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AFFORDABLE CARE ACT (ACA) PLANS

What is this plan?

An ACA plan is a major medical health insurance policy that conforms to the regulations set forth in the Affordable Care Act (Obamacare).

Who should consider these plans?

  • If you want a comprehensive medical insurance coverage plan for anything that might happen, including coverage for maternity, mental health, or pre-existing conditions.
  • Your income is low enough to qualify for government ACA subsidies.

Is there coverage for maternity, mental health, and pre-existing conditions?

Yes.

Are there government subsidies for the monthly premium?

Yes, if you qualify.

What happens if you have a small covered medical expense?

If there is a deductible, you pay the deductible amount first. Then, the plan typically pays a percentage of the remaining covered costs, and you pay the rest. Many preventive care services are free; there is no deductible that you need to meet first for these services.

What happens if you have a huge covered medical expense?

The most you will pay for covered services is the maximum out-of-pocket.

SHORT TERM MEDICAL (STM) PLANS

What is this plan?

Short-term medical plans offer an affordable safety net for consumers who may find themselves temporarily without permanent coverage or unable to afford comprehensive coverage.

Who should consider these plans?

  • You are relatively healthy and are not looking for healthcare coverage for things like maternity, mental health, or pre-existing conditions.
  • You missed the ACA enrollment period.
  • Your income is too high to get ACA subsidies.

– You are only looking for coverage for a short period of time.

Is there coverage for maternity, mental health, and pre-existing conditions?

Typically no; check plans for details.

 

Ar there government subsidies for the monthly premium?

No.

 

What happens if you have a small covered medical expense?

If there is a deductible, you pay the deductible amount first. Then, the plan typically pays a percentage of the remaining covered costs and you pay the rest. You also pay anything above specific benefit limits and anything above policy limits. Some plans require that you meet the deductible even for preventative care.

 

What happens if you have a huge covered medical expense?

After you reach your maximum out-of-pocket, your plan pays the remaining covered expenses, up to specific benefit limits and/or policy limits. Your out-of-pocket costs could be significant.

FIXED INDEMNITY PLANS

What is this plan?

Fixed indemnity plans are supplemental health insurance that helps manage out-of-pocket costs. They provide an extra layer of protection in the event of serious injury or illness.

Who should consider these plans?

  • You want affordable monthly premiums and don’t mind having benefits that are more limited.
  • You want a plan that offsets hospital expenses, and you are okay with paying the rest out-of-pocket.
  • You have missed the ACA enrollment period.

Is there coverage for maternity, mental health, and pre-existing conditions?

Some plans have limited coverage; check plans for details.

Are there government subsidies for the monthly premium?

No.

What happens if you have a small covered medical expense?

The plans will pay up to the fixed benefit amount for covered services; you are responsible for the remaining amounts. No deductible to meet first.

What happens if you have a huge covered medical expense?

The plans will pay you up to the fixed benefit amount for covered services, and you are responsible for the remaining amounts. Your out-of-pocket costs could be significant.

Additional Health Care Coverage Options:

Expand your coverage with these options:

  • Dental Coverage
  • Vision Coverage
  • Critical Illness Coverage
  • Telehealth

Unsure about the right plan for your needs? Our licensed health insurance agents are here to guide you. They have extensive knowledge of various medical plans and can help you find the perfect fit.

If you’re 65 or older, consider exploring Medicare, the federal health insurance program tailored for those 65 and over, as well as young individuals with disabilities or specific diseases.

Save Time by Letting Omnio Group Assist You in Finding the Right Health Insurance Plan for You.

  • Over 440,000 individuals have discovered a health insurance policy that caters to their unique needs through Omnio Group.
  • Omnio Group provides swift, uncomplicated options to help you save time and obtain a health insurance quote. Here’s what you can expect:
  •  Easily compare quotes to discover the ideal health insurance plan for you.
  • Explore diverse health insurance policy options from various carriers.
  • Receive clear, personalized advice from a licensed health insurance agent if you need it.

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Health Insurance Frequently Asked Questions

We can help you get the most out of your coverage. Have a question? Just ask.

The first step in determining the right healthcare insurance plan for your situation is to understand your specific healthcare needs and financial situation. These factors are crucial in deciding the best plan for you.

