Everything You Need to Know About the Affordable Care Act

Health insurance is something that everyone needs. The cost of health care for both routine procedures and emergency medical interventions is often high. Health insurance coverage helps to pay for these costs, making essential services more affordable and accessible.

What Is the Affordable Care Act?

The Affordable Care Act (ACA) is a healthcare reform law signed by President Obama in 2010. It makes health care plans available for people with preexisting conditions, places a limit on out-of-pocket costs, and makes these ten essential benefits a requirement for all plans:

  • Ambulatory services (outpatient care)
  • Preventative care and wellness screenings
  • Pediatric services
  • Emergency services
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance use
  • Rehabilitative and habilitative services
  • Laboratory services
  • Prescription drugs

These benefits are the minimum coverage required. Plans vary and may offer additional coverage like dental and vision.

Who Is Eligible for ACA Health Insurance Plans?

You must meet these requirements to enroll in an ACA plan:

  • Be a U.S. citizen, national, or legally present
  • Reside in the U.S.
  • Not currently incarcerated
  • Have income over 100% of the federal poverty level

Individuals who qualify for Medicare or Medicaid health insurance coverage are not eligible for an ACA plan. Insurance brokers in Jacksonville, FL, can help you determine your eligibility and narrow your options.

Cost of ACA Health Insurance

The ACA makes health insurance more affordable by capping out-of-pocket costs and providing subsidies to eligible candidates. Your income level may qualify you for a premium tax credit or cost-sharing reduction to help offset the cost of your monthly premium. You may be eligible for a premium cost of $0 if your calculated tax credit is equal to or greater than the premium price of your selected plan.

ACA plans come in four categories with varying premium costs and deductibles designated as paid by the insurance company vs. self-paid:

  • Bronze: 60% insurance coverage/40% self-pay
  • Silver: 70% insurance/30% self
  • Gold: 80% insurance/20% self
  • Platinum: 90% insurance/10% self

Some factors to help you choose a plan include your current health and existing conditions, plus the average number of doctor visits you make annually. Bronze-level programs offer low monthly premiums but have a higher cost of care when you need it. Platinum plans have a high monthly premium, but a low cost of care, making them ideal for anyone who requires frequent care. These types of plans are best for emergency care.

How to Get Coverage

You can enroll in a new health insurance plan during open enrollment, typically from November through mid-December or mid-January. If you miss these deadlines, you can get a health plan during a qualified Special Enrollment Period (SEP) following a life event like getting married, having a baby, or losing employer-sponsored health coverage.

Navigating the different plan options can lead to confusion over which is best for your needs. Working with health insurance brokers in Jacksonville, FL, gives you the advantage of personalized assistance to help you find the right plan while benefiting from any potential subsidies offered for your income bracket. Thomas & Associates has agents ready to answer your questions and assist you in finding the best health insurance in Florida.