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

 

How to Evaluate Your Healthcare Needs + Obtain Enough Insurance Coverage
Posted Nov 21, 2017 by Author

How to Evaluate Your Healthcare Needs + Obtain Enough Insurance Coverage

Open enrollment seems to sneak up on us every year. You're still working through the Halloween candy and suddenly are being asked to make an important and—for most of us—mandatory purchase that will cost potentially hundreds of dollars or more each month.

Continue reading: How to Evaluate Your Healthcare Needs + Obtain Enough Insurance Coverage

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

An Obamacare Mistake the Government Wants You to Ignore
Posted Nov 21, 2017 by Jenifer Dorsey

An Obamacare Mistake the Government Wants You to Ignore

The words "glitch" and "Obamacare" were commonly associated with one another during the Affordable Care Act’s first open enrollment period. While the technological problems that plagued state-based and federally facilitated health insurance exchanges may be more or less fixed, there is one Obamacare glitch that’s been there from the beginning and hasn’t gone away.

Continue reading: An Obamacare Mistake the Government Wants You to Ignore

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

The Best Health Insurance If You’re Healthy and Not Subsidy-Eligible
Posted Nov 21, 2017 by Jenifer Dorsey

The Best Health Insurance If You’re Healthy and Not Subsidy-Eligible

Open enrollment for Obamacare plans runs from Nov. 1, 2017, through Dec. 15, 2017. Even if you consider yourself healthy, not taking the time to compare options and select the right health plan can be costly.

Continue reading: The Best Health Insurance If You’re Healthy and Not Subsidy-Eligible

Health Insurance Plans: Automatically Re-enroll or Shop Around?
Posted Nov 20, 2017 by Jenifer Dorsey

Health Insurance Plans: Automatically Re-enroll or Shop Around?

Open enrollment for 2018 health insurance plans goes from Nov. 1, 2017, to Dec. 15, 2017 — just six short weeks!

Continue reading: Health Insurance Plans: Automatically Re-enroll or Shop Around?

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.

Meet the four ACA metal levels

All major medical health plans on the market today are categorized into four tiers by actuarial level—actuarial levels represent the percentage of total expected expenses paid for by the plan. Under the ACA, these tiers have been assigned a metal name: bronze, silver, gold or platinum.

The metal levels and their actuarial value percentages are as follows:

  • Bronze plan – 60% of covered medical expenses paid by the plan; 40% by the consumer
  • Silver plan – 70% of covered medical expenses paid by the plan; 30% by the consumer
  • Gold plan – 80% of covered medical expenses paid by the plan; 20% by the consumer
  • Platinum plan – 90% of covered medical expenses paid by the plan; 10% by the consumer

Which metal plan should you choose?

In general, the higher the share of covered medical expenses paid by the plan, the lower your out-of-pocket cost. However, this scenario also tends to translate into a higher premium.

You may want to choose a:

Bronze plan – If you are relatively healthy, typically see the doctor for preventive care and do not anticipate many medical expenses

Silver plan – If you tend to require a few trips to the doctor each year, take a prescription medication and want to keep your deductible a bit lower*

Gold plan – If you have health conditions that require ongoing medical attention, make frequent trips to the doctor and want to keep your deductible low

Platinum plan – If you want the lowest deductible possible and expect your medical expenses to be substantial

Some people qualify for a subsidy to help offset their ACA plan premium. Use our subsidy calculator to find out if you qualify.

What if you select a high-deductible plan and need healthcare?

While a low monthly premium can be appealing, they often come with the highest plan deductibles.

For instance, you could qualify for a no-cost bronze plan in Texas, but that bronze plan comes with a $6,400 deductible that must be met before your benefits fully take effect. You will pay out of pocket toward that amount.

One solution is to purchase additional benefits with the money you save on the premium. As we like to say, a supplemental plan can “make your bronze plan feel like gold.”

Supplemental plans such as Metal Gap 2 pay lump-sum benefits for covered accidents and illnesses. You can use these benefits however you choose, including medical bills before you reach your plan deductible, living expenses such as groceries and rent/mortgage, non-covered healthcare expenses and more. Coverage may cost as little as $1 per day.

Do plan benefits differ by metal level?

The ACA requires that all major medical insurance plans include the same minimal coverage for healthcare items and services in the 10 categories of essential health benefits. Carriers may choose to offer more than the minimum essential health benefits, however, and that is where plans could vary slightly.

Cost, including plan premium and deductible, will be the biggest difference you will notice between metal level. That is why it is important to shop with cost-sharing in mind and determine what share of covered medical expenses you and your family can afford if you need healthcare.

Health insurance companies are not required to offer plans for all four metal levels. That means certain carriers may choose to offer bronze and silver plans on the exchanges while others might offer only gold and platinum plans.

Work with a health insurance producer to determine what level of coverage might best suit your family’s budget and typical healthcare needs throughout the year. A local health insurance producer can help you explore and compare your benefits options both on and away from your state-based or federally facilitated health insurance exchange.

 

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

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

Does Obamacare Require You to Buy Insurance or Are You Exempt?
Posted Nov 20, 2017 by Jenifer Dorsey

Does Obamacare Require You to Buy Insurance or Are You Exempt?

Dec. 15 is the deadline for enrolling in an ACA plan that begins Jan. 1, and this year it also marks the end of 2018 open enrollment. Maybe you haven’t enrolled because you aren’t sure which plan to buy or feel like you can’t afford coverage

Continue reading: Does Obamacare Require You to Buy Insurance or Are You Exempt?

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?