Health insurance Marketplace Broker

The Affordable Care Act: Providing Access to Affordable Health Insurance

The Affordable Care Act (ACA), also known as Obamacare, is a law that aims to provide affordable health insurance to more people. One of the ways the ACA achieves this goal is by offering subsidies, called “premium tax credits,” to lower the cost of health insurance for households with incomes between 100% and 400% of the federal poverty level (FPL).

If you are needing individual Health Insurance, you should check out the following link or give me a call. The link will make it easier to find coverage that you might want to have.

Enrolling in Health Insurance under the Affordable Care Act

If you are looking for individual health insurance, you can check out the link provided or contact a licensed health insurance agent. This will help you find the coverage that best suits your needs.

Get a quote and signup online for Health Insurance under the Affordable Care Act

The Importance of Health Insurance

Health insurance is essential for everyone, as the cost of medical treatment can result in serious financial consequences without proper coverage. A single hospital trip or surgery can cost tens of thousands of dollars, leaving consumers in excessive medical debt that may be challenging to recover from.

The Affordable Care Act and the Health Insurance Marketplace

In 2010, the Affordable Care Act was signed into law by former President Barack Obama. It changed health insurance for individuals and created the Health Insurance Marketplace, which facilitates the enrollment of millions of Americans in health insurance plans each year. As a licensed health insurance agent, I can help you select an insurance plan that best fits your needs and assist you with your application for health insurance through Healthcare.gov.

Obtaining Health Insurance

Going without health insurance is not an option for most people, as the risk of a severe injury or illness is too high to ignore. Without health insurance coverage, individuals and their families risk incurring unexpected, costly medical bills.

There are many ways to obtain health insurance, including:

  • Employer-sponsored coverage
  • Health insurance companies directly
  • Health Insurance Marketplace
  • Medicaid

If you need health insurance for 2024 and cannot obtain it affordably through your employer, you can take advantage of the open enrollment period to purchase health insurance. The initial open enrollment period is from November 1, 2023, through December 15, 2023, for coverage starting on January 1, 2024.

If you miss the December 15, 2023, deadline, you may be to purchase a plan through January 15, 2024. However, your coverage will not start until February 1, 2024.

Types of Health Insurance Plans

There are four typical insurance plan types to consider:

  1. Exclusive Provider Organization (EPO) – An EPO provides medical services to individuals who use specific doctors, specialists, or hospitals in a plan’s network. While individuals who choose the EPO can enjoy reduced premiums, they may not have coverage with their preferred providers if they are not in the network.
  2. Health Maintenance Organization (HMO) – HMOs limit coverage to only doctors or specialists who participate or contract with the HMO in an effort to reduce medical expenses for their plan participants. To qualify for HMOs, individuals usually must live or work in a specific area. Out-of-network care is not available from HMOs unless an emergency occurs.
  3. Point of Service (POS) – POS plans require payment for every doctor’s visit, but reduced out-of-pocket costs are available for individuals who choose providers in the POS network. If you require the care of a specialist, you will need a referral from your primary care physician.
  4. Preferred Provider Organization (PPO) – A PPO is the most flexible of all the health insurance plans. You can visit doctors, specialists, and hospitals in or out-of-network. Visiting providers in the network will reduce your out-of-pocket expenses, while seeing doctors outside your network will result in additional costs.

Choosing the Right Health Insurance Plan

Selecting a health insurance plan can be confusing and complex. You want to ensure that you choose the right plan for you, with consideration of your healthcare needs and budget. 

I can explain the various options available, including their advantages and disadvantages. Don’t leave your health to chance – seek advice from a qualified health insurance broker who knows how each plan works.

Health Insurance Plans Available

Choosing the right health insurance plan can be a challenging task as it requires careful consideration of both healthcare needs and budget. Several health insurance plans are available for individuals under the age of 65, each with its advantages and disadvantages.

There are four primary classifications of health insurance plans available, including on-exchange plans, off-exchange plans, short-term major medical, hospital indemnity insurance, and employer group health insurance. Health savings accounts (HSAs) are also available and offer tax advantages.

On-Exchange Plans

On-exchange plans are primarily subsidized by the government, including Medicaid, and are appropriate for individuals who qualify for fully-paid health insurance or tax credits to offset their monthly premium costs. If you believe you qualify for an on-exchange plan, you can seek assistance from a qualified health insurance broker to help with the application process and ensure you meet the ACA’s requirements.

Off-Exchange Plans

Off-exchange plans are suitable for individuals who do not qualify for a subsidized on-exchange plan. You can purchase insurance directly through an insurance carrier. An experienced health insurance broker can assist you in understanding the scope of each plan and its cost to select the coverage that meets your family’s needs and your current budget.

Short-Term Major Medical

A short-term major medical plan is appropriate for individuals who need a temporary healthcare solution during significant life changes. The plans offer major medical coverage and can be customized to fit your needs. Purchasers can obtain coverage that starts quickly, sometimes as fast as the following business day. You can renew short-term major medical plans if necessary. Short-term major medical plans are often cheaper than purchasing an ACA-compliant plan through the Healthcare Insurance Marketplace, but they do not include many of the essential benefits of ACA-compliant plans.

Hospital Indemnity Insurance

Hospital indemnity insurance is appropriate for individuals at risk of needing hospital care. A hospital indemnity insurance plan covers an unexpected hospital stay for a given period, typically based on days, weeks, months, or visits. Some hospital indemnity insurance plans offer additional coverage for ambulatory services, surgeries, or childbirth. Special coverage is also available for individuals at risk of stroke or cancer.

