Affordable Care Act Plans

​The Affordable Care Act (Obamacare) made several changes to healthcare in the United States. Among them was the formation of Health Insurance Marketplaces. The marketplaces were created to help individuals and families acquire health insurance that meet the ACA‘s minimum coverage requirements.

The following is a discussion to help explain how ACA health insurance plans on the marketplace work, what you need to consider when picking a plan, the importance of working with an insurance agent to help guide you, and how the premium subsidies work.

How ACA Health Insurance Plans Work

The Health Insurance Marketplaces were formed to offer individuals and small businesses a one-stop-shop to compare and purchase health insurance plans. The available plans vary based on the state. Some states operate through a state-run marketplace while others use the federal marketplace. ACA plans offer a set of health benefits, which include preventive care, prescription drug coverage, emergency services, hospitalization, mental health services, etc. They also are required to meet specific cost-sharing requirements and have limits on out-of-pocket expenses. 

When shopping for a plan, people can compare health insurance options based on the level of coverage, monthly premiums, and out-of-pocket costs. Typically, these plans are put into different categories and placed into one of four levels: Bronze, Silver, Gold, and Platinum, each offering a wide variety of benefits and level of protection. 

Things to Consider When Selecting a Plan

When selecting an ACA plan on the marketplace, it’s important to keep in mind the following aspects: 

1.) Monthly Premiums: This is the cost you pay each month for a plan. Higher premiums usually result in lower out-of-pocket costs, while lower premiums result higher out-of-pocket costs. 

2.) Deductibles: This is the amount you pay and are responsible for before the insurance kicks in. Policies with higher deductibles usually have lower monthly premiums, but not always. 

 3.) Copayments and Coinsurance: Copayments are set amounts that you pay for different services, while coinsurance is a percentage of the total cost of care. It’s important to realize what these costs are and how they will affect your overall healthcare costs. 

4.) Network: Health insurance plans have a network of providers. It is important to verify that your favorite doctors, hospitals, and clinics are included in the plan’s network. 

5.) Prescription Drug Coverage: It is also important to check to see if the plan covers the medications that you need, and if there are any limitations or obstacles to getting them filled. 
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6.) Out-of-Pocket Maximum: This is the most you will pay out-of-pocket for covered healthcare services during a plan year. It is important to know what the out-of-pocket max is so that you can plan for any unexpected medical expenses. 

Working with an Insurance Agent

Working with a licensed insurance agent is extremely helpful when navigating your plan options. Agent’s services are complimentary and are FREE to you. It is important that when you pick an agent that they have a good reputation and are independent. Independent means that they can offer you a variety of different insurance companies to choose from. Working with a good agent, like Chris, Your local Insurance Guy, can save you countless hours and money to ensure that you do not make a wrong selection. 

How Premium Subsidies Work

Premium subsidies are available to individuals and families that meet the required income levels. The subsidies help lower the monthly premium costs of an ACA plan. The amount of premium subsidies that you receive is based on your income and the cost of the benchmark plan in your area. If the cost of the benchmark plan is more than a set percentage of your income, you may be eligible for a larger subsidy. This can help to lower the cost of a plan significantly for a person when selecting a plan on the marketplace. 

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