We offer individual and family health insurance policies directly through carriers and on the Federally Facilitated Marketplace (FFM). Find the carriers listed at http://www.healthcare.gov/.
The Affordable Care Act (ACA) requires that all citizens have health insurance or face a penalty. The ACA also requires that insurance companies include 10 Essential Health Benefits mandated by the Federal government in all of their plans.
Some of these benefits include hospital coverage, doctor visits, diagnostic tests, drug coverage, maternity care, preventative care, and pediatric services.
The Affordable Care Act Explained
The Affordable Care Act has changed the way we purchase and benefit from health insurance. There are no pre-existing condition riders or underwriting questions (apart from being a smoker). No one can be denied a plan for any reason or be “rated-up” due to health conditions.
This means that all Americans can get affordable health insurance coverage no matter what their health situation.
Enrolling in a Health Insurance Plan
There are two different avenues you can take to enroll in a health insurance plan.
• You can buy a plan directly from the insurance carrier, or if you think you may NOT be eligible for government subsidies.
• If you think you MAY be eligible for government subsidies, you can apply through the Federal Marketplace. Some states have their own exchange to purchase health insurance. The states where we are licensed are now all on the Federal Marketplace. Premiums are based on age, zip code, and smoking status.
We find that while the marketplace is not complex, it does have its quirks. Creating a profile and entering your financial information is not always as straight forward as you would think.
Selecting a plan also can be confusing. We don’t recommend that you necessarily pick the cheapest plan. The key to picking the right plan is the network of doctors and the drugs you take.
HMO’s and PPO’s
Many of the plans on the marketplace are Health Maintenance Organizations (HMO). This means that you MUST see doctors in their network. It is critical that you ensure your doctors are in the network or you will not be able to see them.
Some of the plans are Preferred Provider Organizations (PPO). This means that you can see doctors out of the network. Typically you will have a higher deductible, out of pocket maximum and copay for services.
Since the plans all have drug coverage, you also need to ensure that your drugs are covered and understand how the plan you are considering covers the drugs you need. Does it have a separate drug deductible? Is the medical deductible combined with the drug deductible? How does the plan rate your drug and what are the copays?
Health Insurance Cost Subsidies
Depending on your income, you may qualify for premium and/or cost subsidies. Find out more about health care insurance subsidies and how they can lower your overall health insurance costs.
We Are Health Insurance Experts
If this sounds complex, it is. You only have one chance each year to change your plan. That time frame varies every year, but typically encompasses November to the end of January.
As with all insurances, there are Special Enrollment Periods (SEP). If you have a “life event” such as birth, death, marriage or loss of employer coverage you can typically additionally enroll at time of this “life event”.
At Imagine Insurance Advisors, we fully understand all the ins and outs of healthcare coverage and the choices you have to consider. We can help you navigate finding the plan that best fits your needs and the needs of your family.