Small business health insurance in Georgia

How Georgia's market is set up

Georgia Access went live as the state's own exchange on November 1, 2024 for plan year 2025, with nearly every county having three or more carriers on-exchange (Georgia Office of Insurance and Safety Fire Commissioner, November 1, 2024). It enrolled over 1.5 million consumers in its first year (OCI, October 31, 2025). Eight insurers offer individual marketplace plans for 2026, down from nine (KFF). Premiums follow the federal defaults — a 3:1 age curve and tobacco rating up to 1.5:1 (CMS, State Specific Rating Variations).

Georgia Code §33-30-12 defines a small group as at least two and no more than 50 employees, and OCI's SHOP rule uses 50 full-time-equivalent employees or fewer. The state has 159 counties, and premiums vary by rating area.

Georgia's SHOP has one carrier

For plan year 2026, Kaiser Permanente is the only insurance company offering SHOP plans in Georgia, and the program is limited to employers with up to 50 full-time-equivalent employees (Georgia Access, SHOP page). That is not a criticism of Kaiser; it is a statement about choice. A small employer buying through SHOP in Georgia is choosing one carrier's network for every employee. Off-SHOP small-group plans are available from other carriers, but the pattern is the same: one plan, one network, chosen by the employer. On the individual side, the same employee has up to eight carriers to choose from on Georgia Access — which is the choice an ICHRA hands to each person.

What Georgia premiums are doing, and the reinsurance program behind them

Georgia's Section 1332 reinsurance waiver, approved by CMS on November 1, 2020 and running through December 31, 2026, pays a share of high-cost claims so carriers can price individual plans lower. CMS projected an average 10.2% statewide premium reduction in its first year; OCI's 2026 extension hearing reported the effect at 11.8% in 2022 and 9.9% in 2026, with an attachment point of $35,000 and a $500,000 cap. OCI is seeking an extension for 2027–2031 with projected reductions of 9.3% falling to 8.9% (OCI, 1332 waiver public hearing, May 7, 2026).

OCI did not publish an aggregate approved 2026 rate change that we could verify, so we do not state one. What is verifiable: the reinsurance program is what keeps Georgia's individual market — the market every ICHRA employee buys in — cheaper than it would otherwise be, and its future past 2026 depends on the extension.

Your four real options as a Georgia employer

There are four ways to offer health insurance to employees in Georgia, and the state's market rules change how each one performs.

• A small-group plan (2–50 employees) through a carrier or the SHOP route. Predictable coverage, age-rated premiums, annual renewals, participation and contribution minimums. Georgia's SHOP has one carrier for 2026.
• A PEO, which pools your staff into its own group plan and bundles payroll and HR for a fee on top of premiums. See our ICHRA vs PEO comparison.
• A taxable stipend. Simple, but it is wages: you owe employer payroll tax on it, the employee owes income tax, and it does not count as an offer of coverage. See our guide to health insurance stipends.
• An ICHRA — a fixed, tax-free monthly allowance employees use to buy their own individual plan on or off Georgia Access. No participation minimum, no renewal negotiation, and the allowance is a number you choose.

Pathways to Coverage and your lowest-paid employees

Georgia has not adopted full Medicaid expansion. Its Pathways to Coverage program covers adults 19–64 with income up to 100% of the federal poverty level who complete at least 80 hours a month of qualifying activities (Georgia Pathways). The program was extended through December 2026, and federal work requirements apply in Georgia from January 2027 (KFF, January 2026). For an employer with hourly staff, the practical effect is that a Georgia employee earning under the poverty line may be on Pathways, above it may be subsidy-eligible on Georgia Access, and an affordable ICHRA offer changes the second group's subsidy eligibility. Check each lower-wage employee's situation before setting the allowance.

The Georgia ICHRA tax credit bills that did not pass

Two Georgia bills have tried to create a state ICHRA credit. HB 341 (2025), a Ways and Means bill to create an income tax credit for employers offering ICHRAs, was withdrawn from the Rules calendar and recommitted to committee on March 6, 2025 and never received a floor vote. HB 1110 (2026), the Georgia Small Business Healthcare Affordability Act, was favorably reported by substitute from House Ways and Means on March 3, 2026 and did not advance further (Georgia General Assembly, legislation records). Neither is law. Georgia employers should plan an ICHRA on its own economics; if a credit is enacted later, it is upside.

Setting an ICHRA allowance in Georgia

Georgia rates individual premiums on the federal 3:1 age curve, so a 64-year-old's premium can be up to three times a 21-year-old's for the same plan. Federal ICHRA rules let you vary the allowance by age up to that same 3:1 ratio, and in an age-rated state that is usually the fair design: a flat allowance treats a 25-year-old and a 60-year-old very differently in real purchasing power.

Location matters too. Georgia's 159 counties fall into multiple rating areas, and metro Atlanta prices differently from south Georgia. In our 2026 calculator dataset (the figures shown on our ICHRA in Georgia page), the lowest-cost Silver plan for a 40-year-old in Georgia averages about $606/month, ranging from $474 to $751 across the state's 159 counties. That spread is why an allowance set from a statewide average fails the ACA affordability test in some counties and over-funds others.

Our ICHRA calculator uses those county-level 2026 lowest-cost Silver premiums by ZIP code, so you can see the affordability line for each employee before you set a number. For 2026, an offer is affordable when the employee's cost for the lowest-cost Silver plan, minus your allowance, is no more than 9.96% of the applicable income measure (IRS).

Group plan vs. ICHRA for a Georgia employer

The Georgia-specific argument for an ICHRA is choice: one SHOP carrier versus eight on the individual side, with a reinsurance program holding individual premiums down. The argument for a group plan is simplicity for a small, single-site team. The table puts the two side by side.

How to set up an ICHRA in Georgia

The setup is the same federal process as anywhere: adopt a written plan document, define employee classes, set the allowance (by age band and rating area if you choose), deliver the required employee notice at least 90 days before the plan year begins, and reimburse against proof of individual coverage. Give employees a clear enrollment path — Georgia Access or an off-exchange carrier — and time the launch to a window when they can actually enroll: the annual open enrollment, or the special enrollment period that a new ICHRA offer triggers.

Who we are

The ICHRA Broker is licensed in New York and works with employers nationwide, including Georgia. We design, set up, and support ICHRAs for small and mid-sized employers — the county-by-county allowance work, the affordability testing, and the enrollment support employees need. Free quote, no obligation. This page is education, not tax, legal, or insurance advice.

Sources

• Georgia OCI press releases, November 1, 2024 (Georgia Access launch) and October 31, 2025 (1.5 million enrolled).
• KFF, Number of Issuers Participating in the Individual Marketplace (Georgia: 8 in 2026).
• O.C.G.A. §33-30-12 (small group: 2–50) and OCI Rule 120-2-112-.09 (SHOP: 50 FTEs or fewer).
• Georgia Access, Small Business Health Options Program page (Kaiser Permanente only for PY2026).
• CMS, Georgia Section 1332 waiver fact sheet; Georgia OCI, 1332 waiver public hearing presentation, May 7, 2026.
• Georgia Pathways to Coverage, About Pathways; KFF, Medicaid and CHIP eligibility policies (January 2026).
• Georgia General Assembly, HB 341 (2025) and HB 1110 (2026) legislation records.
• CMS, Market Rating Reforms — State Specific Rating Variations (Georgia: federal defaults).
• The ICHRA Broker calculator dataset: 2026 lowest-cost Silver premiums by ZIP.