Affordable Care Act Coverage

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Formerly known as the Patient Protection and Affordable Care Act and Obamacare, ACA (Affordable Care Act) is the U.S. federal statute that represents the overhaul of the healthcare system. The major ACA provisions went into force in 2014, and the act has been slightly changed since. Under the Affordable Care Act coverage, many families have been able to acquire health insurance plans where they otherwise could not. This article will explain exactly what this act is, the enrollment procedure, and the health insurance plans covered by ACA.

What is the Affordable Care Act (ACA)?

ACA, also known as “Obamacare,” is basically a grouping of comprehensive federal healthcare reform laws. These laws have three primary goals to them:

  1. Bring affordable health insurance to as many people as possible. This is done through premium tax credits or subsidies, which lower costs for households that fall between 100% and 400% of the federal poverty level (FPL).
  2. Expansion of the Medicaid program. ACA’s aim is to cover any and all adults with income levels below 138% of the FPL. However, the full expansion is still underway, as some states have refused to expand their Medicaid programs accordingly.
  3. Lowering the costs of health care by supporting and developing innovative ways of medical care delivery methods.
a person standing on a hill spreading their hands
ACA allowed many people to get health coverage where they otherwise could not.

When it comes right down to it, ACA offers greater access to affordable health insurance options to many individuals and families that might otherwise not be able to purchase health coverage. This includes vision, dental, medical, and other types of health insurance. Furthermore, insurers are unable to refuse coverage based on pre-existing conditions (the most important part of the law), nor can they refuse coverage based on gender. There are also no annual or lifetime limits on coverage provided by the ACA.

There are many other benefits to these laws, such as the fact that young adults can stay on their family’s insurance plan until they reach the age of 26.

The way that you apply for Affordable Care Act coverage is usually through the Health Insurance Marketplace. You can find this marketplace by visiting HealthCare.gov. There are strict enrollment periods, and you might need to do some income calculations before you can purchase a plan. Let’s see how you can do this.

When and how can you enrol?

The Open Enrollment Period is the only time in the year when you can apply for coverage. It usually runs from November to January. There are certain situations in which you may be able to apply throughout the entire year (childbirth, marriage/divorce, moving to a new state, etc.). You have several options when it comes to enrollment. You can purchase a health insurance plan through the marketplace, contact your local center, or download an application form and apply via email.

january on a calendar
January marks the end of the Open Enrollment Period. Be quick!

During the open enrollment period, you will also be able to re-enrol in your current plan, choose a new plan to replace the old one, or make changes to your existing insurance plan.

ACA coverage for small businesses

If your business has 50 employees or fewer, you may be eligible for SHOP (Small Business Health Options Program). This will allow you to provide health plans to your employees, qualify you for small business tax credits if you have fewer than 25 full-time employees, and bring a variety of other benefits.

How to use your Affordable Care Act coverage?

It is important to note that even though you apply through the health insurance marketplace, you will ultimately get a plan with one of the insurance providers. That means that any questions you might have will need to be directed to your insurance provider. In other words, if you need to know anything specific about your doctor, treatments, medical equipment, medications, etc., you talk to your insurance provider.

You can find the provider’s contact information on either your bill or your insurance card. If you don’t have either, you can always contact the Health Insurance Marketplace Call Center. You will do the same if you need to appeal a dispute with your insurance company.

ACA Health Insurance Plans

Affordable Care Act coverage is primarily done through health insurance plans. These plans will help you pay for medical services, prescription drugs, and much more. Before you can acquire a plan, however, you need to agree to the terms that are set by your insurance provider. These terms include monthly premiums, deductibles, out-of-pocket expenses, network coverage, etc.

person paying for a service
A health insurance plan will help you pay for medical services.

You can get ACA health insurance plans through either a group coverage plan at your job (or your partner’s job), through your parents’ insurance plan (provided you are under age 26), or through government programs. The most popular government programs include Medicaid, Medicare, and CHIP (Children’s Health Insurance Program). There are also a few other specific options, such as TRICARE and the Veterans Health Administration for military personnel. Finally, your state may provide you with a state-specific health insurance plan.

How to choose the right insurance plan?

The fact of the matter is that even health insurance plans have a “fine print”. Therefore, you will want to ask yourself a few questions before you decide on your health insurance plan. The more questions you ask, the better. Here are some example questions you might want to consider:

  • Are there any co-payments to the plan? Co-payments represent the amount of money you need to pay whenever you receive prescriptions or medical services.
  • Can I visit any doctor, pharmacy, or hospital and still get coverage?
  • Does the plan cover all my medications?
  • If I need to make a claim or a dispute, how is that handled?
  • Will the plan cover home care/nursing home care?
  • Does the plan cover any special conditions? Special conditions include physical therapy, psychiatric care, pregnancy, etc.
  • Will the plan cover specialist services? Specialist services include dentist services, eye doctor services, etc.

To tell the truth, choosing the best Affordable Care Act coverage plan for your needs is not the easiest thing in the world. You can easily make a mistake and potentially lose thousands of dollars. If you want to avoid that, you might want to involve professionals in your choice. ACME Health Life Agency specializes in finding the best possible health insurance plans for our clients. Contact us today, and we will help you find the plan that will provide you with the greatest amount of savings, considering your circumstances.

Why choose us:

Quick and simple process

Most affordable plans

All available options in one place

Helpful guidance

What others say about us:

5.0

I was very pleased with the service I received from ACME. The agent went over all the plans at my disposal, explained everything patiently, and helped me pick the best solutions. I would recommend them to anyone.

Alicia Montgomery