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ACA Health Insurance

Affordable healthcare options for the way you live

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.

What is Obamacare insurance?

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

  1. Ambulatory patient services (outpatient hospital care)
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drug coverage
  7. Rehabilitative and habilitation services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

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.

Know the ACA health insurance basics

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.

Open enrollment for Obamacare health insurance

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.

Special enrollment periods

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.

What if you don't qualify for special enrollment?

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.

Learn More About ACA (Obamacare)

  • healthinsurance.com what will health insurance look like in 2020 red heart and medical device with 2020 wooden sign
    It’s no secret that health insurance is getting more and more complex each year with many changes and proposed rules. So you inevitably might be wondering what changes to expect and what they mean to you, especially when it comes to your health insurance costs and benefits in 2020. Our experts have weighed in to give us their best predictions of what to expect next year. Let’s break them down. Can we expect to see Obamacare rate changes in 2020? In the early years of the Affordable Care Act, enrollees often saw a 10% annual increase in their policy rates nationwide. That’s because many insurance company actuaries originally had to make educated guesses on how plan enrollees would use their benefits. Insurance companies, in turn, took a financial hit because they underestimated the usage of benefits. Obamacare marketplaces have since settled because insurance companies now have a large dataset to finally understand and predict how plan enrollees use their benefits. With this in mind, insurance companies can better predict member costs and adjust premiums to reflect these predictions. In 2019, the premium increases for Obamacare were relatively modest for the second straight year, with the lowest overall increase since the marketplaces came into effect in 2014. The premiums for the second lowest cost silver tiered plan, which is used as a benchmark to establish the subsidies for lower income individuals, also dropped by 1.5% in 39 states relying on HealthCare.gov for the first time since the marketplaces were established in 2014. Enrollment also largely held steady, dropping by only 2.6% nationwide, despite widespread concerns about the Trump administration’s cuts to outreach and marketing efforts and an overall increase in the number of people who were uninsured. It’s predicted that medical costs will be the main driver of rates in 2020, with an increase ranging from 4 to 8%. Average premium increases for 2020 Alabama: 3.9% Alaska: -0.1% Arizona: -2.4% Arkansas: -2.1% California: 0.8% Colorado: -18.2% Connecticut: 7.8% Delaware: -19.5% DC: 9.0% Florida: 0.0% Georgia: 2.4% Hawaii: -1.0% Idaho: 7.0% Illinois: 1.4% Indiana: 9.0% Iowa: -3.3% Kansas: -3.1% Kentucky: 5.0% Louisiana: 11.7% Maine: -1.6% Maryland: -2.9% Massachusetts: 4.5% Michigan: -2.5% Minnesota: 1.6% Mississippi: 2.7% Missouri: -1.8% Montana: -13.1% Nebraska: -5.3% Nevada: 1.0% New Hampshire: 1.1% New Jersey: 8.6% New Mexico: 0.9% New York: 6.8% North Carolina: -5.3% North Dakota: -7.9% Ohio: -7.7% Oklahoma: 1.4% Oregon: 2.3% Pennsylvania: 4.6% Rhode Island: 0.8% South Carolina: -1.9% South Dakota: 6.5% Tennessee: -1.1% Texas: 0.8% Utah: -5.9% Vermont: 11.5% Virginia: -3.6% Washington: 1.0% West Virginia: 6.7% Wisconsin: -3.2% Wyoming: 1.6% Will there be changes to healthcare laws? While rate changes play a major role for consumers when choosing a health insurance plan, healthcare law changes are becoming a vital factor. Since 2014, there has been a constant stream of attempts to alter the Affordable Care Act by Members of Congress who believe that it’s not the right solution for affordable health insurance. Parties on both sides of the aisle are now aiming to change the ACA, whether it’s “Medicare for All” from the left, or repeal and replace from the right. Medicare for All With the 2020 presidential election campaign in full swing, many democratic candidates are suggesting the implementation of a Medicare for All law - proposal specifics will vary depending on which proposal you read.The main idea is that all Americans would be able to enroll in Medicare and would receive a set of benefits provided through the Federal Government. If at all similar to current Medicare, which serves those 65 and older or permanently disabled, enrollees would be allowed to purchase supplemental plans to offset additional costs and provide greater benefits. Although Medicare For All has a lot of support in the House, there is a significant uphill battle to fight it in the Senate. And as long as President Trump is in office, it likely won’t be signed. Repeal and replace Meanwhile, on the other side of the aisle, the Republicans have been pushing for an option to replace the Affordable Care Act for the better part of a decade. They’ve had some political victories, like the defunding of the risk corridor and setting a $0 penalty for being uninsured, but they’ve yet to completely repeal the ACA. The general public who support the ACA have shown that fully repealing Obamacare could be politically disastrous. Plus, a replacement would need to be developed to get the votes needed. The President has tasked Senators Cassidy and Scott to create a replacement bill that will be able to pass. Given the history of ACA replacement bills, this has yet to be seen. Supreme Court ruling A pending case in front of the Supreme Court, brought by the Attorney Generals from certain conservative states, may affect the Affordable Care Act in the near future. The case claims that Congress doesn’t have the authority to enforce the ACA without a penalty for the individual mandate. A Texas Federal Judge has initially ruled that the law is unconstitutional, but the decision was halted while the Supreme Court decides on how to rule. What are my options? For now, the Supreme Court has not deemed the Affordable Care Act as unconstitutional, so you should shop around and compare ACA plans for 2020 as usual. However, even if Congress passes a repeal and replace bill in the next year, it’s unlikely that those changes would go into effect until the following year. Either way, we’re here to help you through any scenario.
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