ACA (Obamacare) Explained:

All plans must include the 10 Essential Health Benefits

Hospitalization, Emergency Services, Prescriptions, Mental Health & Addiction Services, Pediatric Services, Preventative Health Care, Pregnancy, Maternity & Newborn Care, Ambulatory Services, Laboratory Services, Rehabilitative Services

·      People with preexisting conditions cannot be denied. Coverage cannot be dropped or premiums raised due to illness.

·      No cost preventative services. Aimed to keep people healthy & identify conditions early on

·      No lifetime or annual coverage limits

·      Children can stay on parent’s insurance until age 26

·      Tax credits based on household income (up to 400% of poverty level) reducing premiums & out of pocket expenses

·      If your household income is too high, you can still enroll in a plan but you will not receive a tax credit

·      Established the ACA Marketplace, providing health plan shopping, determines tax credit, and enrollment

·      Open enrollment periods established or throughout the year if you have a special life event occur

The Most Common Types Of Health Insurance, Include:

HMO: You can see any health care provider and go to any facility in the insurance company’s network. Usually, you must select a primary care provider (PCP). Some plans require, a referral to a specialist, others do not. You can only go out of the network for emergencies.  Since 2014, the popularity of HMO plans has increased significantly.

PPO: You can see any health care provider and go to any facility in the network. You are not required to choose a primary care physician (PCP) and you do not need a referral to see a specialist. Additionally, you can go out of network. However, you will share more of the expense when you are out of network.

POS: This type of plan is a hybrid of an HMO and PPO. With a POS plan you will typically have to select a primary care physician and you may need a referral for to see a specialist. However, like a PPO, you can go out-of-network, if you’re willing to pay more out of pocket.

HMO, PPO, & POS plans are found on & off the Marketplace (Affordable Care Act).

Short Term Plan: If you can't afford an Affordable Care Act (ACA) plan or have missed the Open Enrollment Period, you may want to consider a short-term plan. Compared to ACA plans, a short-term plan typically provides less coverage. But short-term plans do accept applications year-round. Pre-existing conditions can be excluded or result in denial. Short-term plans do not meet the requirements of the ACA.

Medical Indemnity Plan: Also known as fee-for-service plans, these plans pay you a fixed amount for services, such as $50 for a doctor visit, regardless of the bill for the visit. Many times there is no deductible. However, the also do not have an annual Maxium Out of Pocket, for your protection. The plans cover up to a predetermined fixed amount. Anything in excess, you are responsible for the costs. Review carefully, Medical indemnity plans are not right for everyone.