HEALTH INSURANCE
The Affordable Care Act (ACA) introduced a new set of regulations that many major medical health insurance plans must follow. These plans must include coverage for the ten essential health benefits and have no annual or lifetime coverage maximums. They are also guaranteed issue during open enrollment periods, meaning pre-existing conditions are not factored into eligibility.
Here is everything you need to know about ACA coverage.
No Cost To You
Insurance Consultation
What Is Affordable Care Act Coverage?
Affordable Care Act coverage includes all newly purchased individual and small group health policies. These plans are not required to be sold on the public insurance exchange. This has been true since January 1, 2014. Compliance rules are different for large group plans, and plans that existed before 2014 may have some exemptions to ACA rules.
Reducing Costs +
With ACA
The Affordable Care Act exists to reduce the cost of health care coverage for people who are qualified. Participants can receive premium tax credits as well as cost-sharing reductions. These perks help reduce expenses for families and individuals. Premium tax credits are issued to qualifying individuals, reducing their health insurance bills each month. Cost-sharing reductions are similar, but they reduce out-of-pocket costs for deductibles, copayments, and coinsurance. Your out-of-pocket maximum is reduced too, meaning the total you pay for covered health care services is reduced.
Affordable Care Act Plan Benefits
If you’re wondering what kind of coverage you can get through ACA plans, here are the ten essential benefits that must be covered in every plan:
- Laboratory services
- Mental health and substance use disorder services
- Pregnancy, maternity, and newborn care
- Prescription medications
- Preventive and wellness services and chronic disease management
- Pediatric services
- Rehabilitative and habilitative service
- Ambulatory patient services
- Breastfeeding
- Emergency services
- Family planning
- Hospitalization
Preventive services are also covered through ACA plans. These preventive services are available at no additional cost, and they include checkups, patient counseling, immunizations, and health screenings.
Health Insurance Enrollment
Every year, there is an open enrollment period for people who are looking for care on the Health Insurance Marketplace. This Marketplace is an exchange where people can review the various plans being offered by insurers in their area. If you wish to enroll in a Marketplace plan, but you’ve missed the enrollment period, you must wait for the next enrollment period. This is only if you don’t qualify for a Special Enrollment Period. Special Enrollment Periods are available to people who have unique life circumstances that may have stopped them from enrolling during open enrollment.
ACA Plan Costs
ACA plans are ranked using metal tiers. Each tier denotes a different price point and a new level of benefits. The tiers are Bronze, Silver, Gold, and Platinum. Bronze tier plans are the lowest level of coverage and cost, while platinum tier plans are the most comprehensive and costly.
Costs vary depending on location and the plan you choose. Therefore, it’s best to start collecting quotes with the assistance of a qualified insurance professional.
Hamil Legacy is here to assist you. Give us a call at 972-332-8054 to receive an Insurance Consultation at no cost to you.