | Private Insurance |
|---|---|---|
| Who Offers It | Government (Medicaid or Medicare) | Private companies |
| Cost | Often free or low cost | Monthly premiums vary |
| Eligibility | Income or age/ disability based | Open to any eligible applicant |
| Enrollment | Year-round for public, limited window for private | Limited open enrollment |
| Subsidies | Government pays majority | May have federal subsidies |
| Network | Defined by program | Defined by plan |
To make smart decisions, you should know these terms:
Insurance costs vary based on age, income, and plan choice. Here are some realistic examples for 2026:
| Company | Plan Type | Estimated Monthly Premium |
|---|---|---|
| Blue Cross Blue Shield | Silver | $750-$1,000 |
| Ambetter | Bronze | $650-$900 |
| Kaiser Permanente | Gold | $900-$1,200 |
| CareSource | Silver | $700-$950 |
| Oscar Health | Platinum | $1,000-$1,400 |
These premiums can be significantly reduced with subsidies if you qualify. For example, after subsidies, a 40-year-old might pay around $111 per month on average, whereas without assistance they might pay $729 a month or more.
For Medicare beneficiaries in Georgia in 2026, many Advantage plans have low or $0 premiums, although you still pay the Medicare Part B premium.(CMS)
Most Medicaid beneficiaries in Georgia pay $0 to very low premiums and minimal cost sharing for services.
When choosing between public and private options, consider:
Imagine a 45-year-old single resident with an income of $40,000:
Do I need insurance in Georgia?
While there is no federal penalty for not having health insurance, going without coverage means high medical bills if you have an emergency.
Can I switch plans anytime?
Public programs like Medicaid and Medicare allow year-round enrollment, while private marketplace plans generally can only be changed during open enrollment unless you have a qualifying life event.
Is it cheaper to get public insurance?
Often yes, especially for low-income or elderly individuals. Private plans can be costly without subsidies.
Health insurance in Georgia in 2026 involves navigating both public safety nets like Medicaid and Medicare and private insurance markets such as Georgia Access. Each option has strengths and drawbacks, and your choice depends on eligibility, income, health needs and personal preference.
It is essential to compare plans carefully, understand costs including premiums and deductibles, and enroll during open enrollment windows if you are choosing a private plan. With the changes taking place in 2026, especially around subsidies and marketplace costs, informed decisions can save you money and ensure you get the care you need.
