2025 Individual ACA updates: Blue Value network expanding, Georgia moving to a state-based exchange

• Blue Value Individual Network HMO is expanding to 102 counties in 2025.
• Georgia is transitioning from the Federal platform to a state-based exchange called Georgia Access.
• PCP assignment and referrals for specialists are required for gatekeeper plans; care providers must ensure accurate information for claims payment, network, and member eligibility.

Blue Value expansion

On January 1, 2024, Anthem introduced a new network and set of Affordable Care Act (ACA)-compliant plans in mid-southern Georgia. Almost 40,000 members have enrolled in these plans. We are expanding this network in 2025 from 61 to 102 counties; this expansion includes the cities of Atlanta and Columbus and will broaden access from 13% of Georgia’s Individual consumers to 80%.

The plans are marketed as Anthem Blue Value and will continue to use the Blue Value Individual Network HMO provider network. Members who no longer qualify for Medicaid coverage or are not enrolled in any health benefit plan may find these products a more affordable coverage option. In some counties, we will offer a $0 premium Silver plan with cost share reductions for individuals with the highest subsidy levels. The Blue Value Individual Network HMO provider network will continue to follow all commercial policies located on https://anthem.com/provider under Provider Resources.

Coming soon — a state-based exchange in Georgia

Georgia Access is the state’s program for Georgians to shop for and enroll in Individual ACA health insurance. During Open Enrollment 2025, Georgia Access at https://georgiaaccess.gov will replace healthcare.gov. Consumers can also continue to purchase off-exchange Individual plans directly at anthem.com. Individual ACA Open Enrollment 2025 runs from November 1, 2024, through January 15, 2025.

Individual health plans available in Georgia

Since the implementation of the ACA in 2014, Anthem has been offering ACA-compliant Individual healthcare plans statewide. The charts below illustrate the two main plans: Pathway and Blue Value:

Gatekeeper plans require PCPs and referrals

Pathway Guided Access, Pathway PCP Copay Choice, and Blue Value are gatekeeper plans. These plans require members to have a PCP assigned who will coordinate their care. This PCP (or covering physician who shares the same TIN and address location) will submit referrals to cover care from most specialists. Referrals are not required for dermatologists, mental health and substance use providers, OBGYN providers, chiropractors, optometrists, ophthalmologists, or oral surgeons.

Tips for success:

• All Individual plans: Care providers should always verify member eligibility/benefits and confirm that the care provider participates in the network that supports the member’s plan.
• Gatekeeper plans (Pathway Guided Access, Pathway PCP Copay Choice, and Blue Value):
  • It is important that provider names, primary addresses, and primary specialties are accurate.
  • Specialists need to validate that a referral has been completed prior to seeing the member.
  • PCP offices need to validate patients are assigned to a PCP within the provider’s practice. PCP names are listed on the top right of the member’s ID card. Members can change their PCP immediately by calling the Member Services number listed on the back of the ID card or texting through the Sydney App.

Looking ahead

In upcoming communications, we’ll share more information about new plans and provide a 2025 quick reference guide with details about our referral process for these plans.

We share a health vision with our care providers that means real change for consumers.