The Affordable Care Act is still the law of the land when it comes to comprehensive Major Medical coverage.
Of course, that doesn’t mean there aren’t other options, but it is important to educate yourself on the differences between the ACA-compliant plans & non-qualified health insurance plans!
1) All ACA Plans contain 10 Essential Health Benefits. These include:
|Inpatient Hospitalization||Outpatient Hospitalization|
|Emergency Services||Prenatal & Postnatal Care|
|Mental Health & Substance Abuse Services||Prescription Drug Coverage|
|Preventive Services||Pediatric Care (including dental & vision)|
|Rehabilitative Services||Laboratory Services|
2) ACA-compliant insurance plans must cover pre-existing conditions with no waiting period
Because of this, monthly premiums have increased significantly since the start of the Affordable Care Act.
Additionally, to lower costs to themselves, carriers have limited their network availability through contracted rates with in-network physicians and hospitals. Most plans in our area utilize an HMO-Network or EPO-Network model. This means you must be diligent about checking your providers, verifying they accept your insurance, and obtaining referrals for specialists and certain medical services.
We can be very useful when it comes to navigating an HMO-Network!
3) There is an annual “Open Enrollment Period” that begins on November 1st and ends on December 15th
Plans applied for during this time will be effective January 1st of the following year.
4) Certain life events may deem a “Special Enrollment Period” (SEP)
When you have an SEP, you may be eligible to change plans or enroll in a new plan. An additional SEP has been added for 2021 that lasts until August 15, 2021.
5) The tax penalty for those who decide to "opt out" of ACA-compliant coverage will no longer be applicable for plans bought in 2019 and beyond
6) Depending on income, certain individuals may be eligible for an Advanced Premium Tax Credit (APTC), which is a government subsidy that helps offset the cost of high premiums.
Normally, households that do not qualify for other coverage and earn up to 400% of the Federal Poverty Level (FPL) will qualify for an APTC.
7) In addition to the Advanced Premium Tax Credit, some households may qualify for Cost Sharing Reduction subsidies.
These lower the deductible, out of pocket maximum, and copays on eligible Silver-level insurance plans.
There is NO additional cost to use a broker/agent with an individual health insurance plan.
It is to your advantage to have an advocate for policy servicing and to answer your important questions.
Please call us for more information about, or assistance with, ACA-compliant health plans!
Welcome! We are a small insurance agency serving Texas and Oklahoma.
Call to schedule an appointment with one of our agents at 940-665-1938