ACA Explained
The Affordable Care Act (ACA is a comprehensive health care reform law that was enacted in 2010. You may hear it referred to as “Obamacare”, ACA, or PPACA. The law has three main goals:
- Extend health coverage to millions of uninsured Americans. The law provides subsidies (‘premium tax credits’) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
- Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. Not every state has expanded its Medicaid programs.
- Support advanced medical care delivery methods intended to lower the costs of health care in general.
What Is the Health Insurance Marketplace?
The ACA created a Health Insurance Marketplace, a service that helps eligible consumers shop and enroll in health insurance through websites, call centers, and in-person assistance.
When you apply for individual and family plans through the Marketplace, you’ll submit income and household information. You’ll see if you qualify for:
- Premium tax credits that make insurance more affordable.
- Coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state.
What Do ACA Plans Cover?
All ACA-compliant plans, including each one sold on the Health Insurance Marketplace, must cover standard “essential” health benefits including:
- Breastfeeding
- Hospitalization
- Family planning
- Pediatric services
- Laboratory services
- Emergency services
- Prescription medications
- Ambulatory patient services
- Preventative and wellness services
- Rehabilitative and habilitative service
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
The ACA also kept insurance companies from denying coverage because of pre-existing conditions.
When Can You Enroll?
Each year, there’s an Open Enrollment Period (OEP) on the Health Insurance Marketplace where you can buy switch plans. The OEP for 2022 plans has been extended from November 1 through January 15.
You don’t want to miss this period. If you miss it, you can’t enroll until the following year — unless you qualify for a Special Enrollment Period (SEP) due to change in circumstances. For example, if you get married, divorced, become a parent, or lose a job that gave you health insurance coverage, you may be granted a Special Enrollment Period.
4 Metal Levels
Under the ACA, health plans are divided into four categories or “metal” levels. They’re ranked as Bronze, Silver, Gold, and Platinum, with each category based on how you and your plan split the costs of your health care.
Quantum Insurance Advisors can help you determine what level of coverage is right for you.
Bronze
60% Covered
At this level, you’re responsible for 40% of your medical costs. The Bronze category has the lowest monthly premium, but high deductibles mean you’ll have to pay a lot out of pocket before your insurance steps in and pays.
Silver
70% Covered
At this level, you pay 30% of your medical bills. The Silver plan has a higher monthly premium than the Bronze but is still very affordable. It’s great for people who qualify for cost-sharing reductions (CSR) — a discount for deductibles and copays.
Gold
80% Covered
At the gold level, you pay 20% of your healthcare costs. The Gold plan has a high monthly premium but more of your costs will be covered when you seek treatment.
Platinum
90% Covered
At the platinum level, you pay just 10% of your medical bills, and the insurance company pays 90%. This plan has the highest monthly premium of the four categories, which means you pay lower costs and much lower deductibles when receiving care. It’s great for those who are faced with chronic conditions or significant injuries.
Other Options
Not everyone is able to apply for the Affordable Care Act. If you’re one of these people, you still have options like short-term health insurance — a flexible solution that’s similar to major medical plans. It’s also called temporary health insurance or Term health insurance.
In many states, short-term health plans can last up to 3 years and provide great coverage. You can use one when you need coverage for a transition period in your life. If you are…
- Health and under 65
- Between jobs or waiting for benefits to kick in at your new job
- Turning 26 and coming off your parent’s health insurance
- Looking for coverage to bridge you to Medicare
… then short-term insurance may be right for you!
Healthcare Made Simple
Choosing the right healthcare plan for you and your family can be an easy process when you have the right agent by your side. We’re ready to get you all set up.
Keep out-of-pocket costs at bay by using our agents’ wealth of knowledge about the various plans available to you and your family. After going through all your options together, we can provide our unbiased recommendation.
Why Use an Insurance Advisor?
- Personalized experience. One-on-one service with a licensed agent.
- Open communication. If any changes in policy take place, we update you.
- Simple choices. A comprehensive breakdown of any plan applicable to you.
- Lifetime support. Our commitment goes beyond your initial set up. We continue to monitor your plan and provide useful recommendations as needed.
Quality Health Insurance at an Affordable Price
At Quantum Insurance Advisors, we offer coverage for all situations: Individuals, families, small businesses, and large groups. The industry is ever-changing and we’ll keep you up-to-date on your options. Whether you’re searching for better coverage, recently uninsured, or it’s your first time getting health insurance, we’ll help you secure a high-quality, affordable plan!