Speak to an advisor

888-258-6270

Don’t Miss the 2018 Health Insurance Open Enrollment Period from Nov. 1 to Dec. 15

 

Contents tagged with health insurance 101

10 Essential Obamacare Terms to Know When Shopping for Health Insurance
Posted Nov 21, 2017 by Jenifer Dorsey

10 Essential Obamacare Terms to Know When Shopping for Health Insurance

The health insurance lexicon changed a bit when the Affordable Care Act took effect. The healthcare reform law introduced us to concepts such as minimum essential coverage and essential health benefits. We may have a few open-enrollment periods under our belts, but that doesn’t mean we all understand the ins and outs of health insurance and Obamacare.

Understanding how health insurance and the law work is important as you shop for coverage. Learning basic ACA-related terminology can help you compare plans, determine if they meet your healthcare needs, and understand your financial responsibility.

Top 10 ACA (Obamacare) terms + a bonus term

The following terms include 10 ACA essentials that will help you navigate buying health insurance in the age of Obamacare: 

1. Actuarial value (aka, the metal levels)

The percentage of total average health care costs covered by a health insurance plan. Under the Affordable Care Act, health insurance plans sold through the state-based and federally facilitated exchanges as well as in the private market fit into four coverage levels based on their actuarial value. These are known as the metal levels because they are classified as bronze, silver, gold and platinum.

2. Essential health benefits

Ten categories of health insurance items and services for which all Obamacare plans sold on and away from the state-based and federally facilitated exchanges must include coverage. Job-based health insurance plans must also include these benefits. Within these categories, specific essential health benefits may vary dependent on the benchmark plan selected by each sate.

3. Exemption

The allowance of certain, qualifying individuals to go without minimum essential coverage and not owe the shared responsibility payment. You may be exempt from having health insurance due to financial hardship and other circumstances. Application for exemption is required in many cases.  

4. Health insurance exchange

A platform through which individuals may purchase health insurance plans. As a result of the Affordable Care Act, state-based and federally facilitated health insurance exchanges were created. These public exchanges provide consumers with subsidies and tax credits that help lower their premium payments. 

There are also private health insurance exchanges that may be set up by employers and health insurance companies. These exchanges do not provide access to subsidies and tax credits; however, they may offer consumers additional coverage options such as dental insurance.

5. Individual shared responsibility provision

The Affordable Care Act’s requirement that most Americans have minimum essential health insurance coverage unless they qualify for an exemption. This is commonly referred to as the individual mandate

6. Individual shared responsibility payment

The tax penalty owed by those who do not adhere to the individual shared responsibility provision. By law, individuals are allowed a single period of up to three months without health insurance coverage during the year. Beyond that, unless they qualify for an exemption, they will be subject to the shared responsibility payment, which is the greater of a percentage of household income or a flat dollar amount—the percentage and dollar amount change annually. The IRS states that the amount owed is 1/12 of the annual payment for each month consumers and/or their dependents are not insured and are not exempt.1

7. Minimum essential coverage

Plans that meet the ACA’s basic provisions and thereby fulfill the requirement that most Americans have health insurance. These plans include those sold on the state-based and federally facilitated health insurance exchanges as well as some sold in the private market, those that are job-based, Medicare, Medicaid, CHIP and others. 

8. Open enrollment

The annual time period in which Americans can buy exchange-based individual major medical health insurance plans for themselves and their families. 

9. Qualified health plan

A health insurance plan that meets the Affordable Care Act’s minimum requirements and has been certified by the state-based or federally facilitated exchange through which it is sold. 

10. Special enrollment period

A limited time outside of the standard open-enrollment period in which consumers may be eligible to enroll in a health insurance plan. Special enrollment becomes available due to qualifying life events such as getting married, having a baby or moving and lasts for a limited time—typically within 60 days of the event. This applies to individual health insurance sold on and away from the state-based and federally facilitated health insurance exchanges. 

11. Subsidy

Income-based financial assistance available to those who buy health insurance from state-based and federally facilitated exchanges. These may come in the form of premium tax credits for those whose incomes fall between 100 and 400 percent of the federal poverty level and/or cost-sharing subsidies for those who earn up to 250 percent of the federal poverty level and buy a silver plan. 

