A surge of Georgia residents signed up for health insurance under the Affordable Care Act in the final month of enrollment, with 220,000 applications streaming in before the March 31 deadline.

But fewer than half have paid for the first's month's premium on those policies - an essential step in buying coverage through the federal insurance marketplace, a report from Georgia's Insurance Commission said.

Georgia Insurance Commissioner Ralph Hudgens, a vocal critic of the Affordable Care Act, said in a statement that the 107,581 paid-for policies cover 149,465 Georgia residents.

That doesn't count people who signed up during a two-week extension allowed for those who started but couldn't complete the sign-up process on the website,, before the deadline.

"We will probably need to wait for the big picture until after April 30," said Cindy Zeldin, executive director of Georgians for a Healthy Future, a pro-ACA advocacy group. "It is reasonable to expect the portion of those who paid their premiums to rise substantially closer to those deadlines."

The department's survey showed a large spike in last-minute enrollees. The U.S. Department of Health and Human Services counted 139,371 sign-ups by the end of February.

Georgia's data comes from a self-conducted survey by the five insurers operating on the federal exchange in the state: Alliant, Blue Cross Blue Shield of Georgia, Humana, Kaiser and Peach State.

Other states that opted to let the federal government run their insurance marketplaces, including Tennessee and Alabama, are waiting for enrollment numbers from HHS.

Kate Abernathy, spokeswoman for the Tennessee Department of Commerce and Insurance, said there are no plans for the state to conduct its own survey.

The most recent federal data showed that 77,867 Tennesseans and 55,034 Alabamians signed up for coverage between October and February.

Health analysts have said it will be tricky to track the number of people who actually paid premiums and stayed on plans. Insurers typically must wait three months after premium payments are due to kick someone off a plan.

Besides that, the individual insurance market is traditionally more fluid, with people dropping plans for various reasons - they got coverage from an employer or qualified for Medicaid, for instance.

For those who bought Blue Cross Blue Shield Georgia plans - one of two insurers that sold plans in North Georgia - medical services aren't covered until the first month's premium is paid, spokesman Bert Kelly said.

People who chose plans during the deadline extension weeks now have until May 1 to pay that first premium. If they don't, they aren't covered and will likely have to wait until the next enrollment period in the fall to sign up again.

Blue Cross has not yet released its numbers of new enrollments but said it likely will be preliminary numbers available next week.

BlueCross BlueShield of Tennessee, meanwhile, said it likely will not release enrollment numbers until mid-May.

Company spokesman Gary Tanner said those who selected plans have a 31-day "grace period" to pay their premiums, meaning it will be mid-May before it's clear who will be on their plans to stay.

The vast majority of Georgians who paid for plans - about 104,242 - were eligible for tax subsidies to put toward paying for their coverage, Hudgens said.

But that number is still just 18 percent of the estimated 654,000 Georgians who were eligible for the tax subsidies, an analysis by the Kaiser Family Foundation found.

Contact staff writer Kate Harrison at kharrison@timesfree or 423-757-6673.