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Answering the Top 20 Common Questions About ACA Health Insurance

September 26, 2023

Answering the Top 20 Common Questions About ACA Health Insurance

If you find yourself with questions and confusion about Affordable Care Act (ACA) health insurance, rest assured that you're not alone! As a leading health insurance marketplace, we receive numerous inquiries every day about ACA health insurance. If you have a specific concern, chances are it's addressed as a common question about ACA health insurance in this guide. Continue reading to uncover the answers you seek.

The Basics

Discover the ACA's mission to provide affordable and accessible healthcare, along with its extensive coverage benefits below.

1. What is ACA and how does it make healthcare more affordable and accessible?

ACA makes healthcare more affordable and accessible for everyone. How does it do that? Well, it tackles various issues head-on. For instance, it expands Medicaid so more low-income individuals and families can qualify for the program and receive the care they need. It also creates health insurance marketplaces like ours, where you can easily compare and choose from different plans that fit your budget.

2. Is ACA short-term healthcare or long-term healthcare?

The great thing about ACA is that its available as a short term healthcare or long-term healthcare option. Whether you're in need of temporary coverage during a transition period or seeking a long-term solution for ongoing healthcare needs, ACA has you covered.

3. What health benefits are covered under ACA?

ACA ensures health insurance plans cover a range of essential health benefits. These include services like preventive care (think check-ups and vaccinations), prescription drugs, emergency care, hospital stays, mental health and substance abuse treatment, maternity, and newborn care.

4. Are there options for dental or vision coverage under ACA health insurance plans?

The answer to this common question about ACA health insurance is that many ACA plans offer dental and vision coverage as optional add-ons or as separate standalone plans. This means you have the opportunity to secure comprehensive coverage for not just your medical needs but also for dental treatments and vision care, such as regular check-ups, eyeglasses, or contact lenses.

TIP: Our user-friendly online comparison tool can help you find ACA coverage that suits your financial circumstances, health needs, and network preferences.

 Eligibility

Find out if you're eligible for the Affordable Care Act below.

5. Who is eligible to purchase health insurance through the ACA marketplace?

You're in the right place to find out who can purchase health insurance through the ACA marketplace! Eligibility is based on several factors, and here's a quick rundown to help you figure out if you qualify:

  1. U.S. citizenship or lawful presence
  2. Residency in the state where you're applying for coverage
  3. Income within a specific range for your household size
  4. Ineligible for other government health coverage, such as Medicare or Medicaid.


 

Have Questions About Your Eligibility? That's Where We Come In!

Call 1-800-314-5594 to speak to a licensed insurance agent.

Open weekdays from 8 a.m. to 8 p.m. EST.

6. Can I be denied ACA health insurance coverage based on my pre-existing condition?

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Absolutely not! One of the most significant provisions of ACA health insurance is the protection it offers against being denied coverage based on pre-existing conditions. It's a crucial step toward providing comprehensive and inclusive coverage for everyone.

7. Can I get ACA health insurance if I'm self-employed or a freelancer?

If you're a gig worker or self-employed, this common question about ACA health insurance is particularly important since you do not have the same benefits as traditional employees. It's designed to provide coverage options for individuals in various work arrangements, including those working independently.

8. Are there any special considerations for American Indians and Alaska Natives?

This common question about ACA health insurance is very important. If you're an American Indian or Alaska Native, there are indeed special considerations when it comes to ACA. You may be eligible for unique benefits and services through programs like Indian Health Services (IHS), Tribal Health Programs, or Urban Indian Health Programs. These resources provide access to culturally sensitive care, including preventive services, behavioral health support, and specialized treatments

Applying For ACA

Discover the process of applying for ACA and determine if it's the right fit for you in the following section.

9. How can I apply for ACA health insurance coverage?

Applying for ACA health insurance coverage is easy! To get started, use our user-friendly online comparison tool. It allows you to explore different health insurance plans available in your area and compare their coverage options and costs. You can easily enter your information, such as your location, household size, and income, to see what plans you qualify for and get an estimate of potential subsidies or financial assistance

10. Can I apply and qualify for both Medicaid and ACA health insurance at the same time?

We receive this common question about ACA health insurance frequently. It's possible to qualify for both Medicaid and ACA health insurance through the marketplace simultaneously. If your income falls within the range to qualify for Medicaid, you'll typically be directed to apply for Medicaid.

