Required information for accurate health plan quotes
Being in good health enhances your quality of life. Access to healthcare when you need it, at a cost you can afford, helps greatly toward that end. That’s where health insurance comes in.
The Affordable Care Act has transformed how we shop for healthcare benefits—and who qualifies for coverage. The ACA (or Obamacare, as it is often called) ensures individuals and families who don’t qualify for job-based benefits can obtain affordable healthcare through guaranteed issue major medical insurance.
These plans come in different levels to address varying cost and care needs.
Which you select will depend on your healthcare needs and benefits preferences, what level of coverage you can afford, and whether or not you qualify for income-based subsidies that lower your premium and out-of-pocket expenses.
The ACA brings some uniformity to healthcare. Even though specific benefits may vary, core requirements are now the same for all qualified health plans. The law’s key provisions mandate they:
Be guaranteed issue — You can’t be denied coverage or charged more based on factors such as your health history and gender.
Include, at a minimum, these 10 essential health benefits
Cover specified preventive care at no additional cost — These “free” preventive services come in three categories (all adults, women, children) and include certain screenings, vaccinations, and condition-related counseling. You can’t be charged a copay or coinsurance for these preventive services, even if you haven’t met your plan deductible.
While Obamacare plans have to comply with the guidelines mentioned above, they do come in a few different forms to accommodate where you are in life. After all, your healthcare needs will change along with you—as you make career moves, as your finances shrink or expand, when you turn 26 and age off your parent’s health insurance, if you decide to start a family, and as your health status stays strong or enters periods that require more medical attention.
ACA health insurance plans are categorized into what are known as the metal levels according to their actuarial values. On average, it works out as follows:
Bronze — You pay 40%, the insurance company pays 60% (on average)
Silver — You pay 30%, the insurance company pays 70% (on average)
Gold — You pay 20%, the insurance company pays 80% (on average)
Platinum — You pay 10%, the insurance company pays 90% (on average)
Wouldn’t you just want to choose the plan where you pay the least and the insurer pays the most? Not necessarily.
In general, the lower the premium, the higher the deductible, and vice versa. That means your household budget and typical healthcare needs come into play.
Maybe you’re relatively healthy and want to keep your monthly premium costs low, then a bronze plan may feel like the right choice. Or perhaps you have ongoing health concerns that require more frequent care and prescription medications, then a gold plan with a lower deductible may feel more comfortable. If you qualify for cost-sharing reductions, you’ll want to choose a silver plan that can have an actuarial value as high as 94%.
There are also catastrophic plans, which are available to individuals under 30 or those who have a hardship or affordability exemption, regardless of age. These plans offer a lower monthly premium, but come with a higher deductible ($7,900 in 2019). They don’t qualify for ACA subsidies, though. That means you may want to consider a plan in one of the metal categories if you’re eligible for a subsidy—your premium and deductible could potentially be less.
You can sign up for an individual major medical plan once a year during the annual open enrollment period. In most states, open enrollment for 2020 coverage will take place Nov. 1 through Dec. 15, 2019.
What happens if you fail to get coverage during open enrollment? You’ll need to qualify for a special enrollment period due to a life event such as moving to a new ZIP code, having a baby, losing job-based coverage, or getting married.
A special enrollment period offers a brief amount of time, usually up to 60 days from the qualifying life event, in which you can sign up for or switch your Obamacare plan.
If you miss open enrollment and don’t qualify for special enrollment, then you won’t be able to sign up for major medical insurance until the next open enrollment period. That coverage will be effective Jan. 1 of the upcoming year.