HEALTH INSURANCE COVERAGE

How can I acquire Health Insurance for myself or my family?

We assist individuals and families with enrollment in the Affordable Care Act (ACA), also known as Obamacare. Open Enrollment usually goes from November 1st to December 15th each year. Those plans would start on January 1st of the following year.

Qualifying Life Event (QLE)

What is a QLE? It’s a change in your situation — like getting married, having a baby, or losing health coverage. This can make you eligible for a Special Enrollment Period. Which would allow you to enroll in health insurance outside the yearly Open Enrollment Period.

ACA Purpose

The Affordable Care Act of 2010 was designed to lower the healthcare costs for the federal government. With actual cost in year – 2020 – coming in at over $1 Trillion it’s no wonder why the government was looking for some relief.

Since hospital visits (ER) are the most expensive treatment. Their goal was to significantly reduce those visits through prevention by mandating that everyone have insurance. With insurance, an individual could seek preventive treatment and hopefully ward off a critical care situation.

In theory, this would reduce ER visits thus reducing costs. Of course, the requirement of having insurance is no longer in place. Only time will tell when costs increase due to individuals not having preventive care.

ACA Essential Health Benefits

Obamacare’s 10 essential health benefits are required of all health insurance plans. They must comply with the Affordable Care Act (ACA).

Preventive and wellness visits
Maternity and newborn care
Mental and behavioral health treatment
Services and devices for injuries, disabilities, or chronic conditions
Lab tests.
Pediatric care. Dental and vision included
Prescription drugs
Outpatient care
Emergency room services
Hospitalization

Health Insurance Metal Plans

Bronze – usually the lowest premiums, pays 60% of your costs
Silver – pays 70% of medical costs, but premiums are higher
Gold – covers 80% of your costs
Platinum – covers 90% of your costs, but has the highest premiums

Healthcare Exchange

Exchanges or Marketplaces are websites run by your state or the federal government. These websites show plan options and your eligibility for a subsidy. They open for enrollment each year in November.

Over 11 million Americans purchased ACA insurance last year, and 80+ percent of them received a subsidy.

Health Insurance Subsidy

Eligibility for a subsidy depends on your household income. Income must be between 100% and 400% of the Federal Poverty Level. But there are other stipulations as well –

you must not have access to Medicaid
or be qualified for a employer-based health plan

The subsidy chart (year 2020) shows the maximum income level based on household size (400% federal poverty level) that still qualifies for a subsidy.

**Actual limits may vary by state, these are the general federal levels**

1

$51,040

2

$68,960

3

$86,880

4

$104,800

5

$122,720

6

$140,640

Income Limits by Household Size for 2020

Source: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

More Key Components to ACA

No pre-existing condition clause, company can’t deny coverage
Insurance companies can’t raise payments without State approval
Insurers must spend at least 80% of premiums on medical services
Insurance company can’t drop you from a plan for being sick
Parents can have adult children (up to age 26) on their plans

Health Insurance Final Thoughts

There are several steps to enrolling for an ACA plan but it doesn’t have to be overwhelming. We help folks with enrollments during open enrollment and throughout the year. If you have questions about a plan contact us anytime.

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