Georgia Seeks Federal Approval For New Marketplace Subsidy Structure

Georgia has filed a request with federal regulators to change how it delivers financial help to residents who buy health insurance through the Marketplace, seeking an approval that would take effect for open enrollment in late 2027. The request takes the form of a waiver amendment to the state's reinsurance program and requires sign-off from the Centers for Medicare and Medicaid.

The Office of the Commissioner of Insurance and Safety Fire submitted the proposal. Under the current system, most shoppers see monthly premiums already reduced by federal subsidies paid directly to insurers. Under the proposed system, shoppers would see the full premium cost at enrollment, and the state would then deposit money each month into a designated account for subsidy-eligible enrollees. That money would cover premiums, and any leftover balance could be applied to certain health expenses, similar to a health savings account. The state's proposal to CMS says the change is intended to increase transparency and give Marketplace enrollees more control over monthly spending.

The timeline of how the state arrived here runs through enrollment figures. Just over 90% of Georgians with a Marketplace plan received a subsidy in 2024, when enrollment reached 1.3 million people. Enrollment climbed to 1.5 million the following year. After Congress allowed enhanced premium tax credits to expire, an estimated 5 million Americans dropped or were disenrolled from Marketplace plans. Georgia saw a 12% decrease, about 180,000 people.

The proposal would also change how subsidy amounts are calculated. Instead of tying them to the rising cost of premiums, Georgia's insurance office would tie them to a standard rate of medical inflation, which it says will ensure predictability for consumers. To implement the program, the state would use federal pass-through dollars it already receives for subsidies under the current model to cover tax credits and additional administrative costs. Over $100 million in state funds set aside for reinsurance will remain in place.

Whitney Griggs, a health policy analyst with the nonprofit Georgians for a Healthy Future, said the change could complicate enrollment. "It's a lot of onus on the consumer," she said. "The risk that this places for folks to not know how something works, or to suddenly be overburdened with trying to enroll in health insurance, is pretty high." Griggs said people might also be tempted to choose a cheaper plan with a higher deductible to save money for other health expenses. She added that because the waiver amendment would terminate the state's Navigator Program, it may be harder for people to find nonpartisan, independent assistance when shopping for a Marketplace plan.

Virtual public comment on the state's proposal runs through Nov. 13, with some opportunities for live comment.