Enrollment

Get to know the ins and outs of ACA enrollment periods and special circumstances in this section.

11. What is the open enrollment period for ACA health insurance plans?

The open enrollment period (OEP) for ACA health insurance plans is the designated time when individuals can enroll in or make changes to their health insurance coverage. The next OEP starts November 1, 2023, and ends January 15, 2024.

12. Can I get ACA coverage outside of the open enrollment period?

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If you missed the OEP, don't worry, there are options available to get ACA coverage outside of that timeframe. Special enrollment periods (SEP) exist for individuals experiencing qualifying life events like getting married, having a baby, or losing other healthcare coverage. These periods allow you to sign up for ACA coverage when you experience these qualifying events.

13. Can I switch ACA health insurance plans during the coverage year?

You typically can't switch plans outside of the annual OEP unless you qualify for a SEP due to a qualifying life event. If you qualify, you can take advantage of the opportunity to switch to a different ACA plan that better suits your needs.

14. Can I get retroactive coverage if I missed the deadline for enrolling in an ACA health insurance plan?

The answer to this common question about ACA health insurance is that the SEP is your only option to enroll in a plan retroactively, ensuring you have coverage that extends back to the event date; you cannot obtain retroactive coverage during the OEP. It's important to act promptly and contact your health insurance marketplace or our licensed insurance agents to understand the specific requirements and deadlines.

Financial Assistance & Tax Implications

Get the facts about ACA's financial assistance and tax implications below.

 15. What specific subsidies or financial assistance are available to help lower the cost of ACA?

Premium tax credits and cost-sharing reductions are available to lower the cost of your ACA health insurance. Premium tax credits help lower-income individuals and families by reducing the amount they pay for monthly health insurance premiums. Cost-sharing reductions, on the other hand, help lower out-of-pocket costs like deductibles, copayments, and coinsurance. The amount of assistance you receive depends on factors such as your income and household size.

16. What are the income limits to qualify for ACA health insurance subsidies or cost-sharing reductions?

Income limits vary based on factors such as household size and location. Generally, individuals or families with incomes between 100% and 400% of the federal poverty level may qualify for subsidies, while those with incomes up to 250% of the federal poverty level may be eligible for cost-sharing reductions.

17. Are there any tax implications or reporting requirements if my income changes after I enroll?

Yes is the answer to this common question about ACA health insurance. If your income increases, you may need to repay a portion of your benefits when you file your tax return. On the other hand, if your income decreases, you may be eligible for a higher level of financial assistance. You should report this change promptly to ensure you receive the appropriate subsidies.

 Policyholder Rights

Learn about your rights as an ACA policyholder in this section.

18. How do I file an appeal if my ACA health insurance claim is denied?

If your health insurance claim under ACA is denied, don't worry—Here's what you can do:

  1. Reach out to your insurance provider and ask for a detailed explanation of the denial.
  2. Gather any supporting documents or evidence that can strengthen your case.
  3. Follow the appeal process outlined by your insurance company, which typically involves submitting a written appeal with all the necessary information.


 19. What are my rights as an ACA policyholder regarding grievances?

If you're dissatisfied with the quality of care or services received, you have the right to file a complaint or grievance. This allows you to voice your concerns and seek resolution. You can typically find the specific process for filing a grievance outlined in your health insurance plan's documents.

 20. Can I receive assistance in choosing the right ACA health insurance plan for my specific needs?

We've saved the most common question about ACA health insurance for last—getting assistance in choosing the perfect ACA health insurance plan for your needs is not only your right but an also incredibly beneficial option.

Our team of licensed insurance agents is eagerly waiting to lend a hand. Simply reach out to them at 1-800-314-5594 from 8 a.m. to 8 p.m. EST on weekdays. They'll offer personalized guidance, ensuring you make an informed decision and discover the ideal healthcare coverage tailored to your unique circumstances.

Taking Control of Your Healthcare Journey

In the winding journey of healthcare, it's empowering to realize that you're in the driver's seat. Navigating the Affordable Care Act might have seemed daunting, but these FAQs were designed to clarify the road signs and put your concerns at ease. You're not alone; you're backed by our team of licensed agents ready to assist you on your journey to optimum health coverage. Your health, your choices, your rights—this is the essence of ACA.



 

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