Employer Group Health Insurance

If you’re a business owner seeking to purchase group health insurance for your employees, a qualified health insurance broker can introduce you to the various plan options available. They can help identify the best alternatives that meet your needs and are affordable for your organization.

Typically, employers must purchase their plan annually. Employees can decide between the plans available to them and make a decision that’s appropriate for them.

Health Savings Accounts

Health savings accounts offer tax advantages to individuals, families, and businesses. To enroll in an HSA, you must have a high-deductible health insurance plan, and healthy individuals can find it advantageous, especially if they maximize their yearly savings toward the plan. The money not used for medical expenses for the year rolls over to the following year. Some HSAs also contain investment options, allowing savings to grow over time.

Qualifying for Health Insurance with the Healthcare Insurance Marketplace

 

Individuals who qualify for health insurance with the Healthcare  Insurance Marketplace must:

  • Reside within the United States
  • Be a U.S. citizen or national
  • Not be in jail, prison, or otherwise incarcerated

If you meet the basic qualifications, you can select a health insurance plan during the open enrollment period or if you qualify for a SEP after the open enrollment period ends.

 

Enrollment Periods for the Healthcare Insurance Marketplace

From November 1, 2023, through January 15, 2024, all individuals who meet specific requirements can choose to enroll for a health insurance plan through the Health Insurance Marketplace.

Open enrollment only lasts for a short period; after that, you’ll need to qualify for a Special Enrollment Period (SEP) to obtain 2024 health insurance for yourself and your family.

Individuals who typically need to obtain their health insurance through the Marketplace include those who don’t have coverage through an employer’s policy, are unemployed, self-employed, or don’t have access to health care through other means.

If you don’t enroll for health insurance during open enrollment for 2023, you can only obtain it if you qualify under a SEP. Changes in your life situation that meet the requirements for a SEP include:

  • Loss of qualifying health insurance, such as by changing jobs or stopping work
  • Increase or decrease to the size of your household
  • Change in local residency that impacts the health insurance plans available to you
  • A change in your eligibility for Marketplace coverage, such as a change in your income
  • An enrollment mistake or plan error
  • Other circumstances, generally on a case-by-case basis

In most cases, you have 60 days from the date of the qualifying event to enroll in coverage. If you are enrolling in Marketplace coverage for the first time, you may need to submit documents to prove SEP eligibility.

NOTE: If you experience a change in household income throughout the year, you should report this change to the Marketplace as soon as possible as it may affect the amount of financial assistance that you are eligible for. I can also help you update your Marketplace application as well.

Premium Tax Benefits

Individuals who enroll in health insurance through the ACA’s Health Insurance Marketplace may receive tax credits to pay for coverage. To be eligible for the premium tax credit, you must have an income that falls within 100% to 400% of the federal poverty line as of 2023. The requirements for the tax credits are complex and involve comparing the size of your household to specific earnings levels. People with access to affordable healthcare through their employer or government plans like Medicaid, Medicare, or Tricare are ineligible for tax credits. You can contact a health insurance agent to evaluate your situation and determine whether you qualify for the tax credits.

Essential Health Benefits

All plans available through the Health Insurance Marketplace must provide essential health benefits. These benefits are required by law and cannot be denied. Plans may include additional coverage in some cases. Here are the essential health benefits that all plans must provide:

  1. Preventative and wellness services, including management of chronic diseases
  2. Emergency services and hospitalization
  3. Ambulatory services, including outpatient care without admission into a hospital
  4. Prescription drug benefits
  5. Laboratory services
  6. Maternity and newborn care, both before and after a baby is born.
  7. Substance abuse treatment, including counseling and psychotherapy.
  8. Mental health services
  9. Rehabilitative services and equipment for individuals with injuries, disabilities, and chronic conditions
  10. Pediatric services

All plans must include these benefits without annual limits or lifetime maximums.

 

Free Preventative Health Care

In addition to the essential health benefits, plans available through the Healthcare Insurance Marketplace must provide free preventative healthcare, with no charge for copayment or coinsurance. This means that you can get certain medical services for free, even if you haven’t met your yearly deductible, as long as you see a physician within your network.

The preventative health care services available include:

  • Blood pressure testing for all adults
  • Cholesterol screening for adults of certain ages or who are at high risk.
  • Screening for mental health disorders, including depression
  • Diabetes Type 2 screening for individuals with previously diagnosed high blood pressure
  • Colorectal cancer screening for adults over the age of 50
  • Recommended immunizations.
  • Tobacco use screening and cessation products and services for current smokers
  • And more

Everyone should take advantage of free preventative healthcare services to lower their chances of contracting severe illnesses or diseases. The healthcare services are free of charge as long as the patient seeks care from an in-network physician.

 

Health insurance Marketplace Broker to Help You with Your Health Insurance Needs

 

I am a licensed independent health insurance agent, and I am passionate about helping others find the coverage that they need. I am licensed in 47 states. I currently live in Waipahu, Hawaii, and am a former U.S. Marine and retired from the U.S. Navy.

I will help anyone who needs assistance obtaining health insurance. I am highly familiar with the complexities of the Health Insurance Marketplace, as well as the various alternatives to the Health Insurance Marketplace.

Contact me today to schedule your appointment! I can provide nationwide help over the phone and over the computer and offer local help in Hawaii.