  • If you don’t visit the doctor often and maintain relatively good health, opting for a health insurance plan with a higher deductible and lower premiums may save you money. However, this type of plan may leave you vulnerable to unexpected medical bills in the event of an accident.
  • If you prefer higher premiums with lower cost-sharing or require more than basic preventative medical care, you could consider plans with lower deductibles and more predictable costs.

Most states have Open Enrollment for the Affordable Care Act (ACA) health insurance from November 1st to December 15th. Some states have permanently extended open enrollment. You must be a resident of the state in which your health insurance plan is filed.

Some states with permanently extended open enrollment periods as of 2022 are:

  • Colorado: November 1, 2022, through January 15, 2023
  • California: November 1, 2022, to January 31, 2023
  • District of Columbia: November 1, 2022, to January 31, 2023

A special enrollment period is in effect from February 15, 2021, through August 15, 2021, for individuals and families with ACA marketplace coverage in response to the Covid-19 health pandemic. This special enrollment period is applicable to residents of the 36 states served by the Health Insurance Marketplace.

Typically, the Open Enrollment period at the end of the year is the only time to buy ACA-qualified health insurance via the private market, and you cannot purchase it after the state-specific cutoff date. However, there are qualifying life events that provide a sixty-day period for enrollment.

Some individuals may qualify for Special Enrollment if they experience:

  • Loss of health coverage previously provided by a parent, spouse, or another family member
  • Turning 26 years old and no longer eligible to remain on a parent’s health insurance plan
  • Loss of health insurance due to a parent or guardian’s job loss
  • Loss of health coverage for dependents due to a family member losing health insurance through their employer
  • Legal separation or divorce resulting in the loss of health insurance coverage
  • Death of a family member who previously provided health insurance
  • Gaining U.S. citizenship, making you eligible for an ACA marketplace insurance plan
  • Membership in a federally recognized Native American Indian tribe
  • Status as an Alaskan Native Claims Settlement Act (ANCSA) shareholder
  • Service as an AmeriCorps State and National, VISTA, or NCCC member
  • Release from incarceration

The Affordable Care Act of 2010, also known as Obamacare, outlines a list of ten essential health benefits that individual medical plans offered on the marketplace must cover to be recognized as ACA plans.

The list of legally required services in ACA health insurance plans includes outpatient, emergency services, surgery, maternity and newborn infant care, mental health services, prescription drugs, preventative and rehabilitative care, along with lab services and pediatrics. These plans typically have higher premiums and prices than non-ACA short-term health plans but offer more extensive coverage.

In most cases, a waiting period is required before your health insurance coverage begins. You won’t begin paying your premiums on new healthcare coverage until that coverage starts on January 1st. If you qualify for an ACA plan due to a qualifying life event, your coverage may not begin for at least two weeks.

The specific cost of premiums varies between different plans, and subsidies may be available. Subsidies can cover part of your premium or out-of-pocket costs if your income is below 4 times the federal poverty level. ACA plans help manage expenses with a cap on what you are required to pay. In 2020, the maximum out-of-pocket cost was $8,200 for individuals and $16,000 for families.

The ACA marketplace offers four levels of health insurance plans, each covering a different portion of your healthcare bills:

Bronze (covers approximately 60%)

Silver (covers approximately 70%)

Gold (covers approximately 80%)

 Platinum (covers approximately 90%)

Individuals enrolled through the Health Insurance Marketplace may be able to compare and lower their monthly out-of-pocket costs, making insurance plans more affordable. To qualify for tax credits, you must meet specific requirements:

  • Enrolled in coverage through the marketplace, excluding “catastrophic coverage”
  • Unable to obtain insurance through employer-sponsored plans
  • Ineligible for government-run programs like TRICARE, CHIP, Medicaid, or Medicare
  • Income is at least 100%, but not exceeding 400% of the federal poverty line
  • Married and file taxes jointly
  • Not listed as a dependent on anyone else’s tax return
  • Not listed as a dependent on anyone else’s tax return
  • Eligibility is determined by the marketplace, and you can check if you qualify by answering a few simple questions.

You can purchase indemnity or short-term health insurance at any time, but you cannot change or purchase ACA health insurance outside the Open Enrollment Period unless you experience a qualifying life event. Qualifying life events include, but are not limited to:

  • Loss of health coverage due to job loss
  • Having a child or adopting a child
  • Moving to a new home in a different zip code or county
  • Marriage
  • Turning 26 and losing health insurance under your parent’s plan
  • Cancellation of your current healthcare insurance plan

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