Even in Georgia counties where Georgia Access doesn't offer a PPO, I can help you obtain nationwide PPO coverage. Here's how owners of LLCs, S-corps and smaller companies throughout Georgia are choosing insurance for their households.
Hi, I'm Sam Jaber. I'm licensed to broker health insurance in 36 states, and I help Georgia business owners find coverage by phone. That includes someone running an LLC alone in Alpharetta, a couple operating an S-corp in Savannah, or a Rome machine shop owner with several employees on payroll.
In Georgia, business owners shopping for personal coverage use Georgia Access, the state's exchange. Three local rules make the decision different here. Marketplace PPO plans aren't available in the major Atlanta counties, Georgia never adopted full Medicaid expansion, and the state continuation period after leaving an employer is relatively brief.
Georgia Access lists 211 individual medical plans this year, with HMOs accounting for 203 of them. The remaining 8 PPOs are offered by one insurer and are available in 71 of Georgia's 159 counties. Fulton, DeKalb, Cobb and Gwinnett aren't among the counties where those PPOs are sold.
Regardless of your Georgia county, I can help you apply privately for a nationwide PPO. The insurer asks medical questions about each family member and uses those answers when determining the premium. Its provider network includes hospitals and physicians throughout the country. If everyone in your household is healthy, I'd want you to see that price before making a decision.
When a business consists entirely of owners and their family members, coverage is purchased individually through Georgia Access or the private market. Hiring someone outside that group may make SHOP, the small-business exchange, available for group insurance. Even if your company qualifies, it's worth comparing the group premium against individual coverage for each person.
Your household's expected income for the insurance year determines the premium credit. Schedule C filers and single-member LLC owners begin with business net profit, while S-corp owners count both their wages and pass-through profits. Beginning in 2026, excess credits no longer have a repayment limit. If you underestimate business earnings, the amount owed back when April arrives could be significant.
If you're eligible for a credit, begin with Georgia Access because that's where you can use it. Outside central Atlanta, see whether your county offers a PPO. Within the Atlanta core, focus on HMO networks that include your family's pediatricians and specialists. If a major contract changes your expected earnings, adjust the income estimate instead of leaving it untouched.
Next step: Let's review your previous business tax return and what you expect to make this year. Together we'll settle on a realistic estimate and choose coverage accepted by your family's doctors.
Without a credit, an Atlanta-area household pays the complete listed HMO premium for each person. That's usually the point where I encourage owners to examine private coverage prices too.
Private underwriting examines every applicant separately. After reviewing the medical information, the carrier can approve coverage, refuse it or offer approval with a particular condition excluded. Families in good health often find savings compared with full exchange premiums, while a child attending college in another state can remain within the network. We'll go through the benefits of each policy before deciding.
Next step: Call me with your family's details. I'll quote a nationwide PPO and compare it with the Georgia Access plans and prices offered in your county.
Georgia business owners with very little personal income can run into an eligibility gap. Full Medicaid expansion isn't available, and Pathways has a 100% federal poverty level limit along with qualifying work or activity requirements. Georgia Access premium credits also generally start at that same 100% threshold. Before applying, let's make sure your annual income projection reflects what's actually happening.
Next step: Before enrolling during your business's startup year, call me so we can determine exactly which coverage your household qualifies for.
Georgia's state continuation law covers the remainder of the month in which your insurance ends, followed by three additional policy months. Larger employers subject to COBRA provide that continuation option instead. Regardless of which applies, losing employer coverage gives you a special enrollment opportunity through Georgia Access.
Because that temporary coverage doesn't last long, I'd have the replacement plan arranged before leaving your job.
Next step: Reach out several weeks ahead of your final workday. I'll compare the price of continuing your current coverage with Georgia Access and private PPO alternatives.
Straight answers, no sales pitch.
The marketplace PPO is limited to 71 counties, excluding Fulton, DeKalb, Cobb and Gwinnett. But if you're healthy, I can help you purchase a private nationwide PPO anywhere in Georgia.
SHOP coverage isn't available until you hire an employee who isn't an owner or family member.
Coverage continues through the remaining part of the termination month, followed by three additional policy months.
No. Georgia's Pathways program has a 100% poverty-level ceiling and requires participants to complete eligible work or other qualifying activities.
I'll need your county, the way your company is structured, approximately what it earned after expenses, and the family members needing insurance. From there, I can identify the coverage route I'd recommend and give you actual prices.
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