Estimate your subsidy using the Health Care Reform Calculator

These are only a few key terms you will encounter when buying Obamacare health insurance, but they are some of the most common and essential. Check out our 10 essential insurance terms, which explains deductible, coinsurance, copay and more.

If you need further explanation or guidance in selecting the right health insurance plan, call the number on your screen to speak with a licensed health insurance producer.

Looking for temporary coverage? Explore your short term health insurance options.

 

Originally posted July 17, 2015. Reviewed and updated Nov. 20, 2017. 


Legal Disclaimers

1IRS. “The Individual Shared Responsibility Payment – An Overview.” March 20, 2014. http://www.irs.gov/Affordable-Care-Act/The-Individual-Shared-Responsibility-Payment-An-Overview

 

Continue reading: 10 Essential Obamacare Terms to Know When Shopping for Health Insurance


Complete Guide to the Federal Poverty Level
Posted Nov 21, 2017 by Jenifer Dorsey

Complete Guide to the Federal Poverty Level

You likely know that the Affordable Care Act’s subsidies—both tax credits and cost-sharing reductions alike—are based on your income in relation to the federal poverty level.  

Continue reading: Complete Guide to the Federal Poverty Level


How to Choose the Right ACA Health Insurance Plan
Posted Nov 21, 2017 by Jenifer Dorsey

How to Choose the Right ACA Health Insurance Plan

Choosing health insurance coverage for you and your family is no small decision. Even though the Affordable Care Act requires that all qualified major medical insurance plans cover certain preventive services and include essential health benefits at no additional cost, there are nuances.

Continue reading: How to Choose the Right ACA Health Insurance Plan


Health Insurance Deductibles 101
Posted Nov 20, 2017 by Jenifer Dorsey

Health Insurance Deductibles 101

Welcome to Health Insurance Deductible 101. It’s time to get to know one of your health plan’s key components and better understand how health insurance works.

Continue reading: Health Insurance Deductibles 101


ACA Plan Metal Levels - What They Are, How They Work
Posted Nov 20, 2017 by Jenifer Dorsey

ACA Plan Metal Levels - What They Are, How They Work

When the Affordable Care Act’s state-based and federally facilitated health insurance marketplaces opened for business on Oct. 1, 2013, we were introduced to a new way of selecting health insurance: by actuarial tier, aka metal level.

Continue reading: ACA Plan Metal Levels - What They Are, How They Work


What are ACA–Required Essential Health Benefits?
Posted Nov 20, 2017 by Jenifer Dorsey

What are ACA–Required Essential Health Benefits?

When the Affordable Care Act took effect on Jan. 1, 2014, individual and small group health insurance plans were required to start covering a set of health care services categories known as essential health benefits.

Continue reading: What are ACA–Required Essential Health Benefits?


How Does Dental Insurance Work? A Quick Primer
Posted Sep 22, 2017 by Jenifer Dorsey

How Does Dental Insurance Work? A Quick Primer

 

Continue reading: How Does Dental Insurance Work? A Quick Primer


Where Can I Get Health Insurance Now?
Posted Sep 07, 2017 by Jenifer Dorsey

Where Can I Get Health Insurance Now?

In some ways, buying an individual health insurance plan can seem relatively easy. You can search for and compare a range of plans from different carriers at your convenience, and you can get online health insurance quotes in seconds. Then, depending on the coverage you choose, the application and enrollment process may take only a few minutes.

Continue reading: Where Can I Get Health Insurance Now?


This Could Be Your Plan
Posted Apr 21, 2017 by Jenifer Dorsey

This Could Be Your Plan

What to Do When You Need Long-Term Coverage That Isn’t Obamacare

You need health insurance, and you need it soon. But there’s a bit of a problem: Open enrollment for 2017 Obamacare plans ended January 31, and you do not qualify for a special enrollment period to purchase one now.

Continue reading: This Could Be Your Plan


What is a Fixed-Indemnity Health Plan?
Posted Jan 20, 2017 by Jenifer Dorsey

What is a Fixed-Indemnity Health Plan?

Sometimes, just as you are getting a grasp on major medical plan lingo and how the coverage works, you come across yet another health insurance term you don’t quite understand. Let’s say, for instance, fixed-indemnity plan.

Continue reading: What is a Fixed-Indemnity Health Plan?

1
2
3
>
>>